High rates of persistent and recurrent chlamydia in pregnant women after treatment with azithromycin

Dionne-Odom, Jodie; Subramaniam, Akila; Aaron, Kristal J.; Geisler, William M.; Tita, Alan; Marrazzo, Jeanne

doi:10.1016/j.ajogmf.2020.100216

Cited by 10 publications

(15 citation statements)

References 45 publications

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“…Thus, our results could reflect a delay in treatment, which was not recorded, rather than no treatment at all. In similar studies, ~ 30% of records did not have documented treatments for perinatal STIs 18 , 27 . Goggins et al 27 , examined treatment delays reporting that over 50% of patients experienced delayed STI treatment during pregnancy, with an overall range of 0–221 days.…”

Section: Discussionmentioning

confidence: 93%

“…Suboptimal screening for sexually transmitted infections (~ 60%), delays in treatment (55%), and persistent or recurrent infection (9–14%) are common during pregnancy, particularly in socially disadvantaged populations 3 , 18 . A recent study among 810 women attending clinics in Alabama who were treated with azithromycin for chlamydia had a recurrence rate of 9% and persistence rate of 14% 18 . In that study, HDP were not examined as outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Sexually transmitted infections and risk of hypertensive disorders of pregnancy

Taylor

Hill

Perez‐Patron

et al. 2022

Sci Rep

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Hypertensive disorders of pregnancy (HDP) result in maternal morbidity and mortality but are rarely examined in perinatal studies of sexually transmitted infections. We examined associations between common sexually transmitted infections and HDP among 38,026 singleton pregnancies. Log-binomial regression calculated relative risk (RRs) and 95% confidence intervals (CIs) for associations with gestational hypertension, preeclampsia with severe features, mild preeclampsia, and superimposed preeclampsia. All models were adjusted for insurance type, maternal age, race/ethnicity, and education. Additional adjustments resulted in similar effect estimates. Chlamydia was associated with preeclampsia with severe features (RRadj. 1.4, 95% CI 1.1, 1.9). Effect estimates differed when we examined first prenatal visit diagnosis only (RRadj. 1.3, 95% CI 0.9, 1.9) and persistent or recurrent infection (RRadj. 2.0, 95% CI 1.1, 3.4). For chlamydia (RRadj. 2.0, 95% CI 1.3, 2.9) and gonorrhea (RRadj. 3.0, 95% CI 1.1, 12.2), women without a documented treatment were more likely to have preeclampsia with severe features. Among a diverse perinatal population, sexually transmitted infections may be associated with preeclampsia with severe features. With the striking increasing rates of sexually transmitted infections, there is a need to revisit the burden in pregnant women and determine if there is a link between infections and hypertensive disorders of pregnancy.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Sexually transmitted infections and risk of hypertensive disorders of pregnancy

Taylor

Hill

Perez‐Patron

et al. 2022

Sci Rep

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“…gonorrhoeae infections. 26,[28][29][30] Our test-of-cure visits took place at least 4 weeks after the initial test and reduced the likelihood of false-positive test results due to the persistent presence of C. trachomatis/N. gonorrhoeae nucleic acids.…”

Section: Discussionmentioning

confidence: 99%

“…Second, expedited partner treatment was highly acceptable as an option among participants in this study, with the majority of women selecting expedited partner treatment as their preferred choice of partner treatment. Expedited partner treatment has been shown to improve uptake of partner treatment and for reducing rates of persistent or recurrent C. trachomatis / N. gonorrhoeae infections 26,28–30 . Our test-of-cure visits took place at least 4 weeks after the initial test and reduced the likelihood of false-positive test results due to the persistent presence of C. trachomatis / N. gonorrhoeae nucleic acids.…”

Section: Discussionmentioning

confidence: 99%

High Cure Rate Among Pregnant Women in a Chlamydia trachomatis and Neisseria gonorrhoeae Testing and Treatment Intervention Study in Gaborone, Botswana

