Chlamydia Trachomatis infection of the cervix in the pregnant women

Abstract

Chamydia trachomatis is a bacteria that has been established as an etiologic agent in genitourinary tract infections in both men and women. The present of C. trachomatis in the birth canal of pregnant women places newborn at risk of acquiring inclusion conjunctivitis, pneumonia or both during the birth process. Some women had no symptoms of genital tract infection. Thus, screening of C. trachomatis infection at the cervix in pregnant women were performed. 200 pregnant women in the first trimester of pregnancy attending antenatal clinic at Chulalongkorn Hospital were selected for endocervical chlamydial isolation test. The 140 of 200 pregnant women were isolated again in the third trimester of pregnancy. The technique used for isolation of C. trachomatis was done by using cycloheximide treated McCoy cells. 21 of 140 (15.0%) women harboured C. trachomatis in the first and/or third trimester of pregnancy. The difference of positive chlamydial culture found in the first and third trimester of pregnancy was not statistically significant (p > 0.05, x2 test). The symptoms of genital tract infection such as, vaginal discharge, vaginal itching, dysuria, frequent urination, except vaginal bleeding, were not associated with chlamydial culture positive. C. trachomatis was correlated with age 24 years or younger but not with parity, educational level, history of sexually transmitted disease. Serological test was also performed from 126 pregnant women in the third trimester y using modified micro-immunofluorescent test. Sera were examined at a starting dilution of 1:16 for antichlamydial IgG and of 1:8 for antichlamydial IgM. Type specific antibodies were found against C. trachomatis serotypes D to K (genital serotypes) in 30/126 (13.8%) of the group study. Type specific IgG at a titer of > 1:64, suggesting a significant titer, was present in 20 (15.8%) of the pregnant women. Antichlamydial IgG of titer > 1:16 was associated with history of sexually transmitted disease (p<0.05, x2 test). The minimum inhibitory concentrations of tetracycline, erythromycin and Ru 28965 against 30 strains of C. trachomatis were determined by growth of chlamydiae in cycloheximide treated McCoy cells. The concentrations for inhibition of C. trachomatis inclusion formation were: tetracycline 0.06-0.25 : erythromycin 0.06-0.25; and RU 28965 0.06-0.12 µg/ml. The results showed that these antibiotic were remained the drugs of choice for chlamydial treatment. Since the high prevalence of C. trachomatis infection in pregnant women, routine culture of C. trachomatis was necessary. Antibiotic treatment should be given for chlamydial infected women before delivery to prevent infants from both inclusion conjunctivitis and pneumonia.