Chlamydia Persistence and Bacterial Vaginosis

Greater chlamydia persistence is linked to bacterial vaginosis (BV), says an article published in the Journal of Infectious Diseases. Between diagnosis and therapy, up to 26% of urogenital Chlamydia trachomatis infections resolve on their own. It is uncertain what mechanisms control natural resolution. In order to determine if bacterial vaginosis was linked to increased chlamydia persistence vs spontaneous clearance in a large, longitudinal investigation, Brown and colleagues conducted this study.

The Longitudinal Study of Vaginal Flora tracked women of reproductive age four times a year from 1999 to 2003. After ligase chain reaction testing became available mid-study, baseline chlamydia screening and treatment were started, and unscreened endocervical samples were analyzed after study completion. Between successive visits without the use of chlamydia-active medicines, chlamydia clearance and persistence were determined (N = 320 persistence/N = 310 clearance). Alternating and conditional logistic regression was used to model the relationships between the Nugent score (0-3, no BV; 4-10, intermediate/BV), Amsel-BV, and the persistence vs clearance of chlamydia.

Key Findings

• 48% of chlamydia cases (310/630) spontaneously resolved by the subsequent visit.
• Higher chances of chlamydia persistence were found to be related with Nugent-Intermediate/BV (aOR = 1.89, 95% CI:1.30-2.74), and Amsel-BV (aOR 1.39, 95% CI:0.99-1.96).
• A within-participant study of 67 subjects with both clearance and persistence intervals revealed a greater correlation with Nugent-Intermediate/BV and chlamydia persistence (aOR = 4.77, 95% CI: 1.39-16.35).
• Results were unaffected by BV symptoms.

Unfortunately, chlamydia infection rates continue to be unacceptably high despite government recommendations to test all sexually active women under the age of 25 at least once a year. In order to prevent chlamydia in women, new measures are required. Long-term development of novel biotherapeutics, such as probiotics, to prevent chlamydia, facilitate chlamydial clearance, and enhance reproductive health could be influenced by an understanding of the complex factors, including host, pathogen, and microbiome factors, that result in spontaneous clearance of chlamydia.

Reference

Brown, S. E., Tuddenham, S., Shardell, M. D., Klebanoff, M. A., Ghanem, K. G., & Brotman, R. M. (2023). Bacterial vaginosis and spontaneous clearance of Chlamydia trachomatis in the Longitudinal Study of Vaginal Flora. In The Journal of Infectious Diseases. Oxford University Press (OUP). https://doi.org/10.1093/infdis/jiad142