Spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy

Jeanne S. Sheffield, Williams W. Andrews, Mark A. Klebanoff, Cora MacPherson, J. Christopher Carey, J. M. Ernest, Ronald J. Wapner, Wayne Trout, Atef Moawad, Menachem Miodovnik, Baha Sibai, Michael W. Varner, Steve N. Caritis, Mitchell Dombrowski, Oded Langer, Mary J. O'Sullivan

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

OBJECTIVE: We sought to estimate the rate of spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy and to evaluate factors associated with its resolution. METHODS: A cohort of women enrolled in a large multicenter randomized bacterial vaginosis antibiotic trial (metronidazole versus placebo) that, when randomly allocated, had asymptomatic C trachomatis diagnosed by urine ligase chain reaction (from frozen archival specimens) between 160/7 and 236/7 weeks were included. The urine ligase chain reaction is a highly accurate predictor of genital tract chlamydial infection. A follow-up ligase chain reaction was performed between 24 0/7 and 296/7 weeks. RESULTS: A total of 1,953 women were enrolled in the original antibiotic trial; 1,547 (79%) had ligase chain reaction performed both at randomization and follow-up. Women receiving antibiotics effective against Chlamydia between randomization and follow-up or having symptomatic Chlamydia infection were excluded (26 women). Of the 140 women (9%) who were diagnosed as positive via the initial ligase chain reaction assay, 61 (44%) had spontaneous resolution of Chlamydia by the follow-up ligase chain reaction assay. Factors associated with spontaneous resolution included older age (P = .02), more than 5 weeks from randomization to follow-up (P = .02), and a greater number of lifetime sexual partners (P = .02). Using a logistic regression model, maternal age and a greater-than-5-week follow-up interval remained significant; for every 5-year increase in maternal age, the odds of a positive result on the ligase chain reaction test at follow-up decreased by 40% (odds ratio 0.6; 95% confidence interval 0.4-0.9). Race, substance abuse, parity, and treatment with metronidazole were not associated with spontaneous resolution. Gram stain score and vaginal pH at randomization and follow-up also were not associated. CONCLUSION: The prevalence of asymptomatic C trachomatis in pregnancy was 9%; infection resolved spontaneously in almost half of these women. The association of older age and increasing time interval to spontaneous resolution of Chlamydia is consistent with a host immune-response mechanism.

Original languageEnglish
Pages (from-to)557-562
Number of pages6
JournalObstetrics and Gynecology
Volume105
Issue number3
DOIs
StatePublished - Mar 1 2005
Externally publishedYes

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Ligase Chain Reaction
Chlamydia trachomatis
Pregnancy
Random Allocation
Chlamydia
Metronidazole
Maternal Age
Anti-Bacterial Agents
Logistic Models
Urine
Reproductive Tract Infections
Bacterial Vaginosis
Chlamydia Infections
Sexual Partners
Parity
Substance-Related Disorders
Odds Ratio
Placebos
Confidence Intervals

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Sheffield, J. S., Andrews, W. W., Klebanoff, M. A., MacPherson, C., Carey, J. C., Ernest, J. M., ... O'Sullivan, M. J. (2005). Spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy. Obstetrics and Gynecology, 105(3), 557-562. https://doi.org/10.1097/01.AOG.0000153533.13658.c2

Spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy. / Sheffield, Jeanne S.; Andrews, Williams W.; Klebanoff, Mark A.; MacPherson, Cora; Carey, J. Christopher; Ernest, J. M.; Wapner, Ronald J.; Trout, Wayne; Moawad, Atef; Miodovnik, Menachem; Sibai, Baha; Varner, Michael W.; Caritis, Steve N.; Dombrowski, Mitchell; Langer, Oded; O'Sullivan, Mary J.

In: Obstetrics and Gynecology, Vol. 105, No. 3, 01.03.2005, p. 557-562.

