Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, The Netherlands
Department of Social Medicine and Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
Sex Transm Infect. 2020 Nov;96(7):541-548. doi: 10.1136/sextrans-2019-054267. Epub 2020 Feb 17.
Spontaneous clearance of (CT) infections can occur between diagnosis and treatment. We followed CT patients to assess clearance using a conventional definition (no total CT-DNA, assessed by routine quantitative PCR methods) and a definition accounting for viability, assessed by viability PCR testing.
Three outpatient STI clinics included CT-diagnosed women (The Netherlands, 2016-2017, FemCure study); participants had vaginal CT (vCT) and rectal CT (rCT) (group A: n=155), vCT and were rectally untested (group B: n=351), single vCT (group C: n=25) or single rCT (group D: n=29). Follow-up (median interval 9 days) vaginal and rectal samples underwent quantitative PCR testing (detecting total CT-DNA). When PCR positive, samples underwent V-PCR testing to detect 'viable CT' (CT-DNA from intact CT organisms; V-PCR positive). 'Clearance' was the proportion PCR-negative patients and 'clearance of viable CT' was the proportion of patients testing PCR negative or PCR positive but V-PCR negative. We used multivariable logistic regression analyses to assess diagnosis group (A-D), age, days since initial CT test (diagnosis) and study site (STI clinic) in relation to clearance and clearance of viable CT.
Clearance and clearance of viable CT at both anatomic sites were for (A) 0.6% and 3.9%; (B) 5.4% and 9.4%; (C) 32.0% and 52.0% and (D) 27.6% and 41.4%, respectively. In multivariate analyses, women with single infections (groups C and D) had higher likelihood of clearance than women concurrently infected with vCT and rCT (p<0.001).Of rectally untested women (group B), 76.9% had total CT-DNA and 46.7% had viable CT (V-PCR positive) at the rectal site.
Of untreated female vCT patients who had CT also at the rectal site, or who were rectally untested, only a small proportion cleared CT (in fact many had viable CT) at their follow-up visit (median 9 days). Among single site infected women clearance was much higher.
NCT02694497.
在诊断和治疗之间，（CT）感染可能会自发清除。我们对 CT 患者进行随访，使用常规定义（通过常规定量 PCR 方法评估无总 CT-DNA）和通过活 PCR 检测评估生存能力的定义来评估清除率。
三家门诊性传播感染诊所纳入了 CT 确诊的女性（荷兰，2016-2017 年，FemCure 研究）；参与者的阴道 CT（vCT）和直肠 CT（rCT）均为阳性（组 A：n=155），阴道 CT 阳性而直肠 CT 未检测到（组 B：n=351），单纯阴道 CT 阳性（组 C：n=25）或单纯直肠 CT 阳性（组 D：n=29）。随访（中位数间隔 9 天）阴道和直肠样本进行定量 PCR 检测（检测总 CT-DNA）。当 PCR 阳性时，样本进行 V-PCR 检测以检测“活 CT”（来自完整 CT 生物体的 CT-DNA；V-PCR 阳性）。“清除”是指 PCR 阴性患者的比例，“活 CT 清除”是指 PCR 阴性或 PCR 阳性但 V-PCR 阴性患者的比例。我们使用多变量逻辑回归分析评估诊断组（A-D）、年龄、从初次 CT 检测（诊断）到随访的天数以及研究地点（性传播感染诊所）与清除和活 CT 清除的关系。
两个解剖部位的清除率和活 CT 清除率分别为（A）0.6%和 3.9%；（B）5.4%和 9.4%；（C）32.0%和 52.0%和（D）27.6%和 41.4%。在多变量分析中，与同时感染 vCT 和 rCT 的女性相比，单感染（组 C 和 D）的女性更有可能清除 CT（p<0.001）。对于未直肠检测的女性（组 B），76.9%在直肠部位有总 CT-DNA，46.7%有活 CT（V-PCR 阳性）。
对于未经治疗的女性 vCT 患者，如果 CT 也存在于直肠部位，或者直肠未检测到，只有一小部分在随访时（中位随访时间为 9 天）清除 CT（实际上很多患者有活 CT）。在单部位感染的女性中，清除率要高得多。
NCT02694497。
