Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor.
Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor.
J Infect Dis. 2018 Jan 30;217(4):656-666. doi: 10.1093/infdis/jix545.
Understanding the relationship between the levonorgestrel (LNG)-releasing intrauterine system (IUS) and sexually transmitted infections (STIs) is increasingly important as use of the LNG-IUS grows to include women at higher risk for STIs. This study assessed the impact of the LNG-IUS on development of Chlamydia trachomatis pelvic inflammatory disease, using a baboon model.
Baboons with and those without the LNG-IUS were cervically inoculated with C. trachomatis and monitored daily, and cervical and fallopian tube swab specimens were collected weekly for C. trachomatis quantitation by nucleic acid amplification testing and culture. Vaginal swab specimens were collected for cytokine analysis, and serum samples were obtained for detection of C. trachomatis antibodies.
The LNG-IUS resulted in an increased C. trachomatis burden in the cervix, with the bacterial burden in the LNG-IUS group diverging from that in the non-LNG-IUS group by 6 weeks after infection. One of 7 baboons in the non-LNG-IUS group and 2 of 6 in the LNG-IUS group developed pelvic inflammatory disease, while 3 animals in each group met criteria suggestive of pelvic inflammatory disease. LNG-IUS increased baseline interleukin 8 levels but failed to further upregulate interleukin 8 during infection. In LNG-IUS recipients, early perturbations in the interleukin 1β axis corresponded to decreased C. trachomatis clearance and increased T-helper type 2 immune responses.
LNG-IUS use results in delayed clearance of C. trachomatis and might alter the reproductive tract immune environment.
随着左炔诺孕酮（LNG）释放宫内节育系统（IUS）的使用范围扩大，包括感染性传播疾病（STIs）风险较高的女性，了解 LNG-IUS 与 STIs 之间的关系变得越来越重要。本研究采用狒狒模型评估了 LNG-IUS 对沙眼衣原体盆腔炎症疾病发展的影响。
将 LNG-IUS 组和非 LNG-IUS 组狒狒的宫颈接种沙眼衣原体，并进行每日监测，每周收集宫颈和输卵管拭子标本，通过核酸扩增检测和培养定量检测沙眼衣原体。收集阴道拭子标本进行细胞因子分析，并采集血清样本检测沙眼衣原体抗体。
LNG-IUS 导致宫颈沙眼衣原体负荷增加，感染后 6 周，LNG-IUS 组的细菌负荷与非 LNG-IUS 组的细菌负荷分离。非 LNG-IUS 组的 7 只狒狒中有 1 只，LNG-IUS 组的 6 只狒狒中有 2 只发生了盆腔炎症，而每组的 3 只动物符合盆腔炎症的标准。LNG-IUS 增加了基线白细胞介素 8 水平，但在感染过程中未能进一步上调白细胞介素 8。在 LNG-IUS 受者中，白细胞介素 1β轴的早期失调与沙眼衣原体清除减少和辅助性 T 细胞 2 免疫反应增加有关。
LNG-IUS 的使用导致沙眼衣原体清除延迟，并可能改变生殖道免疫环境。
