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1.  Epidemiology of infection by serotypes D to K of chlamydia trachomatis. 
Non-specific urethritis (NSU) is a sexually transmitted disease; 50% of cases are due to Chlamydia trachomatis, so that this is the commonest sexually transmitted infection in the developed world. Chlamydial infection is now readily diagnosable and the evidence increasingly suggests that it is underdiagnosed. Chlamydial conjunctivitis (in the newborn baby or the adult) in the developed world is a complication of sexually transmitted genital infection by C trachomatis and it indicates a large reservoir of such infections. Because of the association of sexually transmitted diseases, systemic treatment for such chlamydial conjunctivitis should not be given until full genital and serological investigators have been carried out. Chlamydial infection causes serious complications (that were formerly often thought to be gonococcal), such as epididymitis in young men and salpingitis on young women. It may cause local complications in the eye of the newborn baby and even pneumonia in babies and fatal endocarditis in adults. The diagnosis of NSU should lead to the correct treatment of the male patient and of his sexual partners. It is the promiscuous woman, who does not have a regular sexual partner to report back to her that he has NSU, who is at particular risk of undiagnosed chlamydial infection. Routine genital investigations for chlamydia are particularly indicated in her case. Following the parallel of gonorrhoea, it seems that the use of contact tracers may be an effective method for controlling chlamydial infection.
PMCID: PMC1045760  PMID: 7427689
2.  Chlamydial genital infection in Addis Ababa, Ethiopia. A seroepidemiological survey. 
A seroepidemiological survey was undertaken in Addis Ababa to assess the prevalence of chlamydial genital infections among patients attending a sexually transmitted diseases (STD) clinic and patients with no overt genital symptoms. In the STD clinic patients antibodies to Chlamydia trachomatis serotypes D to K (genital types) were detected in 68 of 210 (32.4%) men and in 72 of 159 (45.3%) women, a rate of exposure as high or higher than that found in Europe. Serological evidence of active chlamydial infection was present in 26.7% of men and 28.9% of women. Women were at risk of contracting STD, including chlamydial infections, at the age of 14 years or earlier. The titres of antichlamydial IgG were extremely high in some patients attending the STD clinic, with titres of between 1/512 and 1/8192 in 9.5% of men and 13.2% of women. This suggests that some patients had severe or disseminated chlamydial disease. The prevalence of exposure to chlamydial genital infections among 148 patients with no overt genital disease was 14.2%, which is significantly higher than that found in the United Kingdom. Among the total of 517 patients tested the prevalence of exposure to trachoma, lymphogranuloma venereum, and Chlamydia psittaci agents was very low.
PMCID: PMC1046104  PMID: 7171979
3.  Chlamydial genital infection in Ibadan, Nigeria. A seroepidemiological survey. 
Sera from patients attending a sexually transmitted diseases (STD) clinic, a family planning clinic, and an antenatal clinic in Ibadan, Nigeria, as well as from male blood donors from the same area were tested for the presence of type specific antichlamydial antibodies using a modified micro-immunofluorescence test. Among men and women attending the STD clinic the exposure rates to Chlamydia trachomatis serotypes D to K (genital pathogens) were 18.7% and 26.7% respectively. Antibody titres suggesting active disease in these men and women were found in 11.8% and 22.7% respectively. The highest rate of exposure (35%) was among women attending the family planning clinic; of these women 25% had antibody suggesting active disease. Titres of IgG antibody in this study were similar to those found among men and women with chlamydial genital infections in the United Kingdom. Antibodies to serotypes D to K were also detected in 10.3% of women attending an antenatal clinic and in 9.9% of male blood donors. The prevalence of antibodies to C trachomatis serotypes A to C and lymphogranuloma venereum serotypes was low. These results suggest that the prevalence of chlamydial genital infections in Ibadan, both among STD patients and especially among those individuals not seeking treatment (family planning and antenatal clinic patients), is high. Since serious sequelae can follow chlamydial genital infections it is imperative to carry out further investigations in this area.
