Microbiological Characteristics of Chlamydia trachomatis and Neisseria gonorrhoeae Infections in South African Women

Abstract

h We analyzed data of 263 women with at least one genital or anorectal sexually transmitted infection from a cross-sectional study conducted in rural South Africa. We provide new insights concerning the concurrence of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis infections as well as the characteristics of bacterial loads. Chlamydia trachomatis and Neisseria gonorrhoeae are the most prevalent bacterial sexually transmitted infections (STI) in the world (1). The course of these infections is unpredictable and diverse (2-7). Most infections in women are asymptomatic and frequently remain unrecognized, which increases the risk for reproductive tract complications (6,(8)(9)(10). Insight into the mechanisms that drive the burden of these infections is essential for disease control. In addition to age, HIV infection, and behavioral factors, microbiological characteristics, including bacterial load, may play an important role in the risk of transmission, clinical presentation, and course of infection (6,(11)(12)(13)(14). Chlamydial load has been associated with clinical presentation, severity of infection, and transmissibility in animal models and in patients with ocular C. trachomatis infection (15-17). Gonorrheal loads have been shown to differ between anatomic locations and associated clinical presentations in men (18). Although real-time PCR and quantitation of DNA load have the potential of revealing new insights into the characteristics of infection, there is only limited literature about the relevance of bacterial load and frequency of concurrent STI in women (19,20). Knowledge about microbiological characteristics of infection could possibly help to improve understanding of the differences in STI prevalences at the population level. This study aimed to evaluate the concurrence and bacterial loads of genital and anorectal C. trachomatis and N. gonorrhoeae infections in South African women from a setting of high HIV prevalence.This study was a subanalysis of a previously described crosssectional study of 604 women in rural Mopani District, South Africa (21). In brief, consenting women 18 to 49 years of age who reported sexual activity during the previous 6 months were eligible. Questionnaires were completed and vaginal, anorectal and pharyngeal swabs (Copan Diagnostics, Brescia, Italy) were obtained by health care workers and stored at Ϫ20°C. Menses on the day of recruitment and refusal to have all three anatomic sites tested were exclusion criteria. Symptomatic women were treated the same day according to local treatment protocols, which include a notification slip for the partner. Asymptomatic women with an STI proven by molecular detection were called to return to the clinic for specific treatment. For the evaluation presented in this article, we selected all women (n ϭ 263) vaginally and/or anorectally infected with at least one of the following pathogens: C. trachomatis (n ϭ 107), N. gonorrhoeae (n ϭ 66), Mycoplasma genitalium (n ϭ 66), and Trichomonas vagina...

Whole-Genome Enrichment and Sequencing ofChlamydia trachomatisDirectly from Patient Clinical Vaginal and Rectal Swabs

“…The higher C. trachomatis bacterial load detected in rectal specimens in three of the four patient specimen sets conflicts with two studies that demonstrated similar loads across sets of vaginal and anorectal specimens collected from the same women with and without anal intercourse visiting a STI clinic in the Netherlands and in a high HIV prevalence area in South Africa 76,77 . For this specific study, the trend may be a characteristic of the assay used to determine copy number, the study population itself or, because of the small sample size, may not be representative of the study population as a whole.…”

Whole-Genome Enrichment and Sequencing of Chlamydia trachomatis Directly from Patient Clinical Vaginal and Rectal Swabs

“…The higher C. trachomatis bacterial load detected in rectal specimens in three of the four patient specimen sets conflicts with two studies that demonstrated similar loads across sets of vaginal and anorectal specimens collected from the same women with and without anal intercourse visiting an STI clinic in the Netherlands and in a high-HIVprevalence area in South Africa (57,58). For our study, the trend may be a characteristic of the assay used to determine copy number or the study population itself or, because of the small sample size, may not be representative of the study population as a whole.…”

Prevalence of chlamydia trachomatis infection among reproductive age women in sub Saharan Africa: a systematic review and meta-analysis

“…The sample size of study population varied from 100 [ 24 ] to 4886 [ 19 ], and were conducted between the year 1997–2001 [ 19 , 22 , 30 ], 2002–2006 [ 25 ], 2007–2011 [ 21 , 26 , 31 ] and 2012–2016 [ 23 , 27 , 34 – 36 ]. Geographically,the population screened for Chlamydia trachomatis four regions of Sub-Saharan Africa: East Africa [ 19 , 22 , 27 , 32 – 35 , 37 ],West Africa [ 18 , 20 – 24 , 26 , 28 – 30 ], Southern Africa [ 22 , 31 , 39 ], and middle Africa [ 25 , 38 ] (Table 1 ).…”