title: Long-term eradication of Chlamydia trachomatis genital infection after antimicrobial therapy. Evidence against persistent infection.
abstract: OBJECTIVE
  To determine whether Chlamydia trachomatis urogenital infections persist or relapse after antimicrobial therapy by serial measurement of chlamydial-specific DNA using the polymerase chain reaction (PCR), cell cultures, and serological studies.
  
  
  METHODS
  Prospective evaluation of an inception cohort.
  
  
  METHODS
  University student health clinic.
  
  
  METHODS
  Twenty women with culture-proven and PCR-proven C trachomatis urogenital infections.
  
  
  METHODS
  Incidence of persistent infection as determined by PCR, culture, and serial measurement of local and systemic antibody to C trachomatis for 5 months after doxycycline therapy.
  
  
  RESULTS
  Prior to therapy, C trachomatis was isolated in cell culture from the cervix in 19 of 20 women, from the urethra in 13 women, and from the rectum in 13 women. All culture-positive specimens were also PCR-positive. Immediately after completion of antimicrobial therapy, all women had negative cell cultures for chlamydia. Ten of 20 culture-negative cervical specimens and two culture-negative urethral specimens had chlamydial DNA present immediately after treatment. In addition, three women had detectable DNA from cervical specimens 1 week after treatment. The presence of cervicitis (P = .01), high inclusion counts (P = .004), and serological evidence of recent infection (P = .0004) were each significantly associated with PCR positivity after treatment. All 384 subsequent cervical, rectal, and urethral specimens collected over 5 months were negative by both PCR and culture with the exception of one woman who was reinfected. Serum immunoglobulin M (IgM) titers, geometric mean serum immunoglobulin G (IgG) titers, and prevalence of local antibody to chlamydia progressively declined after treatment.
  
  
  CONCLUSIONS
  Standard antimicrobial therapy is effective in the long-term microbiologic eradication of uncomplicated C trachomatis urogenital infections. The presence of chlamydial DNA after antimicrobial therapy is of short duration and reflects excretion of nonviable organisms rather than persistent infection.
authors.affiliation: Division of Infectious Diseases, Emory University, Atlanta, Ga 30308.
authors.forename: K A
authors.initials: KA
authors.lastname: Workowski
authors.forename: M F
authors.initials: MF
authors.lastname: Lampe
authors.forename: K G
authors.initials: KG
authors.lastname: Wong
authors.forename: M B
authors.initials: MB
authors.lastname: Watts
authors.forename: W E
authors.initials: WE
authors.lastname: Stamm
mesh_terms: D000328:Adult; D000908:Antibodies, Fungal / Q000097:blood; D002690:Chlamydia Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D015331:Cohort Studies; D004271:DNA, Fungal / Q000032:analysis; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D052776:Female Urogenital Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012008:Recurrence
chemical_list: D000908:Antibodies, Fungal; D004271:DNA, Fungal; D004318:Doxycycline