PMCID: PMC1046103  PMID: 7171978
4.  Chlamydial genital infection in prostitutes in Iran. 
The prevalence of chlamydial genital infection was studied in 177 prostitutes in Iran; 100 in Teheran and 77 in the port of Bandar Abbas. Chlamydia trachomatis was isolated in eight (6.9%) of 116 patients with valid cultures. Type-specific antibodies were found against C trachomatis serotypes D to K (genital serotypes) in 94.2% and against serotypes A to C (trachoma serotypes) in 2% of the prostitutes. Type-specific IgM at a titre of greater than or equal to 8, indicating current infection, was found in 29.2%, whereas type-specific IgG at a titre greater than or equal to 64, suggesting a current or recent infection, was present in 71.5%. The lower chlamydial isolation rate in these women may have been due to previous treatment with antichlamydial drugs and because of immune responses resulting from repeated reinfection with chlamydiae. The results indicate that in Iran prostitutes are commonly infected with C trachomatis and are probably a major reservoir of chlamydial genital infection.
PMCID: PMC1046131  PMID: 6824908
5.  Prevalence of antichlamydial antibody in London blood donors. 
The prevalence of type-specific antichlamydial antibody in a population of blood donors in London was studied using a microimmunofluorescence test. Twenty-six (17%) of 150 women and 38 (26%) of 150 men had antichlamydial antibody (IgG at greater than or equal to 1/16 or IgM greater than or equal to 1/8 or both). Of these, five (3%) women had one (0.75%) man had this antibody directed against Chlamydia trachomatis serotypes D-K, responsible for genital infections, and one man had antibody to Chlamydia psittaci agents. The remaining 57 men and women had antibody against an atypical chlamydial isolate designated Chlamydia IOL-207, which is iodine-negative and serologically distinct from both C trachomatis and C psittaci. The nature and location of infection by this agent are obscure. The results of this study suggest that the prevalence of sexually transmitted infection with C trachomatis serotypes D-K in a normal adult population in London is very low.
PMCID: PMC1045842  PMID: 7448582
6.  Chlamydia and the Curtis-Fitz-Hugh syndrome. 
Ten women with acute right upper-quadrant abdominal pain but negative results for biliary investigations had a current or past history of pelvic inflammatory disease. A diagnosis of the Curtis-Fitz-Hugh syndrome was made and was confirmed in five patients by laparoscopy. Neisseria gonorrhoeae was not isolated from the cervical and urethral swabbings of seven patients tested. Chlamydia trachomatis was isolated from the endocervical canal in one of six patients examined. Of sera from nine patients tested by a micro-immunofluorescence test, nine and six samples respectively showed type-specific IgG and IgM antibodies against C trachomatis serotypes D-K. Type-specific IgG and IgA antibodies were also detected in the cervical and urethral discharge of two out of five patients and in the peritoneal aspirate of two. The presence of high titres of IgG or IgM in sera and IgG or IgA in the local discharges of our patients suggests that C trachomatis was probably the cause of the CFH syndrome.
PMCID: PMC1045982  PMID: 7326553
7.  Isolation of Chlamydia from women attending a clinic for sexually transmitted disease. 
Cervical swabs for Chlamydia culture were collected from 638 unselected women attending a sexually transmitted diseases clinic with a fresh complaint. Chlamydia were isolated from 76 (12 per cent.) of the women. When the results were related to the patients' diagnoses, Chlamydia were present in 44 per cent. of women with gonorrhoea and in 22 per cent. of women who were contacts of men with nonspecific urethritis (women who may be regarded as having non-specific genital infection). Chlamydia were uncommon in women with no evidence of genital infection. Significant correlations were found between the presence of Chlamydia and cervical erosion, cervical cytological inflammatory change, and absence of symptoms. Isolates were obtained more frequently from women with non-specific genital infection who were primary contacts than from women who were secondary contacts. These findings support the concept that Chlamydia are pathogens in the genital tract and are sexually transmitted.
PMCID: PMC1045169  PMID: 1242683
8.  Chlamydial urethral infection in Teheran. A study of male patients attending an STD clinic. 
The prevalence of chlamydial infection of the urethra was studied in 172 consecutive male patients attending a sexually transmitted disease clinic in Teheran. Chlamydia trachomatis was isolated in 8.8% of the patients with a valid culture result. Of the five isolates serotyped, two were serotype E and three were serotypes G, H, and K. Type-specific antibodies against C trachomatis serotypes D to K were found in 16% of patients, and IgM, indicating current infection, was detected in 12%. Type-specific antibodies against serotypes A to C (trachoma agent) were detected in 5.4%. The low chlamydial isolation rate may have been due to the inclusion of a large number of patients with a mild or trivial urethritis or a history of previous treatment with antichlamydial drugs. The results indicate that in Iran where trachoma is still endemic, chlamydial infection of the urethra does occur in the urban population and is caused by serotypes D to K.
