The Public Health Service action plan for women's health: STDs.
Explore the source record for details and available documents.
Chlamydia Infections↗
Biomedical subjects
J Schachter
Publications and source records attributed to J Schachter.
Early and late angiographic findings of the "no-reflow" phenomenon following direct angioplasty as primary treatment for acute myocardial infarction.
Explore the source record for details and available documents.
Aged↗
Long-term sequelae of acute pelvic inflammatory disease. A retrospective cohort study.
OBJECTIVE: Our objective was to prospectively assess the frequency and predictors of long-term sequelae of acute pelvic inflammatory disease. STUDY DESIGN: We performed a retrospective cohort study of 140 women admitted for treatment of pelvic inflammatory disease to San Francisco General Hospital in 1985, locating and interviewing 51 women by telephone a median of 37 months later. RESULTS: Twelve (24%) women had pelvic pain for 6 months or more after hospitalization, 22 (43%) had subsequent episode(s) of pelvic inflammatory disease, and 40% were involuntarily infertile. A history of pelvic inflammatory disease prior to admission was associated with infertility (p = 0.05), chronic pelvic pain (p = 0.03), and pelvic inflammatory disease subsequent to hospitalization (p = 0.06). Longer duration of abdominopelvic pain before admission and younger age at the time of first sexual intercourse were associated with both infertility (p = 0.02, p = 0.04) and subsequent pelvic inflammatory disease (p = 0.04, p = 0.0008). CONCLUSIONS: Further studies are needed to more accurately assess the incidence and predictors of long-term sequelae of pelvic inflammatory disease. A reduction in adverse outcome will require more stringent efforts at education and reduction of risk-taking behaviors.
Acute Disease↗
The characterization of nonbacterial prostatitis: search for an etiology.
Nonbacterial prostatitis is often difficult to differentiate from other prostatic complaints and remains a vaguely characterized syndrome. Prostatic fluid inflammatory cells and elevated immunoglobulins raise the suspicion that this syndrome is caused by some undetected infection. Prostatic fluid antibodies against Chlamydia trachomatis, Ureaplasma urealyticum, staphylococcus, Staphylococcus faecalis, Bacteroides fragilis and Clostridium perfringens were measured in men with nonbacterial and bacterial prostatitis, and men without urinary symptoms by an enzyme-linked immunosorbent assay. Prostate specific antigen and prostatic acid phosphatase were measured in the prostatic fluid as indirect measures of secretory activity. Of 44 men with nonbacterial prostatitis 9 (20%) had detectable prostatic fluid antichlamydial antibody titers, compared with 3 of 25 control men (12%) and 2 of 13 (15%) with bacterial prostatitis--no evidence for a higher prevalence of prostatic fluid antichlamydial antibody in men with nonbacterial prostatitis. Prostatic antibodies to the other organisms were rarely detected. When compared with unaffected men the low levels of prostate specific antigen and prostatic acid phosphatase, and more alkaline prostatic fluid in men with bacterial and nonbacterial prostatitis suggest that secretory dysfunction accompanies the inflammation. These data show that none of the organisms studied caused the majority of the cases of nonbacterial prostatitis and that either an agent as yet unidentified or multiple agents may be involved in the etiology of nonbacterial prostatitis.
Acid Phosphatase↗
Persistent infection with Chlamydia pneumoniae following acute respiratory illness.
Chlamydia pneumoniae is emerging as a significant cause of respiratory disease, including pneumonia and bronchitis, in humans. In this recently completed study of infection due to C. pneumoniae in patients presenting with pneumonia to SUNY Health Science Center at Brooklyn, we identified two individuals for whom cultures were positive on multiple occasions over a 1-year period. To determine the frequency of persistent respiratory infection with C. pneumoniae, follow-up specimens were obtained from nine individuals with culture-documented C. pneumoniae infection. Five of these individuals had persistent infection: four had a flulike illness characterized by pharyngitis, and one had bronchitis with prominent bronchospasm. All five individuals appeared to have acute C. pneumoniae infection as determined by results of serologic tests (titers of IgM antibody for all individuals were greater than or equal to 1:16). For three patients, cultures remained positive for 11 months despite therapy with 10- to 21-day courses of tetracycline or doxycycline. These observations suggest that persistent infection with C. pneumoniae may follow acute infection and may persist for many months. Infection with C. pneumoniae may be very difficult to eradicate with use of currently available antibiotics even if there is a clinical response to therapy.
