Reproductive tract infection (RTIs)/sexually transmitted infections (STIs) are recognized as a major public health problem, particularly due to their relationship with HIV infection. Early detection and treatment of Chlamydia trachomatis infection (CTI) among HIV-infected and HIV-uninfected women may impact heterosexual HIV transmission. A total of 120 participants were enrolled: 30 HIV seropositive women with symptoms of RTIs, 30 HIV seropositive women without symptoms of RTIs, 30 HIV seronegative women with symptoms of RTIs, and 30 HIV seronegative women without symptoms of RTIs. One endocervical swab was collected from all participants and CTI was detected by real-time PCR (COBAS TaqMan CT Test, v2.0). CTI was detected in 4 (6.67%) HIV-infected women and in 1 (1.67%) HIV-uninfected woman (OR 4.214; 95% CI 0.457–38.865). Vaginal discharge was present in almost half of HIV-infected and HIV-uninfected women; lower abdominal pain was present in 11 (18.3%) of HIV-infected and in 9 (15%) of HIV-uninfected women. This study showed that CTI is more prevalent among HIV-infected females as compared to HIV-uninfected females. As the use of real-time PCR is not feasible in most hospitals, efforts should be made to develop a simple, sensitive, and specific test to identify women with CTI for prevention of sequelae and HIV transmission. 1. Introduction Genital infection due to Chlamydia trachomatis is one of the most prevalent bacterial sexually transmitted infections (STIs) [1]. According to the WHO estimates, globally 92 million new cases of C. trachomatis infection occur each year and about two-thirds of these cases occur in the developing world, where diagnostic and treatment services are scarce [2, 3]. Most epidemiological data on Chlamydia trachomatis infection (CTI) is from industrialized nations and reliable data from the resource poor developing nations is not available where the disease burden is concentrated. However, it is important to document laboratory-confirmed incidence and prevalence of CTI from the developing world as well. The available Indian data show a wide variation in CT prevalence with infection rates in Indian women ranging from 3.3% to 33% depending on the population sampled [4–13]. Infection with this agent is usually asymptomatic in up to 80% of women which makes diagnosis and detection all the more difficult. Left undetected and untreated the infection may evolve into pelvic inflammatory disease and may result in serious sequelae, such as ectopic pregnancy and infertility [14, 15]. CTI in women has also been linked to adverse
References
[1]
World Health Organization, “Global prevalence and incidence of selected curable sexually transmitted infections-overviewed and estimates,” WHO/CDS/CSR/EDC/2001.10, 2001.
[2]
A. L. Patel, D. Sachdev, P. Nagpal et al., “Prevalence of Chlamydia infection among women visiting a gynaecology outpatient department: evaluation of an in-house PCR assay for detection of Chlamydia trachomatis,” Annals of Clinical Microbiology and Antimicrobials, vol. 9, article 24, 2010.
[3]
J. A. Land, J. E. A. M. van Bergen, S. A. Morré, and M. J. Postma, “Epidemiology of Chlamydia trachomatis infection in women and the cost-effectiveness of screening,” Human Reproduction Update, vol. 16, no. 2, Article ID dmp035, pp. 189–204, 2009.
[4]
R. Alexander, E. Mathai, V. Nayyar, M. Mathew, and P. Jasper, “Low prevalence of chlamydial endocervical infection in antenatal South Indian women,” Genitourinary Medicine, vol. 69, no. 3, pp. 240–241, 1993.
[5]
M. Becker, J. Stephen, S. Moses et al., “Etiology and determinants of sexually transmitted infections in Karnataka state, South India,” Sexually Transmitted Diseases, vol. 37, no. 3, pp. 159–164, 2010.
[6]
L. Brabin, A. Gogate, S. Gogate et al., “Reproductive tract infection, gynaecological morbidity and HIV seroprevalence among women in Mumbai, India,” Bulletin of the World Health Organization, vol. 76, no. 3, pp. 277–287, 1998.
[7]
A. G. Joyce, S. P. Thyagarajan, P. Rajendran et al., “Chlamydia trachomatis genital infection in apparently healthy adult population of Tamil Nadu, India: a population-based study,” International Journal of STD and AIDS, vol. 15, no. 1, pp. 51–55, 2004.
[8]
A. G. Joyee, S. P. Thyagarajan, E. V. Reddy, C. Venkatesan, and M. Ganapathy, “Genital chlamydial infection in STD patients: its relation to HIV infection,” Indian Journal of Medical Microbiology, vol. 23, no. 1, pp. 37–40, 2005.
