Spontaneous Resolution of Asymptomatic Chlamydia trachomatis in Pregnancy
OBJECTIVE:We sought to estimate the rate of spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy and to evaluate factors associated with its resolution. METHODS:A cohort of women enrolled in a large multicenter randomized bacterial vaginosis antibiotic trial (metronidazole versu...
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| Veröffentlicht in: | Obstetrics and gynecology (New York. 1953) 2005-03, Vol.105 (3), p.557-562 |
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| creator | Sheffield, Jeanne S Andrews, Williams W Klebanoff, Mark A MacPherson, Cora Carey, J Christopher Ernest, J M Wapner, Ronald J Trout, Wayne Moawad, Atef Miodovnik, Menachem Sibai, Baha Varner, Michael W Caritis, Steve N Dombrowski, Mitchell Langer, Oded OʼSullivan, Mary J |
| description | OBJECTIVE:We sought to estimate the rate of spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy and to evaluate factors associated with its resolution.
METHODS:A cohort of women enrolled in a large multicenter randomized bacterial vaginosis antibiotic trial (metronidazole versus placebo) that, when randomly allocated, had asymptomatic C trachomatis diagnosed by urine ligase chain reaction (from frozen archival specimens) between 16 and 23 weeks were included. The urine ligase chain reaction is a highly accurate predictor of genital tract chlamydial infection. A follow-up ligase chain reaction was performed between 24 and 29 weeks.
RESULTS:A total of 1,953 women were enrolled in the original antibiotic trial; 1,547 (79%) had ligase chain reaction performed both at randomization and follow-up. Women receiving antibiotics effective against Chlamydia between randomization and follow-up or having symptomatic Chlamydia infection were excluded (26 women). Of the 140 women (9%) who were diagnosed as positive via the initial ligase chain reaction assay, 61 (44%) had spontaneous resolution of Chlamydia by the follow-up ligase chain reaction assay. Factors associated with spontaneous resolution included older age (P = .02), more than 5 weeks from randomization to follow-up (P = .02), and a greater number of lifetime sexual partners (P = .02). Using a logistic regression model, maternal age and a greater-than-5-week follow-up interval remained significant; for every 5-year increase in maternal age, the odds of a positive result on the ligase chain reaction test at follow-up decreased by 40% (odds ratio 0.6; 95% confidence interval 0.4–0.9). Race, substance abuse, parity, and treatment with metronidazole were not associated with spontaneous resolution. Gram stain score and vaginal pH at randomization and follow-up also were not associated.
CONCLUSION:The prevalence of asymptomatic C trachomatis in pregnancy was 9%; infection resolved spontaneously in almost half of these women. The association of older age and increasing time interval to spontaneous resolution of Chlamydia is consistent with a host immune-response mechanism.
LEVEL OF EVIDENCE:III |
| doi_str_mv | 10.1097/01.AOG.0000153533.13658.c2 |
| format | Article |
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METHODS:A cohort of women enrolled in a large multicenter randomized bacterial vaginosis antibiotic trial (metronidazole versus placebo) that, when randomly allocated, had asymptomatic C trachomatis diagnosed by urine ligase chain reaction (from frozen archival specimens) between 16 and 23 weeks were included. The urine ligase chain reaction is a highly accurate predictor of genital tract chlamydial infection. A follow-up ligase chain reaction was performed between 24 and 29 weeks.
RESULTS:A total of 1,953 women were enrolled in the original antibiotic trial; 1,547 (79%) had ligase chain reaction performed both at randomization and follow-up. Women receiving antibiotics effective against Chlamydia between randomization and follow-up or having symptomatic Chlamydia infection were excluded (26 women). Of the 140 women (9%) who were diagnosed as positive via the initial ligase chain reaction assay, 61 (44%) had spontaneous resolution of Chlamydia by the follow-up ligase chain reaction assay. Factors associated with spontaneous resolution included older age (P = .02), more than 5 weeks from randomization to follow-up (P = .02), and a greater number of lifetime sexual partners (P = .02). Using a logistic regression model, maternal age and a greater-than-5-week follow-up interval remained significant; for every 5-year increase in maternal age, the odds of a positive result on the ligase chain reaction test at follow-up decreased by 40% (odds ratio 0.6; 95% confidence interval 0.4–0.9). Race, substance abuse, parity, and treatment with metronidazole were not associated with spontaneous resolution. Gram stain score and vaginal pH at randomization and follow-up also were not associated.
CONCLUSION:The prevalence of asymptomatic C trachomatis in pregnancy was 9%; infection resolved spontaneously in almost half of these women. The association of older age and increasing time interval to spontaneous resolution of Chlamydia is consistent with a host immune-response mechanism.
