Sheffield Jeanne S, Andrews Williams W, Klebanoff Mark A, Macpherson Cora, Carey J Christopher, Ernest J M, Wapner Ronald J, Trout Wayne, Moawad Atef, Miodovnik Menachem, Sibai Baha, Varner Michael W, Caritis Steve N, Dombrowski Mitchell, Langer Oded, O'Sullivan Mary J
Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center at Dallas, Texas 75390-9032, USA.
Obstet Gynecol. 2005 Mar;105(3):557-62. doi: 10.1097/01.AOG.0000153533.13658.c2.
We sought to estimate the rate of spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy and to evaluate factors associated with its resolution.
A cohort of women enrolled in a large multicenter randomized bacterial vaginosis antibiotic trial (metronidazole versus placebo) that, when randomly allocated, had asymptomatic C trachomatis diagnosed by urine ligase chain reaction (from frozen archival specimens) between 16(0/7) and 23(6/7) weeks were included. The urine ligase chain reaction is a highly accurate predictor of genital tract chlamydial infection. A follow-up ligase chain reaction was performed between 24(0/7) and 29(6/7) weeks.
A total of 1,953 women were enrolled in the original antibiotic trial; 1,547 (79%) had ligase chain reaction performed both at randomization and follow-up. Women receiving antibiotics effective against Chlamydia between randomization and follow-up or having symptomatic Chlamydia infection were excluded (26 women). Of the 140 women (9%) who were diagnosed as positive via the initial ligase chain reaction assay, 61 (44%) had spontaneous resolution of Chlamydia by the follow-up ligase chain reaction assay. Factors associated with spontaneous resolution included older age (P = .02), more than 5 weeks from randomization to follow-up (P = .02), and a greater number of lifetime sexual partners (P = .02). Using a logistic regression model, maternal age and a greater-than-5-week follow-up interval remained significant; for every 5-year increase in maternal age, the odds of a positive result on the ligase chain reaction test at follow-up decreased by 40% (odds ratio 0.6; 95% confidence interval 0.4-0.9). Race, substance abuse, parity, and treatment with metronidazole were not associated with spontaneous resolution. Gram stain score and vaginal pH at randomization and follow-up also were not associated.
The prevalence of asymptomatic C trachomatis in pregnancy was 9%; infection resolved spontaneously in almost half of these women. The association of older age and increasing time interval to spontaneous resolution of Chlamydia is consistent with a host immune-response mechanism.
我们试图评估孕期无症状沙眼衣原体的自然清除率，并评估与其清除相关的因素。
纳入一组参与大型多中心随机细菌性阴道病抗生素试验（甲硝唑与安慰剂对照）的女性，她们在随机分组时，于孕16（0/7）至23（6/7）周期间通过尿液连接酶链反应（来自冷冻存档标本）诊断为无症状沙眼衣原体感染。尿液连接酶链反应是生殖道衣原体感染的高度准确预测指标。在孕24（0/7）至29（6/7）周期间进行了随访连接酶链反应。
共有1953名女性参与了最初的抗生素试验；1547名（79%）在随机分组和随访时均进行了连接酶链反应检测。排除在随机分组至随访期间接受有效抗衣原体抗生素治疗或有症状衣原体感染的女性（26名）。在最初连接酶链反应检测诊断为阳性的140名女性（9%）中，61名（44%）在随访连接酶链反应检测时衣原体自然清除。与自然清除相关的因素包括年龄较大（P = 0.02）、从随机分组到随访超过5周（P = 0.02）以及性伴侣数量较多（P = 0.02）。使用逻辑回归模型，母亲年龄和超过5周的随访间隔仍然具有显著性；母亲年龄每增加5岁，随访时连接酶链反应检测呈阳性结果的几率降低40%（比值比0.6；95%置信区间0.4 - 0.9）。种族、药物滥用、产次以及甲硝唑治疗与自然清除无关。随机分组和随访时的革兰氏染色评分及阴道pH值也无关。
孕期无症状沙眼衣原体的患病率为9%；近一半女性的感染自然清除。年龄较大以及衣原体自然清除时间间隔增加之间的关联与宿主免疫反应机制一致。
