Detection of Anorectal and Cervicovaginal Chlamydia Trachomatis Infections following Azithromycin Treatment: Prospective Cohort Study with Multiple Time-Sequential Measures of rRNA, DNA, Quantitative Load and Symptoms

BACKGROUND: Determination of Chlamydia trachomatis (Ct) treatment success is hampered by current assessment methods, which involve a single post-treatment measurement only. Therefore, we evaluated Ct detection by applying multiple laboratory measures on time-sequential post-treatment samples. METHOD...

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Autores principales: Dukers-Muijrers, Nicole H. T. M., Speksnijder, Arjen G. C. L., Morré, Servaas A., Wolffs, Petra F. G., van der Sande, Marianne A. B., Brink, Antoinette A. T. P., van den Broek, Ingrid V. F., Werner, Marita I. L. S., Hoebe, Christian J. P. A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835673/
https://www.ncbi.nlm.nih.gov/pubmed/24278400
http://dx.doi.org/10.1371/journal.pone.0081236
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author Dukers-Muijrers, Nicole H. T. M.
Speksnijder, Arjen G. C. L.
Morré, Servaas A.
Wolffs, Petra F. G.
van der Sande, Marianne A. B.
Brink, Antoinette A. T. P.
van den Broek, Ingrid V. F.
Werner, Marita I. L. S.
Hoebe, Christian J. P. A.
author_facet Dukers-Muijrers, Nicole H. T. M.
Speksnijder, Arjen G. C. L.
Morré, Servaas A.
Wolffs, Petra F. G.
van der Sande, Marianne A. B.
Brink, Antoinette A. T. P.
van den Broek, Ingrid V. F.
Werner, Marita I. L. S.
Hoebe, Christian J. P. A.
author_sort Dukers-Muijrers, Nicole H. T. M.
collection PubMed
description BACKGROUND: Determination of Chlamydia trachomatis (Ct) treatment success is hampered by current assessment methods, which involve a single post-treatment measurement only. Therefore, we evaluated Ct detection by applying multiple laboratory measures on time-sequential post-treatment samples. METHODS: A prospective cohort study was established with azithromycin-treated (1000 mg) Ct patients (44 cervicovaginal and 15 anorectal cases). Each patient provided 18 self-taken samples pre-treatment and for 8 weeks post-treatment (response: 96%; 1,016 samples). Samples were tested for 16S rRNA (TMA), bacterial load (quantitative PCR; Chlamydia plasmid DNA) and type (serovar and multilocus sequence typing). Covariates (including behavior, pre-treatment load, anatomic site, symptoms, age, and menstruation) were tested for their potential association with positivity and load at 3–8 weeks using regression analyses controlling for repeated measures. FINDINGS: By day 9, Ct positivity decreased to 20% and the median load to 0.3 inclusion-forming units (IFU) per ml (pre-treatment: 170 IFU/ml). Of the 35 cases who reported no sex, sex with a treated partner or safe sex with a new partner, 40% had detection, i.e. one or more positive samples from 3–8 weeks (same Ct type over time), indicating possible antimicrobial treatment failure. Cases showed intermittent positive detection and the number of positive samples was higher in anorectal cases than in cervicovaginal cases. The highest observed bacterial load between 3–8 weeks post-treatment was 313 IFU/ml, yet the majority (65%) of positive samples showed a load of ≤2 IFU/ml. Pre-treatment load was found to be associated with later load in anorectal cases. CONCLUSIONS: A single test at 3–8 weeks post-treatment frequently misses Ct. Detection reveals intermittent low loads, with an unknown risk of later complications or transmission. These findings warrant critical re-evaluation of the clinical management of single dose azithromycin-treated Ct patients and fuel the debate on defining treatment failure. Clinicaltrials.gov Identifier: NCT01448876.