Acute Disease↗
Comparison of the major outer membrane protein variant sequence regions of B/Ba isolates: a molecular epidemiologic approach to Chlamydia trachomatis infections.
The molecular evaluation of the chlamydial major outer membrane protein (MOMP) gene (omp1) can facilitate epidemiologic investigations of this pathogen. Genotyping of omp1 provides a more precise characterization of Chlamydia trachomatis than do current immunotyping techniques. Genetic omp1 variants of serovars that are responsible for ocular disease in Tunisia were identified. Archival conjunctival samples collected during 1972 and 1975 from trachoma patients in Douz were sequenced by automation along with additional B and Ba trachoma and genital isolates. Over 90% of the nucleotide changes resulted in an amino acid substitution. Different amino acid sequence changes in variable segments 1, 2, and 4 were found in the specimens collected in 1975 from those collected in 1972. Determination of omp1 genotypes responsible for trachoma will be useful for prospective, epidemiologic studies to identify chlamydial reservoirs within the host, evaluate transmission patterns, and determine the antigenic variation of MOMP for rational vaccine development.
Amino Acid Sequence↗
Evaluation of the humoral immune response in trachoma to Chlamydia trachomatis major outer membrane proteins by sequence-defined immunoassay.
The Chlamydia trachomatis immunodominant major outer membrane protein (MOMP) is both a target of neutralizing antibodies and the serotyping antigen and thus has been a focus of diagnostic, seroepidemiologic, and experimental investigations. The microimmunofluorescence (MIF) test has been the principal tool in serologic investigations of chlamydial infections but is difficult and expensive for routine use; moreover, since it uses whole organisms as antigen, it is incapable of revealing the molecular specificity of the humoral response to infection. These limitations were resolved by using synthetic peptides corresponding to serovar-specific antigenic regions of MOMP in an ELISA-based format to analyze the serospecificity of sera from trachoma cases. The ELISA reaction to the surface-exposed MOMP sequence variable segment 1 was immunodominant and serovar-specific and was in concordance with serovar specificity according to paired MIF test determinations. Understanding the patterns of humoral responses to MOMP determinants in patient populations will advance our knowledge of their role in the immunobiology of naturally acquired infection.
Amino Acid Sequence↗
Chlamydia trachomatis pneumonia induces in vivo production of interleukin-1 and -6.
Cytokine induction during Chlamydia trachomatis pneumonia may alter the pathogenesis or course of disease. We examined interleukin-1 (IL-1) and IL-6 production by measuring mRNA and bioactivity in murine lungs. mRNA and bioactivity for IL-1 alpha, IL-1 beta, and IL-6 increased after Chlamydia infection. These cytokines may be important in regulating host defenses against C. trachomatis.
Animals↗
Multicenter evaluation of the AntigEnz Chlamydia enzyme immunoassay for diagnosis of Chlamydia trachomatis genital infection.