PMCID: PMC1046105  PMID: 7171980
14.  Subclinical pneumonia due to serotypes D-K of Chlamydia trachomatis. Case reports of two infants. 
Pneumonia due to serotypes D-K of Chlamydia trachomatis occurred in a 10-week-old baby, who had been successfully treated with chlortetracycline eye ointment for chlamydial ophthalmia neonatorum, and in a 7-week-old baby being treated for the same condition. Clinical signs of pneumonia were minimal. Such chlamydial pneumonia in infants must be under-diagnosed. Infants with chlamydial ophthalmia neonatorum are now routinely treated with erythromycin suspension by mouth in addition to chlortetracycline eye ointment.
PMCID: PMC1045820  PMID: 7427706
18.  Antichlamydial antibodies in pelvic inflammatory disease. 
The role of Chlamydia trachomatis in pelvic inflammatory disease (PID) diagnosed without laparoscopy was assessed by measuring antichlamydial antibodies in the patient's serum and by comparing the results with those in patients with uncomplicated non-specific genital infection (NSGI) and gonorrhoea and in non-infected controls. A modified microimmunofluorescence test was used. Patients with severe PID had significantly more positive antichlamydial IgG and IgM results than did control subjects, patients with gonorrhoea, and patients with NSGI. Less severe PID was associated with significantly raised levels of antichlamydial IgG antibodies compared with NSGI and controls and with raised levels of IgM antibodies compared with controls. Two patients with PID had lower genital tract gonorrhoea, one of whom had raised antichlamydial antibody levels. These findings may indicate a mixed infection and therapy should be reviewed in such patients. A serological diagnosis of chlamydial infection is relatively easy and cheap and enables a rapid diagnosis of chlamydial infection to be made.
PMCID: PMC1045701  PMID: 526845
19.  Double-blind comparison of two regimens in the treatment of nongonococcal urethritis. Seven-day vs 21-day course of triple tetracyclinc (Deteclo). 
In a double-blind comparison of two regimens of triple tetracycline (Deteclo, Lederle) in the treatment of nongonococcal urethritis, 68 (88.6%) of 70 patients treated with one tablet twice for 21 days and seen four weeks after starting therapy had satisfactory results. This was significantly better than the findings among the 73 patients treated with one tablet twice daily for seven days and followed for four weeks, among whom only 47 (64.4%) had satisfactory results. Results were also better for the group treated with the 21-day regimen at three months afer the start of treatment. When analysed individually at four and 12 weeks, urethral discharge, urethral Gram-stained smears, and first-glass urine test all gave similar results, which were markedly better than those before treatment. It appears that the longer course of treatment it indicated where any regular partner may not be treated. Slightly fewer patients had satisfactory results among those who admitted consuming alcohol than among those who did not. Chlamydiae-negative patients, treated for seven days, had fewer clinically satisfactory results than other sub-groups.
PMCID: PMC1045655  PMID: 114198
20.  Antibodies to Chlamydia trachomatis in acute salpingitis. 
Recent isolation studies have shown Chlamydia trachomatis to be an important aetiological agent in acute salpingitis in women. The present serological study indicates that C. trachomatis is the probable aetiological agent in two-thirds of 143 women with pelvic inflammatory disease (PID). In general, high levels of chlamydial antibody were found in sera and fluids aspirated from the pouch of Douglas and such antibody titres were shown to correlate with the severity of clinically graded tubal inflammation.