Research output: Contribution to journalArticle

Sheffield, JS, Andrews, WW, Klebanoff, MA, MacPherson, C, Carey, JC, Ernest, JM, Wapner, RJ, Trout, W, Moawad, A, Miodovnik, M, Sibai, B, Varner, MW, Caritis, SN, Dombrowski, M, Langer, O & O'Sullivan, MJ 2005, 'Spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy', Obstetrics and Gynecology, vol. 105, no. 3, pp. 557-562. https://doi.org/10.1097/01.AOG.0000153533.13658.c2
Sheffield JS, Andrews WW, Klebanoff MA, MacPherson C, Carey JC, Ernest JM et al. Spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy. Obstetrics and Gynecology. 2005 Mar 1;105(3):557-562. https://doi.org/10.1097/01.AOG.0000153533.13658.c2
Sheffield, Jeanne S. ; Andrews, Williams W. ; Klebanoff, Mark A. ; MacPherson, Cora ; Carey, J. Christopher ; Ernest, J. M. ; Wapner, Ronald J. ; Trout, Wayne ; Moawad, Atef ; Miodovnik, Menachem ; Sibai, Baha ; Varner, Michael W. ; Caritis, Steve N. ; Dombrowski, Mitchell ; Langer, Oded ; O'Sullivan, Mary J. / Spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy. In: Obstetrics and Gynecology. 2005 ; Vol. 105, No. 3. pp. 557-562.
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abstract = "OBJECTIVE: We sought to estimate the rate of spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy and to evaluate factors associated with its resolution. METHODS: A cohort of women enrolled in a large multicenter randomized bacterial vaginosis antibiotic trial (metronidazole versus placebo) that, when randomly allocated, had asymptomatic C trachomatis diagnosed by urine ligase chain reaction (from frozen archival specimens) between 160/7 and 236/7 weeks were included. The urine ligase chain reaction is a highly accurate predictor of genital tract chlamydial infection. A follow-up ligase chain reaction was performed between 24 0/7 and 296/7 weeks. RESULTS: A total of 1,953 women were enrolled in the original antibiotic trial; 1,547 (79{\%}) had ligase chain reaction performed both at randomization and follow-up. Women receiving antibiotics effective against Chlamydia between randomization and follow-up or having symptomatic Chlamydia infection were excluded (26 women). Of the 140 women (9{\%}) who were diagnosed as positive via the initial ligase chain reaction assay, 61 (44{\%}) had spontaneous resolution of Chlamydia by the follow-up ligase chain reaction assay. Factors associated with spontaneous resolution included older age (P = .02), more than 5 weeks from randomization to follow-up (P = .02), and a greater number of lifetime sexual partners (P = .02). Using a logistic regression model, maternal age and a greater-than-5-week follow-up interval remained significant; for every 5-year increase in maternal age, the odds of a positive result on the ligase chain reaction test at follow-up decreased by 40{\%} (odds ratio 0.6; 95{\%} confidence interval 0.4-0.9). Race, substance abuse, parity, and treatment with metronidazole were not associated with spontaneous resolution. Gram stain score and vaginal pH at randomization and follow-up also were not associated. CONCLUSION: The prevalence of asymptomatic C trachomatis in pregnancy was 9{\%}; infection resolved spontaneously in almost half of these women. The association of older age and increasing time interval to spontaneous resolution of Chlamydia is consistent with a host immune-response mechanism.",
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T1 - Spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy

AU - Sheffield, Jeanne S.

AU - Andrews, Williams W.

AU - Klebanoff, Mark A.

AU - MacPherson, Cora

AU - Carey, J. Christopher

AU - Ernest, J. M.

AU - Wapner, Ronald J.

AU - Trout, Wayne

AU - Moawad, Atef

AU - Miodovnik, Menachem

AU - Sibai, Baha

AU - Varner, Michael W.

AU - Caritis, Steve N.

AU - Dombrowski, Mitchell

AU - Langer, Oded

AU - O'Sullivan, Mary J.

