Chlamydial Infections

Chlamydia trachomatis is an obligate intracellular bacterium that has several serotypes, including those that cause lymphogranuloma venereum (LGV). The most commonly encountered strains are those that attach only to columnar or transitional cell epithelium and cause cervical infection.

MATERNAL INFECTIONS.

Genital infection with C trachomatis is one of the most common sexually transmitted bacterial diseases in women of reproductive age (Miller and colleagues, 2004). They are also common in pregnant women, and their incidence depends on the demographical makeup of the population. In 2002, the median chlamydial infection rate among young women screened at prenatal clinics in 28 states was 10.1 percent (Centers for Disease Control and Prevention, 2003b). Risk factors for infection in pregnant women include age younger than 25 years, presence or history of other STD(s), multiple sexual partners, and a new sexual partner within 3 months (Centers for Disease Control and Prevention, 2002d).

Diagnosis. Cultures are expensive and less accurate than newer nucleic acid amplification tests, including PCR. Andrews and associates (1997) reported that a ligase chain reaction assay was both sensitive and specific for genitourinary infection in pregnant women.

Symptomatic Infection. Most pregnant women have asymptomatic infection, but some present with urethral syndrome, urethritis, or Bartholin gland infection (Peipert, 2003). Although mucopurulent cervicitis may be due to either chlamydial or gonococcal infection, or both, it may also result from the normal, hormonally stimulated endocervical glands with abundant mucus production. Other chlamydial infections not usually seen in pregnancy are endometritis, salpingitis, peritonitis, reactive arthritis, and Reiter syndrome.

Asymptomatic Infection and Pregnancy Outcome. Many investigators have examined the effects of asymptomatic chlamydial infection on pregnancy outcome, and its role remains controversial. Sozio and Ness (1998) found no association with increased abortion. Some investigators, but not all, have found that untreated cervical infection increases the risk of preterm delivery, prematurely ruptured membranes, and perinatal mortality.

Chlamydial infection appears to be associated neither with an increased risk of chorioamnionitis nor with pelvic infection after cesarean delivery (Blanco and colleagues, 1985; Gibbs and Schachter, 1987). Conversely, delayed postpartum uterine infection with C trachomatis has been described by Hoyme and associates (1986). The syndrome, which develops 2 to 3 weeks postpartum, is distinct from early postoperative metritis. It is characterized by vaginal bleeding or discharge, low-grade fever, lower abdominal pain, and uterine tenderness.

NEONATAL INFECTIONS.