LEVEL OF EVIDENCE:III</description><identifier>ISSN: 0029-7844</identifier><identifier>EISSN: 1873-233X</identifier><identifier>DOI: 10.1097/01.AOG.0000153533.13658.c2</identifier><identifier>PMID: 15738024</identifier><identifier>CODEN: OBGNAS</identifier><language>eng</language><publisher>New York, NY: by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Adult ; Anti-Infective Agents - therapeutic use ; Biological and medical sciences ; Chlamydia Infections - complications ; Chlamydia Infections - diagnosis ; Chlamydia trachomatis ; Double-Blind Method ; Female ; Gynecology. Andrology. Obstetrics ; Humans ; Ligase Chain Reaction ; Medical sciences ; Metronidazole - therapeutic use ; Pregnancy ; Pregnancy Complications, Infectious - diagnosis ; Remission, Spontaneous ; Vaginosis, Bacterial - complications ; Vaginosis, Bacterial - diagnosis ; Vaginosis, Bacterial - drug therapy</subject><ispartof>Obstetrics and gynecology (New York. 1953), 2005-03, Vol.105 (3), p.557-562</ispartof><rights>2005 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.</rights><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4449-a875e2ac6b8120e9df22262ffa33320cfa9ef71aa578212c195d0eef5b2322ce3</citedby><cites>FETCH-LOGICAL-c4449-a875e2ac6b8120e9df22262ffa33320cfa9ef71aa578212c195d0eef5b2322ce3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16680093$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15738024$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sheffield, Jeanne S</creatorcontrib><creatorcontrib>Andrews, Williams W</creatorcontrib><creatorcontrib>Klebanoff, Mark A</creatorcontrib><creatorcontrib>MacPherson, Cora</creatorcontrib><creatorcontrib>Carey, J Christopher</creatorcontrib><creatorcontrib>Ernest, J M</creatorcontrib><creatorcontrib>Wapner, Ronald J</creatorcontrib><creatorcontrib>Trout, Wayne</creatorcontrib><creatorcontrib>Moawad, Atef</creatorcontrib><creatorcontrib>Miodovnik, Menachem</creatorcontrib><creatorcontrib>Sibai, Baha</creatorcontrib><creatorcontrib>Varner, Michael W</creatorcontrib><creatorcontrib>Caritis, Steve N</creatorcontrib><creatorcontrib>Dombrowski, Mitchell</creatorcontrib><creatorcontrib>Langer, Oded</creatorcontrib><creatorcontrib>OʼSullivan, Mary J</creatorcontrib><creatorcontrib>National Institute for Child Health and Human Development Maternal-Fetal Medicine Units Network</creatorcontrib><title>Spontaneous Resolution of Asymptomatic Chlamydia trachomatis in Pregnancy</title><title>Obstetrics and gynecology (New York. 1953)</title><addtitle>Obstet Gynecol</addtitle><description>OBJECTIVE:We sought to estimate the rate of spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy and to evaluate factors associated with its resolution.
METHODS:A cohort of women enrolled in a large multicenter randomized bacterial vaginosis antibiotic trial (metronidazole versus placebo) that, when randomly allocated, had asymptomatic C trachomatis diagnosed by urine ligase chain reaction (from frozen archival specimens) between 16 and 23 weeks were included. The urine ligase chain reaction is a highly accurate predictor of genital tract chlamydial infection. A follow-up ligase chain reaction was performed between 24 and 29 weeks.
RESULTS:A total of 1,953 women were enrolled in the original antibiotic trial; 1,547 (79%) had ligase chain reaction performed both at randomization and follow-up. Women receiving antibiotics effective against Chlamydia between randomization and follow-up or having symptomatic Chlamydia infection were excluded (26 women). Of the 140 women (9%) who were diagnosed as positive via the initial ligase chain reaction assay, 61 (44%) had spontaneous resolution of Chlamydia by the follow-up ligase chain reaction assay. Factors associated with spontaneous resolution included older age (P = .02), more than 5 weeks from randomization to follow-up (P = .02), and a greater number of lifetime sexual partners (P = .02). Using a logistic regression model, maternal age and a greater-than-5-week follow-up interval remained significant; for every 5-year increase in maternal age, the odds of a positive result on the ligase chain reaction test at follow-up decreased by 40% (odds ratio 0.6; 95% confidence interval 0.4–0.9). Race, substance abuse, parity, and treatment with metronidazole were not associated with spontaneous resolution. Gram stain score and vaginal pH at randomization and follow-up also were not associated.
CONCLUSION:The prevalence of asymptomatic C trachomatis in pregnancy was 9%; infection resolved spontaneously in almost half of these women. The association of older age and increasing time interval to spontaneous resolution of Chlamydia is consistent with a host immune-response mechanism.
