Identifying the Impact of Chlamydia trachomatis Screening and Treatment on Mother-to-Child Transmission, and Respiratory Neonatal Outcomes in Mexico.

Chlamydia trachomatis (C. trachomatis) screening and treatment in pregnancy allows the opportunity to reduce adverse pregnancy and neonatal outcomes worldwide. Although C. trachomatis infection is easily treated and cured with antibiotics, only some countries have routine pregnancy screening and treatment programs. We therefore evaluated whether just one maternal screening for C. trachomatis is enough to prevent adverse pregnancy and negative neonatal outcomes. Among the 4087 first-time gynecological-obstetric consultations granted at the National Institute of Perinatology in 2018, we selected the study population according to a case-cohort design. Antenatal C. trachomatis screening and treatment interventions were performed on 628 pregnant women using COBAS® TaqMan CT. C. trachomatis DNA was also detected in samples from 157 infants of these mothers. In the maternal cohort, incidence of C. trachomatis infection was 10.5%. The vertical transmission rate was 1.5% for the cohort of mothers who tested positive for C. trachomatis and received treatment, and 29.7% for those with a negative test. By evaluating symptomatic neonatal infection, the hazard rate of perinatal pneumonia was 3.6 times higher in C. trachomatis-positive babies than in C. trachomatis-negative babies. Despite the low rate of mother-to-child transmission in women positive for C. trachomatis, possible maternal infection that is not detected in pregnancy significantly increases the risk of neonatal infection with consequent perinatal pneumonia.

Frecuencia y detección molecular de Gardnerella vaginalis en una institución de tercer nivel / Frequency and molecular detection of Gardnerella vaginalis in a third level institute

Resumen Antecedentes: Los padecimientos vaginales son la razón más común para que las mujeres busquen atención médica, con una prevalencia global que oscila entre el 23 y el 29% en mujeres en edad reproductiva. La vaginosis bacteriana es una de las principales causas de estos padecimientos, y el agente etiológico más frecuentemente identificado es Gardnerella vaginalis, sin embargo su diagnóstico es difícil, ya que requiere de medios artificiales selectivos enriquecidos y diferenciales. Objetivo: Determinar la frecuencia de G. vaginalis mediante la amplificación de ácidos nucleicos empleando la reacción en cadena de la polimerasa (PCR) en muestras cervicovaginales de pacientes que asisten a un instituto de tercer nivel. Método: Se analizaron 121 muestras cervicovaginales para la detección molecular del ARN ribosomal 16S de G. vaginalis. Resultados: G. vaginalis. se detectó en 34 muestras, de estas, 23 fueron de mujeres embarazadas y 11 de no embarazadas. Conclusión: La PCR de punto final detectó tres veces más la presencia de G. vaginalis que el medio de cultivo artificial.

Abstract Background: Vaginal conditions are the most common reason for women to seek medical care, with an overall prevalence ranging from 23 to 29% in women of reproductive age. Bacterial vaginosis is one of the main causes of these conditions, and the most frequently identified etiological agent is Gardnerella vaginalis, however, its diagnosis is difficult since it requires enriched and artificial selective culture media. Objective: To determine the frequency of G. vaginalis by nucleic acid amplification using polymerase chain reaction (PCR) in cervicovaginal samples from patients attending a third level institute. Method: One hundred twenty-one cervicovaginal samples were analyzed for molecular detection of 16S ribosomal RNA from G. vaginalis. Results: G. vaginalis was detected in 34 samples, of these, 23 were from pregnant women and 11 from non-pregnant women. Conclusion: Endpoint PCR detected three times more the presence of G. vaginalis than artificial culture medium.