PY - 2005/3/1

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N2 - OBJECTIVE: We sought to estimate the rate of spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy and to evaluate factors associated with its resolution. METHODS: A cohort of women enrolled in a large multicenter randomized bacterial vaginosis antibiotic trial (metronidazole versus placebo) that, when randomly allocated, had asymptomatic C trachomatis diagnosed by urine ligase chain reaction (from frozen archival specimens) between 160/7 and 236/7 weeks were included. The urine ligase chain reaction is a highly accurate predictor of genital tract chlamydial infection. A follow-up ligase chain reaction was performed between 24 0/7 and 296/7 weeks. RESULTS: A total of 1,953 women were enrolled in the original antibiotic trial; 1,547 (79%) had ligase chain reaction performed both at randomization and follow-up. Women receiving antibiotics effective against Chlamydia between randomization and follow-up or having symptomatic Chlamydia infection were excluded (26 women). Of the 140 women (9%) who were diagnosed as positive via the initial ligase chain reaction assay, 61 (44%) had spontaneous resolution of Chlamydia by the follow-up ligase chain reaction assay. Factors associated with spontaneous resolution included older age (P = .02), more than 5 weeks from randomization to follow-up (P = .02), and a greater number of lifetime sexual partners (P = .02). Using a logistic regression model, maternal age and a greater-than-5-week follow-up interval remained significant; for every 5-year increase in maternal age, the odds of a positive result on the ligase chain reaction test at follow-up decreased by 40% (odds ratio 0.6; 95% confidence interval 0.4-0.9). Race, substance abuse, parity, and treatment with metronidazole were not associated with spontaneous resolution. Gram stain score and vaginal pH at randomization and follow-up also were not associated. CONCLUSION: The prevalence of asymptomatic C trachomatis in pregnancy was 9%; infection resolved spontaneously in almost half of these women. The association of older age and increasing time interval to spontaneous resolution of Chlamydia is consistent with a host immune-response mechanism.

AB - OBJECTIVE: We sought to estimate the rate of spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy and to evaluate factors associated with its resolution. METHODS: A cohort of women enrolled in a large multicenter randomized bacterial vaginosis antibiotic trial (metronidazole versus placebo) that, when randomly allocated, had asymptomatic C trachomatis diagnosed by urine ligase chain reaction (from frozen archival specimens) between 160/7 and 236/7 weeks were included. The urine ligase chain reaction is a highly accurate predictor of genital tract chlamydial infection. A follow-up ligase chain reaction was performed between 24 0/7 and 296/7 weeks. RESULTS: A total of 1,953 women were enrolled in the original antibiotic trial; 1,547 (79%) had ligase chain reaction performed both at randomization and follow-up. Women receiving antibiotics effective against Chlamydia between randomization and follow-up or having symptomatic Chlamydia infection were excluded (26 women). Of the 140 women (9%) who were diagnosed as positive via the initial ligase chain reaction assay, 61 (44%) had spontaneous resolution of Chlamydia by the follow-up ligase chain reaction assay. Factors associated with spontaneous resolution included older age (P = .02), more than 5 weeks from randomization to follow-up (P = .02), and a greater number of lifetime sexual partners (P = .02). Using a logistic regression model, maternal age and a greater-than-5-week follow-up interval remained significant; for every 5-year increase in maternal age, the odds of a positive result on the ligase chain reaction test at follow-up decreased by 40% (odds ratio 0.6; 95% confidence interval 0.4-0.9). Race, substance abuse, parity, and treatment with metronidazole were not associated with spontaneous resolution. Gram stain score and vaginal pH at randomization and follow-up also were not associated. CONCLUSION: The prevalence of asymptomatic C trachomatis in pregnancy was 9%; infection resolved spontaneously in almost half of these women. The association of older age and increasing time interval to spontaneous resolution of Chlamydia is consistent with a host immune-response mechanism.

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