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Long-term Eradication of Chlamydia trachomatis Genital Infection After Antimicrobial Therapy Evidence Against Persistent Infection

Kimberly A. Workowski, MD; Mary F. Lampe, PhD; Kim G. Wong; Mary B. Watts, MD; Walter E. Stamm, MD
JAMA. 1993;270(17):2071-2075. doi:10.1001/jama.1993.03510170061031.
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Objective.  —To determine whether Chlamydia trachomatis urogenital infections persist or relapse after antimicrobial therapy by serial measurement of chlamydial-specific DNA using the polymerase chain reaction (PCR), cell cultures, and serological studies.

Design.  —Prospective evaluation of an inception cohort.

Setting.  —University student health clinic.

Participants.  —Twenty women with culture-proven and PCR-proven C trachomatis urogenital infections.

Measurements.  —Incidence of persistent infection as determined by PCR, culture, and serial measurement of local and systemic antibody to C trachomatis for 5 months after doxycycline therapy.

Results.  —Prior to therapy, C trachomatis was isolated in cell culture from the cervix in 19 of 20 women, from the urethra in 13 women, and from the rectum in 13 women. All culture-positive specimens were also PCR-positive. Immediately after completion of antimicrobial therapy, all women had negative cell cultures for chlamydia. Ten of 20 culture-negative cervical specimens and two culture-negative urethral specimens had chlamydial DNA present immediately after treatment. In addition, three women had detectable DNA from cervical specimens 1 week after treatment. The presence of cervicitis (P=.01), high inclusion counts (P=.004), and serological evidence of recent infection (P=.0004) were each significantly associated with PCR positivity after treatment. All 384 subsequent cervical, rectal, and urethral specimens collected over 5 months were negative by both PCR and culture with the exception of one woman who was reinfected. Serum immunoglobulin M (IgM) titers, geometric mean serum immunoglobulin G (IgG) titers, and prevalence of local antibody to chlamydia progressively declined after treatment.

Conclusions.  —Standard antimicrobial therapy is effective in the long-term microbiologic eradication of uncomplicated C trachomatis urogenital infections. The presence of chlamydial DNA after antimicrobial therapy is of short duration and reflects excretion of nonviable organisms rather than persistent infection.(JAMA. 1993;270:2071-2075)


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