Análisis molecular y filogenético del genotipo F de Chlamydia trachomatis aislados en México en 2011 / Molecular and phylogenetic analysis of the F genotype of Chlamydia trachomatis isolated in Mexico in 2011

Resumen Antecedentes: Chlamydia trachomatis es la bacteria que se detecta con mayor frecuencia en las infecciones de transmisión sexual. Se han identificado 20 genotipos de C. trachomatis mediante el gen ompA y varias genovariantes mediante el análisis de polimorfismo de un solo nucleótido (SNP). En México, el genotipo F es el más frecuente. Objetivo: Identificar la existencia de subtipos del genotipo F. Método: Se analizaron siete cepas del genotipo F de C. trachomatis aisladas en 2011, mediante secuenciación de nucleótidos y mapeo con enzimas de restricción. Resultados: El análisis de SNP mostró dos cepas con el mismo SNP en el nucleótido 288 (C288T), mientras que con enzimas de restricción se identificó una variante con diferente RFLP (polimorfismo de la longitud de fragmentos de restricción) cuando se tratan con la mezcla de enzimas HinfI y TaqI. Conclusión: En México se encuentran dos subtipos del genotipo F y solo las enzimas de restricción HinfI y TaqI pueden identificar la existencia de uno de estos genotipos F.

Abstract Background: Chlamydia trachomatis is the most frequently identified bacterium in sexually transmitted infections. Twenty C. trachomatis genotypes have been determined using the ompA gene and several genovariants by single nucleotide polymorphism (SNP) analysis. In Mexico, the F genotype is the most frequent. Objective: To identify subtypes of the F genotype. Method: Seven C. trachomatis genotype F strains isolated in 2011 were analyzed by nucleotide sequencing and restriction enzyme mapping. Results: SNP analysis showed two strains with the same SNP at nucleotide 288 (C288T), while with res-triction enzymes, a variant with different RFLP (restriction fragment length polymorphism) was identified when treated with the mixture of HinfI and TaqI enzymes. Conclusion: In Mexico, there are two subtypes of F, and only with restriction enzymes HinfI and TaqI can identify one of the genovariants of the F genotype.

PCR múltiplex para el diagnóstico de microorganismos atípicos transmitidos sexualmente / Multiplex PCR testing for the atypical microorganisms diagnosis sexually transmitted

Resumen Antecedentes: Las infecciones de transmisión sexual son un problema de salud pública mundial. El análisis rutinario incluye solo pruebas microbiológicas y serológicas para el diagnóstico de patógenos. Los microorganismos atípicos como Chlamydia trachomatis y micoplasmas no son identificados debido a los requerimientos. Además, no es incluida Gardnerella vaginalis, aunque se asocia a la vaginosis bacteriana. Objetivo: Desarrollar una PCR múltiplex para el diagnóstico de C. trachomatis, micoplasmas y G. vaginalis. Método: Se estandarizó la PCR múltiplex utilizando oligonucleótidos para C. trachomatis (gen ompA, orf6 plasmídico), Mycoplasma/Ureaplasma y G. vaginalis (genes rRNA16s). Resultados: Se estandarizaron pruebas de PCR múltiplex para los microorganismos estudiados, optimizándose las concentraciones y condiciones de las reacciones múltiplex. Se obtuvieron PCR dúplex para C. trachomatis (ompA, orf6), Chlamydia/Gardnerella y Chlamydia/micoplasmas y tríplex para Chlamydia/Mycoplasma/Ureaplasma. También un cuádruplex para Chlamydia/Mycoplasma/Ureaplasma/Gardnerella. Los resultados fueron verificados por PCR e hibridación automática (HybriSpot 12) y análisis in silico. Conclusión: Se desarrollaron pruebas de PCR múltiplex con una alta sensibilidad y especificidad para la identificación de C. trachomatis, micoplasmas y G. vaginalis.

Abstract Background: Sexually transmitted infections are a global public health problem. Routine analysis includes microbiological and serological tests for the diagnosis of pathogens. Atypical microorganisms such as Chlamydia trachomatis and mycoplasmas are not determined due to the requirements for their identification. Furthermore, Gardnerella vaginalis is not included despite being associated with bacterial vaginosis. Objective: To develop a multiplex PCR to diagnose Chlamydia, mycoplasmas, and Gardnerella. Method: Standardization of multiplex PCR tests was carried out using oligonucleotides for the identification of Chlamydia (ompA gene, plasmid orf6), Mycoplasma/Ureaplasma and Gardnerella (rRNA16s genes). Results: Multiplex PCR tests were standardized for the microorganisms studied, optimizing the concentrations and conditions of the multiplex reactions. Duplex PCR was obtained for Chlamydia (ompA, orf6), Chlamydia/Gardnerella, and Chlamydia/mycoplasmas, and triplex PCR for Chlamydia/mycoplasmas. Also, a quadruplex for Chlamydia, Mycoplasma/Ureaplasma and Gardnerella. PCR and automatic hybridization verified the results obtained (HybriSpot 12) and in silico analysis. Conclusion: Multiplex PCR tests with high sensitivity and specificity were developed to identify C. trachomatis, mycoplasmas, and G. vaginalis.

