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Article 4 : Spontaneous Resolution of Genital
Chlamydia
trachomatis Infection in Women and Protection
from Reinfection

Groupe 4 : discussion and results

Presented by:
• Malak farhat
• Katia zankar Presented to:
• Mariam baker Dr.Mirna chahine.
Discussion and results.
1.Results:

• Of 245 registered women, 200 (81.6%) returned for follow-

up visits, and the majority (56.0%) had a history of
chlamydia.
• Spontaneous chlamydia resolution was demonstrated in 44
participants (22.0%) at the time of registration.
• To characterize the bias due to the fact that participants are
lost followed, the characteristics of the participants were
compared according to the follow-up status.
Figure 1: Forest plot of odds ratios and 95% CI for chlamydia reinfection at follow-up based on
chlamydia resolution status at enrollment (time of treatment) and age. Estimates to the right of
the vertical line indicate reinfection is more likely, and those to the left indicate reinfection is less
likely. When the 95% confidence interval does not cross the vertical line, then the odds ratio is
significantly different from 1. Unadjusted results are from separate univariate analyses for
chlamydia resolution status at enrollment (the time of treatment) and age. Adjusted results are
estimates from a multivariable model, including chlamydia resolution status at enrollment and
age as independent variables.
Figure 1: Forest plot of odds ratios
and 95% CI for chlamydia
reinfection at follow-up based on
chlamydia resolution status at
enrollment (time of treatment)
and age. Estimates to the right of
the vertical line indicate
reinfection is more likely, and
those to the left indicate
reinfection is less likely. When the
95% confidence interval does not
cross the vertical line, then the
odds ratio is significantly different
from 1. Unadjusted results are
from separate univariate analyses
for chlamydia resolution status at
enrollment (the time of
treatment) and age. Adjusted
results are estimates from a
multivariable model, including
chlamydia resolution status at
enrollment and age as
independent variables.
• Chlamydia reinfection occurred in 33 participants with a follow-up
study visit. The median time since enrollment in the follow-up study
visit was 183 days.
• The Spontaneous Resolution Status at enrollment and age were each
significantly associated with reinfection status in uni-varied analyses.
• The chances of chlamydia reinfection was 4 times higher for
participants with infection demonstrated at the time of enrollment
compared to those with spontaneous resolution (figure 1). In addition,
the chances of reinfection were 3.0 times higher for participants aged
<25 years compared to those who were older.
2.Discussion:
• Our study is the first to demonstrate an association of natural resolution of
genital chlamydial infection in humans with a decreased risk for
reinfection. In our study, we found that older age (≥25 years) was
associated with a lower risk for reinfection.
• While lower chlamydia prevalence in older age groups may, in part, reflect
lower behavioral risk, it may also reflect protective immunity that
developed from repeated chlamydia exposures in a subset of the older
population.
• Our study reaffirms that up to 20% of women who test positive chlamydia
at the time of treatment has a reinfection within one year of treatment of
the infection.
 2: An age (›or 8=25)was
associated with a low risk of
1-An association reinfection.
between the
natural resolution
of clamydia
infection and the
reduced risk of
re-infection.
The study
demonstrated

3: up to 20% of
women tested + for
chlamydia at the time
of traitement have
reinfection in the
following year
• This is a relatively high rate of reinfection with chlamydia after
treatment may suggest that some infected people do not develop
immunity.
• In a model murine chlamydia, antibiotic treatment administered before
immunization the responses were fully developed an impaired
development of immunity protection.
• In addition recent population studies in Canada have reported high
rates of reinfection by chlamydia it has been suggested that this may
be, in part, due to early treatment of chlamydia through a chlamydia
control program leading to a reduction in immunity development and,
therefore, increased susceptibility to reinfection ("the hypothesis of
discontinuation of immunity").
3.Study with and against:
Most of the positive tests that have repeat can be due
to reinfection from a partner but a small number
cannot be ruled out that this is a persistent infection
due to azithromycin treatment failure.

Study with Study against

elevated azithromycin it suggests that women who

levels in men show have infected with
symptoms of chlamydial chlamydia are cured by the
urethritis. treatment of azithromycin.
4.Limitation:

• It is likely that prior chlamydia is underrecognized in populations

with a high chlamydia prevalence and this could have led to
misclassification of prior chlamydia in our study.

• It is difficult for humans in STD clinics to register because they

have treated for urethritis before the results of chlamydia will be
known, which makes it impossible to assess spontaneous
resolution before returning for treatment a positive test.
5.Prospective:

1. The possibility that the genotypic differences of C. trachomatis could

influence the risk of persistence and / or reinfection of chlamydia, and
for this in the future study to understand these results should consider
incorporating the genotyping of C. trachomatis.

