Cervicitis and ectropion, but not bacterial vaginosis, are associated with an increased chlamydial load in the vagina

• Published in: International journal of STD & AIDS 2004-05, Vol.15, p.7
• Main Authors: Fernandes, A, Herring, A, Longhurst, D, Eastick, K
• Format: Article
• Language: English
• Subjects: Chlamydia
• ISSN: 0956-4624; 1758-1052

To assess the significance of chlamydial loads in vulvo-vaginal swabs (VVS) and first-catch urine (FCU) specimens from women diagnosed with chlamydia. Chlamydial loads were performed on VVS and FCU specimens from 64 chlamydia-positive women attending a Department of Genitourinary Medicine. A proforma was used to collect demographic and clinical information prospectively. Cervicitis was defined as >30 PMN/HPF on Gram-stained cervical smear and bacterial vaginosis (BV) as grade 3 using Hay-Ison's criteria. Chlamydial load was evaluated using real-time polymerase chain reaction (PCR) and calculated as number of DNA copies per millilitre of urine and per millilitre of VVS eluate. Results were analysed using the 't'-test with the log(e) for chlamydial load. The mean vulvo-vaginal load was 1.3 x 10 super(5) copies/mL (range 0-3.7 x 10 super(7)), which was approximately 50 times higher than the mean of 2.8 x 10 super(3) copies/mL (range 0-8.7 x 10 super(5)) for urine. Cervicitis (P = 0.036) and ectropion (P = 0.045) were associated with higher vulvo-vaginal load (mean values 4.1 x 10 super(5) and 3.4 x 10 super(5) compared with 6.2 x 10 super(4) and 6.5 x 10 super(4), respectively). Women with BV had a mean load 7.0 x 10 super(4), those without, a mean load 2.8 x 10 super(5), which was not significantly different (P = 0.326). A higher chlamydial load was not associated with younger age, presence of vaginal discharge, week of the menstrual cycle, use of hormonal contraception or time since last sexual intercourse. This technology has the potential to offer new insights into chlamydial disease pathogenesis.