RESUMO
Background and Aim: Chlamydia [C.] trachomatis infections in females are a major cause of tubal factor infertility and ectopic pregnancy. However, the precise pathogenesis of C. trachomatis infections remains to be elucidated. Not all women who have undergone a C. trachomatis infection will develop tubal pathology. Variations, like single nucleotide polymorphisms [SNPs], in immunologically important host genes are assumed to play a role in the course and outcome of a C. trachomatis infection. We studied whether genetic traits [carrying multiple SNPs in different genes] in the bacterial sensing system are associated with an aberrant immune response and subsequently with tubal pathology following a C. trachomatis infection. The genes studied all encode for pattern recognition receptors [PRRs] involved in sensing bacterial components
Methods: Of 259 subfertile women, serum was available for C. trachomatis IgG antibody testing and genotyping [common versus rare allele] of the PRR genes TLR9, TLR4, CD14 and CARD15/NOD2. In all women, a laparoscopy was performed to assess the grade of tubal pathology. Tubal pathology was defined as extensive peri-adnexal adhesions and/or distal occlusion of at least one tube
Results: Following a C. trachomatis infection [i.e. C. trachomatis IgG positive], infertile women carrying two or more SNPs in C. trachomatis PRR genes were at increased risk of tubal pathology compared to women carrying less than two SNPs [73% vs 33% risk]. The differences were not statistically significant [P = 0.15], but a trend was observed
Conclusion: Carrying multiple SNPs in C. trachomatis PRR genes tends to result in an aberrant immune response and a higher risk of tubal pathology following a C. trachomatis infection. Larger studies are needed to confirm our preliminary findings
RESUMO
Aim: To compare the frequencies, concentrations, and antimicrobial susceptibilities of vaginal microbes isolated from women with bacterial vaginosis [BV] before and after therapy with intra-vaginal clindamycin or metronidazole
Design: Prospective randomized controlled study
Patients and Methods: 119 non-pregnant women aged 20 - 45 with clinical and Gram stain evidence ofBV were randomized to receive intra-vaginal clindamycin or metronidazole. Vaginal swabs were collected at baseline and 7 to 12 days, 35 to 45 days, and 70 to 90 days following therapy for quantitative vaginal culture. For the 99 women completing all four visits, statistical analyses were performed comparing differences in vaginal microflora between the two treatment arms and between visits in the same treatment group. Antimicrobial susceptibility testing using the agar dilution method was performed for anaerobic gram-negative rods
Results: Although both therapies resulted in decreased colonization by Gardnerella vaginalis and Mycoplasma hominis, only metronidazole treatment resulted in a significant decrease in the frequency and concentration of Prevotella bivia and black-pigmented Prevotella species. Of the 865 anaerobic gram-negative rods evaluated for susceptibility, only 3 [0.3%] were resistant to metronidazole, whereas clindamycin resistance increased significantly for P. bivia and black-pigmented anaerobic gram-negative rods persisting following clindamycin therapy. Clindamycin-resistant subpopulations of P. bivia and black-pigmented Prevotella species emerged 7 to 12 days after therapy even among women colonized initially by clindamycinsusceptible strains. These resistant subpopulations persisted at high frequencies [42 to 50%] 70 to 90 days following therapy
Conclusion: The two topical agents for treatment of BV have differing microbiologic effects on the vaginal microflora. The emergence of clindamycin-resistant anaerobic gram-negative rods following therapy is of concern