LEVEL OF EVIDENCE:III</description><subject>Adult</subject><subject>Anti-Infective Agents - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Chlamydia Infections - complications</subject><subject>Chlamydia Infections - diagnosis</subject><subject>Chlamydia trachomatis</subject><subject>Double-Blind Method</subject><subject>Female</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Humans</subject><subject>Ligase Chain Reaction</subject><subject>Medical sciences</subject><subject>Metronidazole - therapeutic use</subject><subject>Pregnancy</subject><subject>Pregnancy Complications, Infectious - diagnosis</subject><subject>Remission, Spontaneous</subject><subject>Vaginosis, Bacterial - complications</subject><subject>Vaginosis, Bacterial - diagnosis</subject><subject>Vaginosis, Bacterial - drug therapy</subject><issn>0029-7844</issn><issn>1873-233X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkNuKFDEQQIMo7rj6C9II-ta9lUrSSXwbhnV3YWHFC_gWMpnEaU13xqSbZf7engtMvYQqTqWqDiEfKDQUtLwB2iyf7hqYgwomGGsoa4VqHL4gC6okq5GxXy_JAgB1LRXnV-RNKX8OfKvZa3JFhWQKkC_Iw_ddGkY7-DSV6psvKU5jl4YqhWpZ9v1uTL0dO1etttH2-01nqzFbtz1WS9UN1dfsfw92cPu35FWwsfh35_ea_Pxy-2N1Xz8-3T2slo-145zr2iopPFrXrhVF8HoTELHFECxjDMEFq32Q1FohFVJ0VIsNeB_EGhmi8-yafDr9u8vp3-TLaPquOB_j6QjTSi6pVnwGP59Al1Mp2Qezy11v895QMAeRBqiZRZqLSHMUaRzOze_PU6Z17zeX1rO5Gfh4BmxxNoY8O-jKhWtbBaDZzPET95zi6HP5G6dnn83W2zhuj6NbFFAjgAA2Z_VhGc3-AwgRjIw</recordid><startdate>200503</startdate><enddate>200503</enddate><creator>Sheffield, Jeanne S</creator><creator>Andrews, Williams W</creator><creator>Klebanoff, Mark A</creator><creator>MacPherson, Cora</creator><creator>Carey, J Christopher</creator><creator>Ernest, J M</creator><creator>Wapner, Ronald J</creator><creator>Trout, Wayne</creator><creator>Moawad, Atef</creator><creator>Miodovnik, Menachem</creator><creator>Sibai, Baha</creator><creator>Varner, Michael W</creator><creator>Caritis, Steve N</creator><creator>Dombrowski, Mitchell</creator><creator>Langer, Oded</creator><creator>OʼSullivan, Mary J</creator><general>by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved</general><general>Elsevier Science</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200503</creationdate><title>Spontaneous Resolution of Asymptomatic Chlamydia trachomatis in Pregnancy</title><author>Sheffield, Jeanne S ; Andrews, Williams W ; Klebanoff, Mark A ; MacPherson, Cora ; Carey, J Christopher ; Ernest, J M ; Wapner, Ronald J ; Trout, Wayne ; Moawad, Atef ; Miodovnik, Menachem ; Sibai, Baha ; Varner, Michael W ; Caritis, Steve N ; Dombrowski, Mitchell ; Langer, Oded ; OʼSullivan, Mary J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4449-a875e2ac6b8120e9df22262ffa33320cfa9ef71aa578212c195d0eef5b2322ce3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adult</topic><topic>Anti-Infective Agents - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Chlamydia Infections - complications</topic><topic>Chlamydia Infections - diagnosis</topic><topic>Chlamydia trachomatis</topic><topic>Double-Blind Method</topic><topic>Female</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Humans</topic><topic>Ligase Chain Reaction</topic><topic>Medical sciences</topic><topic>Metronidazole - therapeutic use</topic><topic>Pregnancy</topic><topic>Pregnancy Complications, Infectious - diagnosis</topic><topic>Remission, Spontaneous</topic><topic>Vaginosis, Bacterial - complications</topic><topic>Vaginosis, Bacterial - diagnosis</topic><topic>Vaginosis, Bacterial - drug therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sheffield, Jeanne S</creatorcontrib><creatorcontrib>Andrews, Williams W</creatorcontrib><creatorcontrib>Klebanoff, Mark A</creatorcontrib><creatorcontrib>MacPherson, Cora</creatorcontrib><creatorcontrib>Carey, J Christopher</creatorcontrib><creatorcontrib>Ernest, J M</creatorcontrib><creatorcontrib>Wapner, Ronald J</creatorcontrib><creatorcontrib>Trout, Wayne</creatorcontrib><creatorcontrib>Moawad, Atef</creatorcontrib><creatorcontrib>Miodovnik, Menachem</creatorcontrib><creatorcontrib>Sibai, Baha</creatorcontrib><creatorcontrib>Varner, Michael W</creatorcontrib><creatorcontrib>Caritis, Steve N</creatorcontrib><creatorcontrib>Dombrowski, Mitchell</creatorcontrib><creatorcontrib>Langer, Oded</creatorcontrib><creatorcontrib>OʼSullivan, Mary J</creatorcontrib><creatorcontrib>National Institute for Child Health