The current standard of care treatment for chlamydia sometimes fails to eradicate the disease, according to a review published ahead of print in Infection and Immunity, and the culprit may be in the gut.
Chlamydia trachomatis not only infects the reproductive tract, but abides persistently - though benignly - in the gastrointestinal tract. There it remains even after eradication from the genitals by the antibiotic, azithromycin, says first author Roger Rank, of the Arkansas Children’s Research Institute, Little Rock. And that reservoir is likely a source of the all-too-common reinfections that follow treatment.
The source of the reinfections has long been a conundrum. Some are blamed on continued intercourse with an infected partner. This is not surprising since chlamydia is usually asymptomatic in men.
Chlamydiae have long been assumed often to persist within the genital tract in a non-replicating form, but Rank says there is no evidence for this. “While all agree that chlamydiae may persist in a patient for long periods of time, and that recurrent infections do develop, there has been no agreement on how and where and in what form chlamydiae persist,” says Rank.
In a recent study, coauthor and Arkansas colleague Laxmi Yeruva showed in mice that azithormycin eradicated the genital infection, but not the GI infection.
Rank showed further - also in mice - that chlamydial infection of the GI does not elicit an inflammatory response, and never resolves, unlike in the genital tract.
Chlamydia is a disease caused by the bacteria Chlamydia trachomatis. It is most commonly sexually transmitted.
Causes, incidence, and risk factors
Chlamydia infection is the most common sexually transmitted disease in the United States. Sexually active individuals and individuals with multiple partners are at highest risk.
Signs and tests
The diagnosis of chlamydia infection involves sampling of the urethral discharge in males or cervical secretions in females. If an individual engages in anal sexual contact, samples from the rectum may also be needed. The sample is sent for a fluorescent or monoclonal antibody test, DNA probe test, or cell culture. Some of these tests may also be performed on urine samples.
“However, we found that GI infection does produce a strong immune response that can actually be effective against a genital infection, but that is unable to cure the GI infection,” says Rank.
While chlamydial persistence in the GI tract has largely escaped notice of late, it was documented in the veterinary literature in numerous animals as early as the 1950s, says Rank. His reading of that early literature was a major factor motivating his and Yeruva’s studies, and this review, Rank says.
Chlamydia reinfection risk highest in school-age females
Interventions are needed to prevent chlamydia re-infections in very young women, sexual health physicians say.
The risk of re-infection is highest in women under the age of 16, particular in the first year after an initial infection, they report in the journal STI.
In a study of almost 41,000 women treated for chlamydia infections, 3236 had at least one repeat chlamydia notification over an average of almost four years.
Chlamydia trachomatis is the most common cause of sexually transmitted disease in the world. In the US, approximately 1.4 million cases occur annually, according to the Centers for Disease Control and Prevention. Adolescents are most affected, and 6.8 percent of sexually active females ages 14-19 become infected annually.
Infection and Immunity is a publication of the American Society for Microbiology (ASM). The ASM is the largest single life science society, composed of over 39,000 scientists and health professionals. Its mission is to advance the microbiological sciences as a vehicle for understanding life processes and to apply and communicate this knowledge for the improvement of health and environmental and economic well-being worldwide.
American Society for Microbiology