[9]
A. Malik, S. Jain, M. Rizvi, I. Shukla, and S. Hakim, “Chlamydia trachomatis infection in women with secondary infertility,” Fertility and Sterility, vol. 91, no. 1, pp. 91–95, 2009.
[10]
J. Mania-Pramanik, P. K. Meherji, J. S. Gokral, and U. M. Donde, “Chlamydia trachomatis infection in an urban setting,” Sexually Transmitted Infections, vol. 77, no. 2, p. 141, 2001.
[11]
S. Rastogi, B. Das, S. Salhan, and A. Mittal, “Effect of treatment for Chlamydia trachomatis during pregnancy,” International Journal of Gynecology and Obstetrics, vol. 80, no. 2, pp. 129–137, 2003.
[12]
V. Singh, S. Salhan, B. C. Das, and A. Mittal, “Predominance of Chlamydia trachomatis serovars associated with urogenital infections in females in New Delhi, India,” Journal of Clinical Microbiology, vol. 41, no. 6, pp. 2700–2702, 2003.
[13]
V. Singh, A. Sehgal, L. Satyanarayana, M. M. Gupta, A. Parashari, and D. Chattopadhya, “Clinical presentation of gynecologic infections among Indian women,” Obstetrics and Gynecology, vol. 85, no. 2, pp. 215–219, 1995.
[14]
V. Mittal, J. Agarwal, A. Jain, and A. K. Verma, “Prevalence of genital Chlamydia trachomatis in women using PCR on urine specimen,” Biomedical Research, vol. 21, no. 3, pp. 301–304, 2010.
[15]
C. A. Gaydos, M. Theodore, N. Dalesio, B. J. Wood, and T. C. Quinn, “Comparison of three nucleic acid amplification tests for detection of Chlamydia trachomatis in urine specimens,” Journal of Clinical Microbiology, vol. 42, no. 7, pp. 3041–3045, 2004.
[16]
C. L. Haggerty, S. L. Gottlieb, B. D. Taylor, N. Low, F. Xu, and R. B. Ness, “Risk of sequelae after chlamydia trachomatis genital infection in women,” Journal of Infectious Diseases, vol. 201, supplement 2, pp. S134–S155, 2010.
[17]
G. R. Burstein, C. A. Gaydos, M. Diener-West, M. R. Howell, J. M. Zenilman, and T. C. Quinn, “Incident Chlamydia trachomatis infections among inner-city adolescent females,” The Journal of the American Medical Association, vol. 280, no. 6, pp. 521–526, 1998.
[18]
G. R. Burstein, G. Waterfield, A. Joffe, J. M. Zenilman, T. C. Quinn, and C. A. Gaydos, “Screening for gonorrhea and chlamydia by DNA amplification in adolescents attending middle school health centers: oppportunity for early intervention,” Sexually Transmitted Diseases, vol. 25, no. 8, pp. 395–402, 1998.
[19]
K. Thomas and I. Simms, “Chlamydia trachomatis in subfertile women undergoing uterine instrumentation: how we can help in the avoidance of iatrogenic pelvic inflammatory disease?” Human Reproduction, vol. 17, no. 6, pp. 1431–1432, 2002.
[20]
U. Sarin, P. Bhalla, and J. Biswas, “A prospective study of lower genital tract infection by Chlamydia trachomatis in pregnancy,” Journal of Obstetrics and Gynecology of India, pp. 342–347, 1993.
[21]
D. Nair, P. Bhalla, and M. D. Mathur, “Comparison of enzyme immunoassay and direct fluorescent antibody test for the detection of Chlamydia trachomatis in non gonococcal urethritis,” Indian Journal of Medical Microbiology, vol. 17, no. 4, pp. 184–186, 1999.
[22]
S. Garg, P. Bhalla, N. Sharma et al., “Comparison of self-reported symptoms of gynaecological morbidity with clinical and laboratory diagnosis in a New Delhi slum,” Asia-Pacific Population Journal, vol. 16, no. 2, pp. 75–92, 2001.
[23]
R. Chawla, P. Bhalla, and H. P. S. Sachdev, “A pilot study of Chlamydia trachomatis pneumonia in infants,” Indian Journal of Medical Microbiology, vol. 22, no. 3, pp. 185–188, 2004.
