Renault Cybèle A, Israelski Dennis M, Levy Vivian, Fujikawa Bruce K, Kellogg Timothy A, Klausner Jeffrey D
Stanford University School of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford, CA 94305-5107, USA.
Sex Health. 2011 Mar;8(1):69-73. doi: 10.1071/SH10030.
The dynamics of chlamydia clearance after treatment administration for chlamydial urogenital infection are unknown. We estimated the time to clearance of Chlamydia trachomatis (CT) ribosomal RNA (rRNA) after administration of azithromycin for cervical chlamydial infection using APTIMA Combo 2 (Gen-Probe, Inc., San Diego, CA, USA).
A total of 115 women diagnosed with urogenital chlamydial infection, defined as a positive APTIMA urine or endocervical specimen, were enrolled in the present study. Vaginal swabs on the day of treatment (Day 0) and on Days 3, 7, 10 and 14 after treatment with 1 g of azithromycin were self-obtained by participants. Specimens were tested in a single laboratory. Our analysis was limited to women who were CT-confirmed by vaginal swab at baseline, who returned all follow-up swabs, and who reported sexual abstinence during the follow-up period (n = 61).
Among 61 participants, 48 (79%) had a negative APTIMA at Day 14. Subjects with a negative APTIMA at each time-point were as follows: 0/61 (0%) on Day 0, 7/61 (12%) on Day 3, 28/61 (46%) on Day 7, 40/61 (66%) on Day 10, and 48/61 (79%) on Day 14. Multiple linear regression analysis predicted time to clearance at 17 days (95% confidence interval, 16-18 days) after administration of azithromycin. Seventeen of the 94 participants (18.1%) who screened positive for chlamydia had a negative vaginal swab on Day 0, indicating possible spontaneous clearance of CT.
After treatment, CT rRNA declined with time. As rRNA was still detectable in 21% of the women 14 days after treatment, APTIMA should not be used as a test-of-cure in the 14-day period following azithromycin administration.
衣原体性泌尿生殖系统感染治疗后衣原体清除的动态情况尚不清楚。我们使用APTIMA Combo 2（美国加利福尼亚州圣地亚哥市Gen-Probe公司）评估了阿奇霉素治疗宫颈衣原体感染后沙眼衣原体（CT）核糖体RNA（rRNA）的清除时间。
本研究共纳入115名被诊断为泌尿生殖系统衣原体感染的女性，其定义为APTIMA尿液或宫颈标本呈阳性。参与者自行采集治疗当天（第0天）以及1克阿奇霉素治疗后第3、7、10和14天的阴道拭子。标本在单一实验室进行检测。我们的分析仅限于基线时阴道拭子CT检测确诊、返回所有随访拭子且在随访期间报告禁欲的女性（n = 61）。
61名参与者中，48名（79%）在第14天APTIMA检测呈阴性。各时间点APTIMA检测呈阴性的受试者情况如下：第0天为0/61（0%），第3天为7/61（12%），第7天为28/61（46%），第10天为40/61（66%），第14天为48/61（79%）。多元线性回归分析预测阿奇霉素给药后清除时间为17天（95%置信区间，16 - 18天）。衣原体筛查呈阳性的94名参与者中有17名（18.1%）在第0天阴道拭子检测呈阴性，表明CT可能自然清除。
治疗后，CT rRNA随时间下降。由于治疗14天后仍有21%的女性可检测到rRNA，因此在阿奇霉素给药后的14天内，APTIMA不应作为治愈检测方法。