2. Important to continue to provide treatment for chlamydia in order to

minimize the risk of complications, many of which are subclinical or
silent.
6.Conclusion:

Immune infection

Contribute to the Contribute to the

May differ between humans resolution of the infection development of protective
immunity
7.Strong points ,Weak points:
Strong points Weak points
Prospective study There are many references
The presence of limitation and perspective Low use of figures and tables in the method part.
 

Presence of a comparison between 2 studies in Inability to do the study on another population

the discussion part. (Men evaluated in STD clinics are difficult to fit
into such a natural history study design because
they are often treated empirically for urethritis
before chlamydia)
 

  Paragraphs are not clear and it’s hard to

understand
 
•Reference:
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2010. Atlanta: U.S. Department of Health and
Human Services, 2011.
CatesWJr. Estimates of the incidence and prevalence of sexually transmitted diseases in the United States. Sex Transm Dis 1999; 26:S2–7.
World Health Organization. Global prevalence and incidence of selected curable sexually transmitted infections: overview and estimates. http
://www.who.int/hiv/pub/sti/who_hiv_aids_2001.02.pdf. Accessed 19 October 2012.
Centers for Disease Control and Prevention. Summary of notifiable diseases— United States, 2010. MMWR 2012; 59(No. RR-53):1–116.
Datta SD, Torrone E, Kruszon-Moran D, et al. Chlamydia trachomatis trends in the United States among persons 14 to 39 years of age, 1999–
2008. Sex Transm Dis 2012; 39:92–6.
Dunne EF, Chapin JB, Rietmeijer CA, et al. Rate and predictors of repeat Chlamydia trachomatis infection among men. Sex Transm Dis 2008;
35:S40–4.
Geisler WM, Wang C, Morrison SG, Black CM, Bandea CI, Hook EW 3rd. The natural history of untreated Chlamydia trachomatis infection in
the interval between screening and returning for treatment. Sex Transm Dis 2008; 35:119–23.
Généreux M, Leclerc P, Bédard L, Allard R. Upsurge of chlamydial reinfection in a large Canadian city: an indication of suboptimal chlamydia
screening practices? Can J Public Health 2010; 101:420–4.
Brunham RC, Rekart ML. The arrested immunity hypothesis and the epidemiology of chlamydia control. Sex Transm Dis 2008; 35:53–4.
Moss NJ, Ahrens K, Kent CK, Klausner JD. The decline in clinical sequelae of genital Chlamydia trachomatis infection supports current control
strategies. J Infect Dis 2006; 193:1336–8.
Sutton MY, Sternberg M, Zaidi A, St Louis ME, Markowitz LE. Trends in pelvic inflammatory disease hospital discharges and ambulatory visits,
United States, 1985–2001. Sex Transm Dis 2005; 32:778–84.

Workowski KA, Lampe MF, Wong KG, Watts MB, Stamm WE. Longterm eradication of Chlamydia trachomatis
genital infection after antimicrobial therapy. Evidence against persistent infection. JAMA 1993;
270:2071–5.

15. Renault CA, Israelski DM, Levy V, Fujikawa BK, Kellogg TA, Klausner JD. Time to clearance of
Chlamydia trachomatis ribosomal RNA in women treated for chlamydial infection. Sex Health 2011;
8:69–73.
 Chen MY, Fairley CK, Donovan B. Discordance between trends in chlamydia notifications and hospital admission
rates for chlamydia related diseases in New SouthWales, Australia. Sex Transm Infect 2005; 81:318–22.
 Rekart ML, Gilbert M, Meza R, et al. Chlamydia public health programsand the epidemiology of pelvic
inflammatory disease and ectopic pregnancy.J Infect Dis 2013; 207:30–8.
 Van Der Pol B, Liesenfeld O, Williams JA, et al. Performance of the cobas CT/NG test compared to the Aptima AC2
and Viper CTQ/GCQ assays for detection of Chlamydia trachomatis and Neisseria gonorrhoeae. J Clin Microbiol
2012; 50:2244–9.
 Centers for Disease Control and Prevention. Screening tests to detect Chlamydia trachomatis and Neisseria
gonorrhoeae infections—2002 MMWR 2002; 51(No. RR-15) 1–40.
 Batteiger BE, Tu W, Ofner S, et al. Repeated Chlamydia trachomatis genital infections in adolescent women. J Infect
Dis 2010; 201:42–51.
 Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or
persistent gonorrhea or chlamydialinfection. N Engl J Med 2005; 352:676–85. 1856 •
 . Jawetz E, Rose L, Hanna L, Thygeson P. Experimental inclusion conjunctivitis in man: measurements of infectivity
and resistance. JAMA 1965; 194:620–32.
 Grayston JT, Wang SP, Yeh LJ, Kuo CC. Importance of reinfection in the pathogenesis of trachoma. Rev Infect Dis
1985; 7:717–25.
 Katz BP, Batteiger BE, Jones RB. Effect of prior sexually transmitted disease on the isolation of Chlamydia
trachomatis. Sex Transm Dis1987; 14:160–4.