Greater chlamydia persistence is associated with 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 which mechanisms govern natural resolution. To determine whether bacterial vaginosis was associated with increased chlamydia persistence versus spontaneous clearance in a large, longitudinal study, Brown and colleagues conducted this study.
The Longitudinal Study of Vaginal Flora followed women of childbearing age four times a year from 1999 to 2003. After ligase chain reaction tests became available midway through the study, baseline chlamydia screening and treatment were initiated and unscreened endocervical samples were analyzed upon completion of the study. Between consecutive visits without the use of chlamydia-active drugs, 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 versus clearance of chlamydia.
The main findings of this research were;
1. 48% of chlamydia cases (310/630) resolved spontaneously at the next visit.
2. Higher odds of chlamydia persistence were found to be associated 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).
3. A participant study with 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).
4. Results were not affected by BV symptoms.
Unfortunately, the rate of chlamydia infections remains unacceptably high, despite government recommendations to test all sexually active women under the age of 25 at least once a year. New measures are needed to prevent chlamydia in women. The long-term development of novel biotherapeutics, such as probiotics, to prevent chlamydia, facilitate chlamydia clearance and improve reproductive health may be influenced by understanding the complex factors, including host, pathogen and microbiome factors, that result in spontaneous clearance of chlamydia.
Brown, SE, Tuddenham, S., Shardell, MD, Klebanoff, MA, Ghanem, KG, & Brotman, RM (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