[24]
S. Vidhani, S. Mehta, P. Bhalla, R. Bhalla, V. K. Sharma, and S. Batra, “Seroprevalence of Chlamydia trachomatis infection amongst patients with pelvic inflammatory diseases and infertility,” Journal of Communicable Diseases, vol. 37, no. 3, pp. 233–238, 2005.
[25]
J. B. Mahony, K. E. Luinstra, J. W. Sellors, D. Jang, and M. A. Chernesky, “Confirmatory polymerase chain reaction testing for Chlamydia trachomatis in first-void urine from asymptomatic and symptomatic men,” Journal of Clinical Microbiology, vol. 30, no. 9, pp. 2241–2245, 1992.
[26]
K. Jaton, J. Bille, and G. Greub, “A novel real-time PCR to detect Chlamydia trachomatis in first-void urine or genital swabs,” Journal of Medical Microbiology, vol. 55, no. 12, pp. 1667–1674, 2006.
[27]
Ministry of Health and Family Welfare Government of India, National Guidelines on Prevention, Management and Control of Reproductive Tract Infections Including Sexually Transmitted Infections, NACO, 2007.
[28]
World Health Organization, “A new approach to STD control and AIDS prevention,” Global AIDS News, vol. 4, pp. 13–15, 1994.
[29]
K. Ray, M. Bala, M. Bhattacharya, S. Muralidhar, M. Kumari, and S. Salhan, “Prevalence of RTI/STI agents and HIV infection in symptomatic and asymptomatic women attending peripheral health set-ups in Delhi, India,” Epidemiology and Infection, vol. 136, no. 10, pp. 1432–1440, 2008.
[30]
K. Nessa, S. A. Waris, A. Alam et al., “Sexually transmitted infections among brothel-based sex workers in Bangladesh: high prevalence of asymptomatic infection,” Sexually Transmitted Diseases, vol. 32, no. 1, pp. 13–19, 2005.
[31]
A. Sharma, Y. S. Marfatia, and M. Modi, “Reproductive tract infections in HIV positive women: a case control study,” Indian Journal of Sexually Transmitted Diseases and AIDS, vol. 30, no. 1, pp. 16–18, 2009.
[32]
B. Acosta-Cázares, L. Ruiz-Maya, and J. E. de la Pe？a, “Prevalence and risk factors for Chlamydia trachomatis infection in low-income rural and suburban populations of Mexico,” Sexually Transmitted Diseases, vol. 23, no. 4, pp. 283–288, 1996.
[33]
A. E. Miranda, C. L. Szwarcwald, R. L. Peres, and K. Page-Shafer, “Prevalence and risk behaviors for chlamydial infection in a population-based study of female adolescents in Brazil,” Sexually Transmitted Diseases, vol. 31, no. 9, pp. 542–546, 2004.
[34]
M. L. Alcaide, D. L. Jones, N. Chitalu, and S. Weiss, “Chlamydia and Gonorrhea infections in HIV-positive women in urban Lusaka, Zambia,” Journal of Global Infectious Diseases, vol. 4, no. 3, pp. 141–144, 2012.
[35]
S. S. Balamurugan and N. D. Bendigeri, “Community-based study of reproductive tract infections among women of the reproductive age group in the urban health training centre area in Hubli, Karnataka,” Indian Journal of Community Medicine, vol. 37, no. 1, pp. 34–38, 2012.
[36]
D. L. Church, A. Zentner, H. Semeniuk, E. Henderson, and R. Read, “Reasons for testing women for genital Chlamydia trachomatis infection in the Calgary region,” Canadian Journal of Infectious Diseases, vol. 14, no. 1, pp. 35–40, 2003.
[37]
V. Kouri, J. Cartaya, M. E. Rodríguez et al., “Prevalence of Chlamydia trachomatis in human immunodeficiency virus-infected women in Cuba,” Memorias do Instituto Oswaldo Cruz, vol. 97, no. 8, pp. 1073–1077, 2002.
[38]
G. U. Natividad-Villanueva, E. Santiago, R. M. Manalastas Jr. et al., “Human immunodeficiency virus in plasma and cervicovaginal secretions in Filipino women,” International Journal of STD and AIDS, vol. 14, no. 12, pp. 826–829, 2003.
[39]
K. Seck, N. Samb, S. Tempesta et al., “Prevalence and risk factors of cervicovaginal HIV shedding among HIV-1 and HIV-2 infected women in Dakar, Senegal,” Sexually Transmitted Infections, vol. 77, no. 3, pp. 190–193, 2001.