et al. 2022

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Between March 2021 and March 2022, 251 pregnant women were tested for Chlamydia trachomatis and Neisseria gonorrhoeae infection in Botswana. Fifty-eight (23%) tested positive for at least 1 infection, and 57 (98%) were treated. No participants tested positive at test of cure. In some settings, cost of test of cure may outweigh the benefits.C hlamydia trachomatis and Neisseria gonorrhoeae are curable sexually transmitted infections (STIs) that are linked to adverse pregnancy and neonatal outcomes, including preterm birth, premature membrane rupture, miscarriage, low birth weight, and conjunctivitis and pneumonia in exposed newborns. [1][2][3][4][5] In most low-and middle-income countries (LMICs), including Botswana, a World Health Organization-endorsed algorithmic syndromic management approach has been adapted for STI diagnosis and management. 6 In few countries, C. trachomatis and N. gonorrhoeae screening is routinely offered in antenatal care. 7 In most high-income countries where STI testing is offered, repeat testing for pregnant women after a C. trachomatis/N. gonorrhoeae-positive test result is recommended because of risk of reinfection and treatment failure. [8][9][10][11] Current US Centers for Disease Prevention and Control guidelines recommend a test of cure at approximately 4 weeks after treatment and a rescreen at 3 months after treatment for pregnant women who have been diagnosed with C. trachomatis infection to document eradication of the infection. 9 A rescreen at 3 months after treatment is recommended for pregnant women who test positive for N. gonorrhoeae. 9 Current World Health Organization treatment guidelines do not include guidance on the need for a test of cure and repeat screening after a positive C. trachomatis or N. gonorrhoeae test result.Multiple studies have evaluated integration of diagnostic C. trachomatis and N. gonorrhoeae testing into antenatal care in LMICs. [12][13][14][15][16][17][18][19][20][21] In resource-constrained settings, repeat testing for test of cure may not be feasible because of the added costs of testing. 22 Within this context, we evaluated the rate of microbiological cure after a positive C. trachomatis/N. gonorrhoeae test result among pregnant women enrolled in an STI testing and treatment intervention study in Gaborone, Botswana. We also assessed factors that may be associated with cure, including partner treatment.

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“…In addition, prenatal Chlamydia has been associated with several adverse outcomes, including preterm birth, pregnancy loss, 4 and preeclampsia 5 . Despite the prevalence of C. trachomatis and potential adverse effects on pregnancy, there continues to be suboptimal Chlamydia screening (<60%), 6–8 delays in treatment (55%), as well as reinfection or persistent infection (9%–14%) during pregnancy 9,10 . In addition, it has been shown in non‐pregnant individuals that screening and antibiotic treatment does not always prevent long‐term sequelae.…”

Section: Introductionmentioning

confidence: 99%

Chlamydia trachomatis antigen induces TLR4‐TAB1‐mediated inflammation, but not cell death, in maternal decidua cells

Ortiz

Driscoll

Menon

et al. 2022

American J Rep Immunol

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Background: During gestation, the decidua is an essential layer of the maternalfetal interface, providing immune support and maintaining inflammatory homeostasis.Although Chlamydia (C.) trachomatis is associated with adverse pregnancy outcomes the pathogenic effects on maternal decidua contributing to adverse events are not understood. This study examined how C. trachomatis antigen affects cell signaling, cell death, and inflammation in the decidua.Methods: Primary decidua cells (pDECs) from term, not-in-labor, fetal membranedecidua were cultured using the following conditions: (1) control -standard cell culture conditions, (2) 100 ng/ml or ( 3) 200 ng/ml of C. trachomatis antigen to model decidual cell infection in vitro. Differential expression of Toll-like receptor (TLR) 4 (receptor for C. trachomatis antigen), signaling pathway markers phosphorylated TGF-Beta Activated Kinase 1 (PTAB1), TAB1, phosphorylated p38 mitogen-activated protein kinases (Pp38 MAPK), and p38 MAPK (western blot), decidual cell apoptosis and necrosis (flow cytometry), and inflammation (ELISA for cytokines) were determined in cells exposed to C. trachomatis antigen. T-test was used to assess statistical significance (p < 0.05). Results: C. trachomatis antigen significantly induced expression of TLR4 (p = 0.03) and activation of TAB1 (p = 0.02) compared to controls. However, it did not induce p38 MAPK activation. In addition, pDECs maintained their stromal cell morphology when exposed to C. trachomatis antigen showing no signs of apoptosis and/or necrosis but did induce pro-inflammatory cytokine interleukin (IL)-6 (100 ng/ml: p = 0.02 and 200 ng/ml: p = 0.03), in pDECs compared to controls. Conclusion: Prenatal C. trachomatis infection can produce antigens that induce TLR4-TAB1 signaling and IL-6 inflammation independent of Pp38 MAPK and apoptosis and necrosis. This suggests that C. trachomatis can imbalance decidual inflammatory homeostasis, potentially contributing to adverse events during pregnancy.

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High rates of persistent and recurrent chlamydia in pregnant women after treatment with azithromycin

Cited by 10 publications

References 45 publications

Sexually transmitted infections and risk of hypertensive disorders of pregnancy

Sexually transmitted infections and risk of hypertensive disorders of pregnancy

High Cure Rate Among Pregnant Women in a Chlamydia trachomatis and Neisseria gonorrhoeae Testing and Treatment Intervention Study in Gaborone, Botswana

Chlamydia trachomatis antigen induces TLR4‐TAB1‐mediated inflammation, but not cell death, in maternal decidua cells

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