Recent Developments of Chlamydia trachomatis and Mycoplasma Infections in Women

Abstract: The aim of this thesis was to elucidate developments in epidemiology, clinical manifestations and complications in Chlamydia trachomatis (C.trachomatis) and Mycoplasma genitalium (M.genitalium) infection. In study I the frequencies of non-gonococcal salpingitis, gonococcal salpingitis and ectopic pregnancy (EP) were observed over a period of 28 years and correlated to the prevalence of Neisseria gonorrhoeae (N.gonorrhoeae) and C.trachomatis. The frequency of acute salpingitis reflected the prevalence of N.gonorrhoeae and C.trachomatis in our population. The frequency of acute salpingitis and ectopic pregnancy might be used to estimate the occurrence of C.trachomatis during the 1970s and early 1980s before diagnostic facilities became available. In study II we explored the possible presence of C.trachomatis DNA at the time of EP using freshly frozen tubal tissue and analyzing for C.trachomatis with PCR and a highly sensitive real time PCR test. We also investigated the correlation between c-hsp60 antibodies and h-hsp60. C.trachomatis DNA could not be detected in any of the tubal tissue specimens from our patients with EP although highly sensitive diagnostic methods were used. Prior EP /PID was associated with ct-hsp60 antibodies but not with human hsp60. Comparison of the antibody levels of chlamydial hsp60 and human hsp60 in our patients with EP showed no correlation. In study III we compared clinical manifestations of infections with nvCT and wild type C.trachomatis (wtCT) in both men and women and estimated the frequency of ascending infections (PID) in women. The mean age of patients with nvCT infection was slightly lower than in patients with wtCT infection although nvCT was distributed in all age groups. Men and women with nvCT or wtCT infection were similar with regard to sexual lifestyle parameters and they had the same frequency of previous chlamydial infection. Asymptomatic infection seemed more common in women with nvCT infection than in women with wtCT infection. No case of PID associated with nvCT was found. Our findings suggest a difference in virulence between the nvCT and the wtCT. Study IV was performed to investigate the prevalence, clinical findings and complications of M.genitalium in women. In 7,598 women tested for M.genitalium and C.trachomatis the prevalence was 2.1 % and 2.6 % respectively. M.genitalium was associated with cervicitis and the observed association was independent of age and C.trachomatis infection. The frequency of symptoms and clinical signs were higher in patients with C.trachomatis infection suggesting that M.genitalium is a less aggressive pathogen in terms of symptoms and clinical signs. M.genitalium was clearly associated with PID in patients requesting termination of pregnancy.