To evaluate the AntigEnz Chlamydia enzyme immunoassay (EIA) (Baxter/Bartels, Issaquah, Wash.), we studied 320 men and 1,209 women attending clinics for sexually transmitted diseases in Baltimore, San Francisco, and Seattle. At examination, two separate swabs were obtained from each patient, one for chlamydial culture and one for EIA. Cervical samples were collected from women, and urethral samples were collected from men. The prevalence of chlamydial infection by culture was 9% in Baltimore (n = 532), 11% in Seattle (n = 500), and 9% in San Francisco (n = 497). To resolve specimens with discrepant culture and EIA results, the EIA transport buffer was centrifuged and the resuspended pellet was stained by direct immunofluorescence to determine whether elementary bodies were present. Overall sensitivity of the AntigEnz Chlamydia assay compared with culture was 87% in men and 86% in women, and overall specificities were 94 and 97%, respectively. Differences between centers were seen, with sensitivities ranging from 76% among men and 79% among women in Seattle to 100% among men and 95% among women in Baltimore. With a true positive considered to be either a culture-positive or an EIA- and direct immunofluorescence-positive specimen, the revised sensitivity was 91% in men and 88% in women. Overall revised specificity was 99% in both men and women. We conclude that in this high-prevalence population, the sensitivity and specificity of this assay compare favorably with those of other noncultural antigen detection tests for the diagnosis of chlamydial genital infection.
Antigens, Bacterial↗
Concepts of termination and post-termination patient-analyst contact.
This paper examines the relationship of concepts of termination to the role of post-termination patient-analyst contact. The concept of termination seems to have been derived historically from at least three elements: the conception of the analytic process; the goal of analysis; and the therapeutic outcome of analysis. Evidence from clinical experience fails to substantiate analysts' belief that post-termination patient-analyst contacts are likely to be damaging to the patient. Most analysts structure termination so that subsequent contact with the patient is conditional upon the patient's need for additional analytic help. However, they themselves seek multiple post-termination contacts with their own training analyst. Periodic post-termination patient-analyst contacts as extensions of the analytic situation provide the analyst with an improved perspective for evaluating the prior analytic work and provide the patient with evidence of the analyst's continuing physicianly concern for his/her well-being. The latter extends the therapeutic alliance which had supported the earlier analytic work and which probably enhances the maintenance of analytic gains and facilitates continued self-analytic work.
Communication↗
The effect of cigarette smoking, Chlamydia trachomatis infection, and vaginal douching on ectopic pregnancy.
We conducted a case-control study of the relation between ectopic pregnancy and three exposures of interest: cigarette smoking, previous chlamydial infection, and vaginal douching. Cases were women with surgically confirmed tubal ectopic pregnancy; controls were women with intrauterine pregnancy at 14 weeks' gestation or less. All women were between the ages of 18-40 and were cared for at the same hospital. Sixty-nine case women and 101 controls were interviewed and underwent serologic tests for Chlamydia trachomatis exposure. Cases were more likely than controls to be nulliparous, non-white, and unmarried and to report a high school education or less (P less than .05). The proportions of cases and controls who reported smoking during the month of conception were 51 and 20%, respectively. The adjusted odds ratio for smoking was 2.4 (95% confidence interval 1.2-5.1) when current smokers were compared with former smokers and women who had never smoked. The proportions of women who had previous chlamydial infection (immunoglobulin G [IgG] greater than 1:64) among cases and controls were 35 and 20% (adjusted odds ratio 1.3, 95% confidence interval 0.6-3.0). Overall, 28% of cases and 19% of controls douched once or more per month (adjusted odds ratio 0.8, 95% confidence interval 0.3-2.2). We conclude that current cigarette smoking may be associated independently with ectopic pregnancy and that smoking cessation before the month of conception may reduce this risk. For these women, previous chlamydial infection and vaginal douching did not appear to increase significantly the risk of ectopic pregnancy.
Adult↗
Pathogenesis of pelvic inflammatory disease. What are the questions?
Pelvic inflammatory disease is usually caused by Chlamydia trachomatis or Neisseria gonorrhoeae. Chlamydiae and gonococci are primary pathogens of the cervix and often ascend. Resultant damage to the cervix may permit organisms to move upward, but this mechanism of action is not well understood. Puberty and hormones, particularly oral contraceptives, may enhance chlamydial infection, but the mechanisms and likelihood of spread to the upper tract are ill defined. Upper tract infection with C trachomatis involves an acute phase, characterized by an influx of polymorphonuclear leukocytes and a chronic or persistent phase characterized by the presence of mononuclear cells (delayed hypersensitivity). Gonococci invade nonciliated epithelial cells, but are toxic to ciliated cells, due to elaborated lipooligosaccharides and peptidoglycan. Certain gonococci stimulate chemotaxis of polymorphonuclear leukocytes whose release of toxic metabolites may damage tissue. The immunologic mechanisms that permit specific host responses to these two organisms are now being elucidated and should receive more attention by researchers.