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spelling pubmed-38356732013-11-25 Detection of Anorectal and Cervicovaginal Chlamydia Trachomatis Infections following Azithromycin Treatment: Prospective Cohort Study with Multiple Time-Sequential Measures of rRNA, DNA, Quantitative Load and Symptoms Dukers-Muijrers, Nicole H. T. M. Speksnijder, Arjen G. C. L. Morré, Servaas A. Wolffs, Petra F. G. van der Sande, Marianne A. B. Brink, Antoinette A. T. P. van den Broek, Ingrid V. F. Werner, Marita I. L. S. Hoebe, Christian J. P. A. PLoS One Research Article BACKGROUND: Determination of Chlamydia trachomatis (Ct) treatment success is hampered by current assessment methods, which involve a single post-treatment measurement only. Therefore, we evaluated Ct detection by applying multiple laboratory measures on time-sequential post-treatment samples. METHODS: A prospective cohort study was established with azithromycin-treated (1000 mg) Ct patients (44 cervicovaginal and 15 anorectal cases). Each patient provided 18 self-taken samples pre-treatment and for 8 weeks post-treatment (response: 96%; 1,016 samples). Samples were tested for 16S rRNA (TMA), bacterial load (quantitative PCR; Chlamydia plasmid DNA) and type (serovar and multilocus sequence typing). Covariates (including behavior, pre-treatment load, anatomic site, symptoms, age, and menstruation) were tested for their potential association with positivity and load at 3–8 weeks using regression analyses controlling for repeated measures. FINDINGS: By day 9, Ct positivity decreased to 20% and the median load to 0.3 inclusion-forming units (IFU) per ml (pre-treatment: 170 IFU/ml). Of the 35 cases who reported no sex, sex with a treated partner or safe sex with a new partner, 40% had detection, i.e. one or more positive samples from 3–8 weeks (same Ct type over time), indicating possible antimicrobial treatment failure. Cases showed intermittent positive detection and the number of positive samples was higher in anorectal cases than in cervicovaginal cases. The highest observed bacterial load between 3–8 weeks post-treatment was 313 IFU/ml, yet the majority (65%) of positive samples showed a load of ≤2 IFU/ml. Pre-treatment load was found to be associated with later load in anorectal cases. CONCLUSIONS: A single test at 3–8 weeks post-treatment frequently misses Ct. Detection reveals intermittent low loads, with an unknown risk of later complications or transmission. These findings warrant critical re-evaluation of the clinical management of single dose azithromycin-treated Ct patients and fuel the debate on defining treatment failure. Clinicaltrials.gov Identifier: NCT01448876. Public Library of Science 2013-11-20 /pmc/articles/PMC3835673/ /pubmed/24278400 http://dx.doi.org/10.1371/journal.pone.0081236 Text en © 2013 Dukers-Muijrers et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Dukers-Muijrers, Nicole H. T. M.
Speksnijder, Arjen G. C. L.
Morré, Servaas A.
Wolffs, Petra F. G.
van der Sande, Marianne A. B.
Brink, Antoinette A. T. P.
van den Broek, Ingrid V. F.
Werner, Marita I. L. S.
Hoebe, Christian J. P. A.
Detection of Anorectal and Cervicovaginal Chlamydia Trachomatis Infections following Azithromycin Treatment: Prospective Cohort Study with Multiple Time-Sequential Measures of rRNA, DNA, Quantitative Load and Symptoms
title Detection of Anorectal and Cervicovaginal Chlamydia Trachomatis Infections following Azithromycin Treatment: Prospective Cohort Study with Multiple Time-Sequential Measures of rRNA, DNA, Quantitative Load and Symptoms
title_full Detection of Anorectal and Cervicovaginal Chlamydia Trachomatis Infections following Azithromycin Treatment: Prospective Cohort Study with Multiple Time-Sequential Measures of rRNA, DNA, Quantitative Load and Symptoms
title_fullStr Detection of Anorectal and Cervicovaginal Chlamydia Trachomatis Infections following Azithromycin Treatment: Prospective Cohort Study with Multiple Time-Sequential Measures of rRNA, DNA, Quantitative Load and Symptoms
title_full_unstemmed Detection of Anorectal and Cervicovaginal Chlamydia Trachomatis Infections following Azithromycin Treatment: Prospective Cohort Study with Multiple Time-Sequential Measures of rRNA, DNA, Quantitative Load and Symptoms
title_short Detection of Anorectal and Cervicovaginal Chlamydia Trachomatis Infections following Azithromycin Treatment: Prospective Cohort Study with Multiple Time-Sequential Measures of rRNA, DNA, Quantitative Load and Symptoms
title_sort detection of anorectal and cervicovaginal chlamydia trachomatis infections following azithromycin treatment: prospective cohort study with multiple time-sequential measures of rrna, dna, quantitative load and symptoms
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835673/
https://www.ncbi.nlm.nih.gov/pubmed/24278400
http://dx.doi.org/10.1371/journal.pone.0081236
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