and Human Development Maternal-Fetal Medicine Units Network</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Obstetrics and gynecology (New York. 1953)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sheffield, Jeanne S</au><au>Andrews, Williams W</au><au>Klebanoff, Mark A</au><au>MacPherson, Cora</au><au>Carey, J Christopher</au><au>Ernest, J M</au><au>Wapner, Ronald J</au><au>Trout, Wayne</au><au>Moawad, Atef</au><au>Miodovnik, Menachem</au><au>Sibai, Baha</au><au>Varner, Michael W</au><au>Caritis, Steve N</au><au>Dombrowski, Mitchell</au><au>Langer, Oded</au><au>OʼSullivan, Mary J</au><aucorp>National Institute for Child Health and Human Development Maternal-Fetal Medicine Units Network</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Spontaneous Resolution of Asymptomatic Chlamydia trachomatis in Pregnancy</atitle><jtitle>Obstetrics and gynecology (New York. 1953)</jtitle><addtitle>Obstet Gynecol</addtitle><date>2005-03</date><risdate>2005</risdate><volume>105</volume><issue>3</issue><spage>557</spage><epage>562</epage><pages>557-562</pages><issn>0029-7844</issn><eissn>1873-233X</eissn><coden>OBGNAS</coden><abstract>OBJECTIVE:We sought to estimate the rate of spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy and to evaluate factors associated with its resolution.
METHODS:A cohort of women enrolled in a large multicenter randomized bacterial vaginosis antibiotic trial (metronidazole versus placebo) that, when randomly allocated, had asymptomatic C trachomatis diagnosed by urine ligase chain reaction (from frozen archival specimens) between 16 and 23 weeks were included. The urine ligase chain reaction is a highly accurate predictor of genital tract chlamydial infection. A follow-up ligase chain reaction was performed between 24 and 29 weeks.
RESULTS:A total of 1,953 women were enrolled in the original antibiotic trial; 1,547 (79%) had ligase chain reaction performed both at randomization and follow-up. Women receiving antibiotics effective against Chlamydia between randomization and follow-up or having symptomatic Chlamydia infection were excluded (26 women). Of the 140 women (9%) who were diagnosed as positive via the initial ligase chain reaction assay, 61 (44%) had spontaneous resolution of Chlamydia by the follow-up ligase chain reaction assay. Factors associated with spontaneous resolution included older age (P = .02), more than 5 weeks from randomization to follow-up (P = .02), and a greater number of lifetime sexual partners (P = .02). Using a logistic regression model, maternal age and a greater-than-5-week follow-up interval remained significant; for every 5-year increase in maternal age, the odds of a positive result on the ligase chain reaction test at follow-up decreased by 40% (odds ratio 0.6; 95% confidence interval 0.4–0.9). Race, substance abuse, parity, and treatment with metronidazole were not associated with spontaneous resolution. Gram stain score and vaginal pH at randomization and follow-up also were not associated.
CONCLUSION:The prevalence of asymptomatic C trachomatis in pregnancy was 9%; infection resolved spontaneously in almost half of these women. The association of older age and increasing time interval to spontaneous resolution of Chlamydia is consistent with a host immune-response mechanism.
LEVEL OF EVIDENCE:III</abstract><cop>New York, NY</cop><pub>by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>15738024</pmid><doi>10.1097/01.AOG.0000153533.13658.c2</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Obstetrics and gynecology (New York. 1953), 2005-03, Vol.105 (3), p.557-562 |
| issn | 0029-7844 1873-233X |
| language | eng |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adult Anti-Infective Agents - therapeutic use Biological and medical sciences Chlamydia Infections - complications Chlamydia Infections - diagnosis Chlamydia trachomatis Double-Blind Method Female Gynecology. Andrology. Obstetrics Humans Ligase Chain Reaction Medical sciences Metronidazole - therapeutic use Pregnancy Pregnancy Complications, Infectious - diagnosis Remission, Spontaneous Vaginosis, Bacterial - complications Vaginosis, Bacterial - diagnosis Vaginosis, Bacterial - drug therapy |
| title | Spontaneous Resolution of Asymptomatic Chlamydia trachomatis in Pregnancy |
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