Chlamydia Infections↗
Chlamydia pneumoniae pneumonia with pleural effusion: diagnosis by culture.
A case of Chlamydia pneumoniae pneumonia with pleural effusion in an otherwise healthy 19-year-old man is described. Diagnosis was made by serologic means as well as by culture of both the nasopharynx and the pleural fluid.
Adolescent↗
Combination antimicrobial therapy in the treatment of acute pelvic inflammatory disease.
We compared the clinical and microbiologic efficacy of two broad-spectrum combination antimicrobial regimens in the treatment of 148 patients with acute pelvic inflammatory disease. Patients were randomized to inpatient treatment with either cefoxitin and doxycycline (n = 75) or clindamycin and tobramycin (n = 73). These antibiotics were administered intravenously for at least 4 days, and up to 48 hours beyond defervescence. Patients were discharged on a regimen of oral doxycycline or clindamycin in accordance with the intravenous regimen to complete a total duration of therapy of 2 weeks. Neisseria gonorrhoeae (53%) and Chlamydia trachomatis (31%) were the microorganisms that were isolated most frequently from the genital tract of enrolled patients. At follow-up, N. gonorrhoeae was isolated in two patients, and C. trachomatis was isolated in none. The overall initial favorable response rate to combination antimicrobial therapy was 98.5% (130/132) in patients with uncomplicated pelvic inflammatory disease and 81% (13/16) in patients with pelvic inflammatory disease that was complicated by tuboovarian abscess. A greater than 70% decrease in abdominal tenderness score occurred in 89% of 111 patients within 6 weeks of hospital discharge. There were no significant differences between antibiotic treatment groups in any response categories or in toxicity. During the initial hospitalization, five patients (three with tuboovarian abscess; one with a pyosalpinx, and one with intractable acute and chronic pelvic inflammatory disease) required surgical intervention. These results support the recommendation to use broad-spectrum combination antimicrobial therapy for the treatment of acute pelvic inflammatory disease.
Acute Disease↗
Role of Chlamydia pneumoniae in acute chest syndrome of sickle cell disease.
Children with sickle cell disease and acute chest syndrome were investigated for infection with Chlamydia pneumoniae and Mycoplasma pneumoniae. Of 30 patients who had 32 episodes of acute chest syndrome, four (13%) had C. pneumoniae isolated from the nasopharynx; two of these also had serologic evidence of acute infection, and one had positive nasopharyngeal isolates on two subsequent occasions during the course of 1 year with stable, elevated titers of anti-C. pneumoniae IgG, suggesting chronic infection. Two patients with negative cultures had serologic evidence of infection with C. pneumoniae. None of 32 cultures for M. pneumoniae were positive, and although anti-M. pneumoniae IgM developed in two patients, one of these patients had evidence of C. pneumoniae infection (positive culture and seroconversion). We conclude that C. pneumoniae infection is prevalent in our sickle cell population with acute chest syndrome. Until further studies clarify the pathophysiologic significance of C. pneumoniae infection, we believe that early inclusion of erythromycin as antimicrobial therapy for acute chest syndrome seems reasonable.
Adolescent↗
Sexually transmitted diseases in postpubertal female rape victims.
Seventy-six postpubertal women were referred from a municipal hospital emergency room within 60 h of sexual assault for evaluation. Of the 76 victims, 20 (26%) had active Chlamydia trachomatis infection detected by culture (11 subjects), a fourfold serologic titer rise (6), or both (3). The risk of acquiring C. trachomatis infection after sexual assault was 3%-16%. Pelvic inflammatory disease was detected in 8 (11%) of the 76 victims. Bacterial vaginosis was diagnosed in 38 women (50%), at least 8 of whom appeared to have been infected during the assault. Trichomoniasis was found in 17 victims (22%), at least 5 of whom may have acquired the infection at the time of the assault. In view of the high rates of these infections and the poor compliance with follow-up (76% [58/76] kept their appointments), all postpubertal victims of sexual assault should be offered treatment with ceftriaxone, 250 mg intramuscularly, followed by 100 mg of oral doxycycline and 500 mg of oral metronidazole twice daily for 7 days.
