Whittington W L, Kent C, Kissinger P, Oh M K, Fortenberry J D, Hillis S E, Litchfield B, Bolan G A, St Louis M E, Farley T A, Handsfield H H
Department of Medicine, University of Washington, Public Health, Seattle & King County, USA.
Sex Transm Dis. 2001 Feb;28(2):117-23. doi: 10.1097/00007435-200102000-00011.
Sequelae of genital Chlamydia trachomatis infection in women are more strongly linked to repeat infections than to initial ones, and persistent or subsequent infections foster continued transmission.
To identify factors associated with persistent and recurrent chlamydial infection in young women that might influence prevention strategies.
Teenage and young adult women with uncomplicated C trachomatis infection attending reproductive health, sexually transmitted disease, and adolescent medicine clinics in five US cities were recruited to a cohort study. Persistent or recurrent chlamydial infection was detected by ligase chain reaction (LCR) testing of urine 1 month and 4 months after treatment.
Among 1,194 women treated for chlamydial infection, 792 (66.4%) returned for the first follow-up visit, 50 (6.3 %) of whom had positive LCR results. At that visit, women who resumed sex since treatment were more likely to have chlamydial infection (relative risk [RR], 2.0; 95% CI, 1.03-3.9), as were those who did not complete treatment (RR, 3.4; 95% CI, 1.6-7.3). Among women who tested negative for C trachomatis at the first follow-up visit, 36 (7.1%) of 505 had positive results by LCR at the second follow-up visit. Reinfection at this visit was not clearly associated with having a new sex partner or other sexual behavior risks; new infection was likely due to resumption of sex with untreated partners. Overall, 13.4% of women had persistent infection or became reinfected after a median of 4.3 months, a rate of 33 infections per 1,000 person months.
Persistent or recurrent infection is very common in young women with chlamydial infection. Improved strategies are needed to assure treatment of women's male sex partners. Rescreening, or retesting of women for chlamydial infection a few months after treatment, also is recommended as a routine chlamydia prevention strategy.
女性生殖系统沙眼衣原体感染的后遗症与重复感染的关联比与初次感染的关联更为紧密，持续或后续感染会促使疾病持续传播。
确定可能影响预防策略的、与年轻女性沙眼衣原体持续感染和反复感染相关的因素。
招募了美国五个城市生殖健康、性传播疾病及青少年医学诊所中患单纯性沙眼衣原体感染的青少年及年轻成年女性参与一项队列研究。在治疗后1个月和4个月通过尿液连接酶链反应（LCR）检测来发现沙眼衣原体持续感染或反复感染情况。
在1194例接受沙眼衣原体感染治疗的女性中，792例（66.4%）返回进行首次随访，其中50例（6.3%）LCR检测结果呈阳性。在此次随访中，治疗后恢复性行为的女性更易感染沙眼衣原体（相对风险[RR]为2.0；95%置信区间为1.03 - 3.9），未完成治疗的女性也是如此（RR为3.4；95%置信区间为1.6 - 7.3）。在首次随访沙眼衣原体检测呈阴性的女性中，505例中有36例（7.1%）在第二次随访时LCR检测结果呈阳性。此次随访时再次感染与拥有新的性伴侣或其他性行为风险并无明显关联；新感染可能是由于与未治疗的伴侣恢复性行为所致。总体而言，13.4%的女性出现持续感染或在中位时间4.3个月后再次感染，感染率为每1000人月33例感染。
沙眼衣原体感染的年轻女性中，持续感染或反复感染非常常见。需要改进策略以确保对女性的男性性伴侣进行治疗。还建议将治疗后几个月对女性进行沙眼衣原体感染的重新筛查或复测作为常规的衣原体预防策略。
