title: High Prevalence of Co-Infections by Invasive and Non-Invasive Chlamydia trachomatis Genotypes during the Lymphogranuloma Venereum Outbreak in Spain.
abstract: The evolution of Chlamydia trachomatis is mainly driven by recombination events. This fact can be fuelled by the coincidence in several European regions of the high prevalence of non-invasive urogenital genotypes and lymphogranuloma venereum (LGV) outbreaks. This scenario could modify the local epidemiology and favor the selection of new C. trachomatis variants. Quantifying the prevalence of co-infection could help to predict the potential risk in the selection of new variants with unpredictable results in pathogenesis or transmissibility. In the 2009-2013 period, 287 clinical samples with demonstrated presence of C. trachomatis were selected. They were divided in two groups. The first group was constituted by 137 samples with C. trachomatis of the LGV genotypes, and the second by the remaining 150 samples in which the presence of LGV genotypes was previously excluded. They were analyzed to detect the simultaneous presence of non-LGV genotypes based on pmpH and ompA genes. In the first group, co-infections were detected in 10.9% of the cases whereas in the second group the prevalence was 14.6%, which is the highest percentage ever described among European countries. Moreover, bioinformatic analyses suggested the presence among men who have sex with men of a pmpH-recombinant variant, similar to strains described in Seattle in 2002. This variant was the result of genetic exchange between genotypes belonging to LGV and members of G-genotype. Sequencing of other genes, phylogenetically related to pathotype, confirmed that the putative recombinant found in Madrid could have a common origin with the strains described in Seattle. Countries with a high prevalence of co-infections and high migration flows should enhance surveillance programs in at least their vulnerable population.
authors.affiliation: Servicio de Microbiología Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Rodriguez-Dominguez
authors.affiliation: Servicio de Microbiología Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Gonzalez-Alba
authors.affiliation: Centro Sanitario Sandoval, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Puerta
authors.affiliation: Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain; Laboratorio de Microbiología, Centro Sandoval, Madrid, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Menendez
authors.affiliation: Servicio de Microbiología Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Sanchez-Diaz
authors.affiliation: Servicio de Microbiología Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Canton
authors.affiliation: Centro Sanitario Sandoval, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: del Romero
authors.affiliation: Servicio de Microbiología Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Unidad de Resistencia a Antibióticos y Virulencia Bacteriana (RYC-CSIC), Madrid, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Galan
mesh_terms: D001425:Bacterial Outer Membrane Proteins / Q000235:genetics; D002692:Chlamydia trachomatis / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D060085:Coinfection / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D016680:Genome, Bacterial; D005838:Genotype; D018451:Homosexuality, Male / Q000235:genetics; D006801:Humans; D008219:Lymphogranuloma Venereum / Q000453:epidemiology / Q000382:microbiology*; D008297:Male; D008969:Molecular Sequence Data; D010802:Phylogeny; D015995:Prevalence; D013030:Spain / Q000453:epidemiology
chemical_list: D001425:Bacterial Outer Membrane Proteins; C410162:PmpH protein, Chlamydia trachomatis; C078167:OMPA outer membrane proteins