Adolescent↗
Role of L3T4-bearing T-cell populations in experimental murine chlamydial salpingitis.
A role for both the cellular and humoral components of the immune response has been established for chlamydial infection. The significance of helper (L3T4) T cells was evaluated by using a Chlamydia trachomatis murine salpingitis model for upper genital tract chlamydial infection. Mouse oviducts were inoculated with C. trachomatis by using the mouse pneumonitis agent (MoPn) or control medium. Mice depleted of L3T4-bearing lymphocytes had significantly higher (P less than 0.05) numbers of organisms recovered at day 7 postinoculation. The rate of hydrosalpinx formation was significantly higher in the mice depleted of L3T4-bearing lymphocytes (27 of 31 [87%] ) than in the infected undepleted group (8 of 16 [50%] ) (P less than 0.01). The geometric mean antichlamydial immunoglobulin G titers at day 54 postinoculation were significantly higher in the L3T4-depleted mice (mean titer, 2,030) than in the undepleted group (mean titer, 776; P less than 0.05). The rate of fertility was lower in the L3T4-depleted group (2 of 31 [6%]) than in the infected, undepleted mice (2 of 16 [13%]), but this difference did not reach statistical significance. In conclusion, the greater persistence of organisms in the oviduct and higher rates of hydrosalpinx formation in mice depleted of L3T4-bearing cells suggests that these cells play a role in the clearing of organisms following infection and thus in reducing the degree of oviduct obstruction and damage.
Animals↗
Production of colony-stimulating factors during pneumonia caused by Chlamydia trachomatis.
The colony-stimulating factors (CSFs) are cytokines involved in the production, differentiation, and activation of host phagocytes. During murine infection with Chlamydia trachomatis (MoPn), plasma CSF levels increased in euthymic (nu/+) and athymic (nu/nu) BALB/c mice. Levels declined later in infection, with the nu/+ mice resolving the infection but the nu/nu mice succumbing by day 16. Either live or heat-killed Chlamydia organisms could induce CSF increases on day 7 postchallenge in nu/+ mice; however, by day 14, only mice challenged with live organisms maintained high plasma levels. CSFs were also produced by spleen cells of nu/+ and nu/nu mice in response to Chlamydia antigen. Spleen cell CSF production was detectable by days 3 to 5 postinfection. In nu/+ mice, spleen cell CSF production was elevated throughout the rest of the time course but in nu/nu mice fell significantly at day 14. Like the plasma CSF activity (CSA) production, spleen cell CSA production on day 7 was seen in mice challenged with either live or heat-killed Chlamydia organisms, but on day 14 only nu/+ mice challenged with live organisms maintained significant CSA production. To further characterize the T-cell dependence of CSA production, spleen cells of nu/+ mice were depleted of T cells or T-cell subsets before producing supernatants. On day 14 postinfection, the CD4+ lymphocyte was the major producer of CSFs. Additionally, there were different types of CSFs secreted by nu/+ and nu/nu mice as determined by the ability of spleen cell supernatants to support the granulocyte-macrophage CSF/interleukin 3-dependent cell line FDCP-1. Supernatants from nu/+ mice had 4 to 8 times the level of FDCP-1 CSF activity of the supernatants from nu/nu mice. These results support the evidence that nu/+ mice were producing some CSFs by T-cell-dependent mechanisms. This is the first report of CSF production in vivo during Chlamydia infection. Furthermore, we show that CSFs are produced by both T-cell-dependent and T-cell-independent mechanisms. The capacity of the CSFs to increase the production and effector function of phagocytes may be important to host defenses.
Animals↗