PMCID: PMC1045577  PMID: 427512
21.  Rapid diagnosis of chlamydial infection of the cervix. 
A rapid serodiagnostic test for the presumptive diagnosis of chlamydial infection of the cervix has been developed. The method used in based on the modified micro-immunofluorescence test using pooled chlamydial antigens and the detection of different immunoglobulin classes of chlamydial antibody in sera and cervical secretions. The presence of IgG chlamydial antibody at a level of 1/64, or IgM antibody at a level of 1/8 or greater, or both in sera and IgG or IgA antibody at a level of 1/8 or more or both in cervical secretions was closely associated with the isolation of Chlamydia trachomatis and non-specific genital infection. In general, serodiagnosis was three to nine times more sensitive than cultural methods, and the detection of IgG chlamydial antibody in cervical secretions alone provided the most sensitive of the serological tests. This sensitive, low-cost, rapid, and simple serodiagnostic test for the presumptive diagnosis of chlamydial infection of the cervix, coupled with transportation of specimens by post, offers advantages over conventional isolation techniques for the routine diagnosis and management of chlamydial genital infections.
PMCID: PMC1045559  PMID: 367526
22.  Role of Chlamydia trachomatis in non-acute prostatitis. 
The possible role of Chlamydia trachomatis in non-acute prostatitis was investigated by cultural and serological techniques in a study of 53 adult males. C. trachomatis was isolated from the urethra of only one of the 53 patients and from none of the 28 specimens of prostatic fluid from the same patients. By means of a modified microimmunofluorescent test, serum chlamydial IgG antibodies at a titre of 1/64 or greater, or IgM antibodies at a titre of 1/8 or greater, or both were detected in six of the patients, suggesting a recent or current chlamydial infection, while IgG or IgA antibodies at a titre of 1/8 or greater were detected in the specimens of prostatic fluid from two of the 28 men studied. In the seven patients with evidence of chlamydial infection, as well as in a further 13 of the 53 patients studied, the presenting symptoms suggested non-gonococcal urethritis (NGU) rather than prostatitis. Thus in this study C. trachomatis would appear to play a minor aetiological role, if any, in non-acute prostatitis.
PMCID: PMC1045534  PMID: 709348
23.  Urethritis due to Chlamydia trachomatis. 
Ninety-five men suffering from gonococcal urethritis were treated and observed. Forty-nine developed postgonococcal non-specific urethritis (PGU). Seventeen men were demonstrated to be free from PGU after careful observation; these formed a control group. Chlamydia trachomatis was isolated from urethral material from 26 (53%) of the PGU group but from none of the controls. This difference was highly significant (P less than 0-001). It confirms that C. tachomatis is a pathogen in the urethra. The presence of specific IgM antibody to C. trachomatis in serum from some men developing PGU, from whom that organism was isolated, suggests that the infection was recent in those cases. Ureaplasma urealyticum (T strain mycoplasma) was isolated from urethral material taken from 22 (45%) of the 49 men in the PGU group, and from 12 (71%) of the 17 in the control group. Mycoplasma hominis was isolated from 10 (20%) of the 49 men in the PGU group, and from four (24%) of the 17 men in the control group. Thus, no evidence was obtained that mycoplasmas (U. urealyticum, M. hominis) are patogenic in the urethra.
PMCID: PMC1045386  PMID: 871894
24.  Isolation of Chlamydia trachomatis from the male urethra. 
Chlamydia trachomatis was isolated from 26% of urethral swabs taken from 509 men with urethritis. The highest yield of 68% was obtained from a selected group of men with nonspecific urethritis (NSU) who had a frank urethral discharge. This is a higher than in previous reports, and is significantly higher than the isolation of C. trachomatis from men with less severe urethritis. The higher yield was similar to C. trachomatis isolation rates reported among patients with severe trachoma in hyperendemic areas. Men with a previous history of NSU had low isolation rates. Overall, 30% of 385 men with NSU had positive chlamydial culture results, 7% of 59 men with gonococcal urethritis alone were Chlamydia-positive, 15% of 59 men with gonorrhoea followed by NSU (post-gonococcal urethritis) were Chlamydia-positive, and only 3% of 61 men without urethritis harboured Chlamydia. Swabs taken from the cervical os of 28 of 108 female contacts of men with NSU had a positive result for C. trachomatis. Significantly more pairs of sexual partners had the same chlamydial culture result than had different results. The chlamydial isolation rate was higher among men admitting a casual sexual contact than in men claiming only regular partnerships. The findings provide further evidence for the sexual transmission of C. trachomatis and for its aetiological role in NSU.
PMCID: PMC1045357  PMID: 870145

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