Versteeg Bart, Bruisten Sylvia M, Heijman Titia, Vermeulen Wilma, van Rooijen Martijn S, van Dam Alje P, Schim van der Loeff Maarten F, de Vries Henry J C, Scholing Maarten
Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands.
Amsterdam Infection and Immunity Institute, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
PLoS One. 2017 Sep 21;12(9):e0185295. doi: 10.1371/journal.pone.0185295. eCollection 2017.
The use of a nucleic acid amplification test (NAAT) as a test of cure after treatment is subject to discussion, as the presence of C. trachomatis nucleic acids after treatment may be prolonged and intermittent without presence of infectious bacteria. We used cell culture to assess if a positive RNA- or DNA-based NAAT after treatment indicates the presence of viable C. trachomatis.
We included women with asymptomatic urogenital C. trachomatis infection visiting the Amsterdam STI clinic from September 2015 through June 2016. Endocervical swabs were collected prior to treatment with azithromycin, and during three follow-up visits 7, 21 and 49 days after treatment. Collected swabs were subjected to C. trachomatis culture and a RNA- and DNA-based NAAT. High-resolution multilocus sequence typing (hr-MLST) was used to further differentiate potential re-infections.
We included 90 women with a positive RNA-test prior to receiving treatment of whom 81 (90%) were also DNA-positive, and 69 (76.7%) culture-positive. Prolonged and intermittent positive RNA and DNA results over time were observed. Three women had culture positive results at the second visit, but all were negative at the third visit. Five women had NAAT-positive results at the fourth visit of whom three women were also culture-positive indicating a viable infection. All five women reported unprotected sexual contact since the first visit. From 2, hr-MLST sequence types were obtained. One had a different sequence type indicating a new infection the other was identical to the previously found indicating a potentially persisting infection.
Most RNA- or DNA-positive results after treatment of urogenital C. trachomatis may be caused by non-viable molecular remnants since they cannot be confirmed by culture. In a minority viable C. trachomatis was found in culture at the second visit, indicating that patients may remain infectious at least 7 days after treatment.
核酸扩增检测（NAAT）作为治疗后治愈的检测方法存在争议，因为治疗后沙眼衣原体核酸的存在可能会延长且呈间歇性，而此时并无感染性细菌。我们使用细胞培养来评估治疗后基于RNA或DNA的NAAT阳性是否表明存在活的沙眼衣原体。
我们纳入了2015年9月至2016年6月期间前往阿姆斯特丹性传播感染诊所就诊的无症状泌尿生殖系统沙眼衣原体感染女性。在使用阿奇霉素治疗前以及治疗后7天、21天和49天的三次随访中采集宫颈拭子。将采集的拭子进行沙眼衣原体培养以及基于RNA和DNA的NAAT检测。使用高分辨率多位点序列分型（hr-MLST）进一步区分潜在的再次感染。
我们纳入了90名治疗前RNA检测呈阳性的女性，其中81名（90%）DNA检测也呈阳性，69名（76.7%）培养呈阳性。观察到随着时间推移RNA和DNA结果呈延长且间歇性阳性。三名女性在第二次就诊时培养结果呈阳性，但在第三次就诊时均为阴性。五名女性在第四次就诊时NAAT检测呈阳性，其中三名女性培养也呈阳性，表明存在活的感染。所有五名女性自首次就诊以来均报告有未采取保护措施的性接触。从2名女性中获得了hr-MLST序列类型。一名女性的序列类型不同，表明是新感染，另一名与之前发现的相同，表明可能是持续性感染。
泌尿生殖系统沙眼衣原体治疗后大多数RNA或DNA阳性结果可能由无活性的分子残余物引起，因为它们无法通过培养得到证实。少数情况下，在第二次就诊时培养发现有活的沙眼衣原体，这表明患者在治疗后至少7天可能仍具传染性。