Modelling the Unidentified Abortion Burden from Four Infectious Pathogenic Microorganisms (Leptospira interrogans, Brucella abortus, Brucella ovis, and Chlamydia abortus) in Ewes Based on Artificial Neural Networks Approach: The Epidemiological Basis for a Control Policy.

Unidentified abortion, of which leptospirosis, brucellosis, and ovine enzootic abortion are important factors, is the main cause of disease spread between animals and humans in all agricultural systems in most developing countries. Although there are well-defined risk factors for these diseases, these characteristics do not represent the prevalence of the disease in different regions. This study predicts the unidentified abortion burden from multi-microorganisms in ewes based on an artificial neural networks approach and the GLM. METHODS: A two-stage cluster survey design was conducted to estimate the seroprevalence of abortifacient microorganisms and to identify putative factors of infectious abortion. RESULTS: The overall seroprevalence of Brucella was 70.7%, while Leptospira spp. was 55.2%, C. abortus was 21.9%, and B. ovis was 7.4%. Serological detection with four abortion-causing microorganisms was determined only in 0.87% of sheep sampled. The best GLM is integrated via serological detection of serovar Hardjo and Brucella ovis in animals of the slopes with elevation between 2600 and 2800 meters above sea level from the municipality of Xalatlaco. Other covariates included in the GLM, such as the sheep pen built with materials of metal grids and untreated wood, dirt and concrete floors, bed of straw, and the well water supply were also remained independently associated with infectious abortion. Approximately 80% of those respondents did not wear gloves or masks to prevent the transmission of the abortifacient zoonotic microorganisms. CONCLUSIONS: Sensitizing stakeholders on good agricultural practices could improve public health surveillance. Further studies on the effect of animal-human transmission in such a setting is worthwhile to further support the One Health initiative.

Identification of Chlamydia trachomatis genotypes in newborns with respiratory distress.

INTRODUCTION: One hundred thirty million Chlamydia trachomatis infections are reported worldwide each year. Nineteen serotypes of this pathogen can cause infection in pregnant women and neonates. The distribution of these genotypes in newborns with respiratory infections in Mexico is unknown. MATERIAL AND METHODS: We tested 1062 bronchial lavage samples from neonates with respiratory distress syndrome for Chlamydia infection. The diagnosis of Chlamydia was made by plasmid detection with an in-house PCR assay, and genotypes were identified using a PCR-RFLP assay for the ompA gene. RESULTS: The genotyping of 40 strains identified 14 as I/Ia (35%), 13 as E (32.5%), 7 as D (17.5%), 5 as F (12.5%), and 1 as L2 (2.5%). The relative risk analysis showed that genotype D was associated with neonatal sepsis (RR, 5.83; 95% confidence interval [CI], 1.51-25.985; P < .02), while the I/Ia genotype was significantly associated with chorioamnionitis in the mother (2.8; 95% CI, 1.4-5.5; P < .05). CONCLUSIONS: Although C. trachomatis genotypes I/Ia and E of were the strains involved most frequently in respiratory infections in Mexican neonates, 80% of patients with genotype F developed respiratory disease. In contrast, genotype D was associated with neonatal sepsis, and genotype I/Ia with chorioamnionitis.

Identification of Chlamydia trachomatis genotypes in Mexican men with infertile women as sexual partners.

BACKGROUND: Chlamydia trachomatis is considered a public health problem due to the high prevalence in sexually active women and men. The distribution of genital Chlamydia genotypes among Mexican men is unknown. OBJECTIVE: To assess the prevalence of Chlamydia genotypes in men with infertile women as sexual partners. METHODS: A total of 659 urine samples were collected from men whose sexual partners were infertile women; the identifying Chlamydia infection was by means of a real-time nucleic acid amplification test (qPCR). OmpA gene PCR-RFLP and sequencing were used to confirm the genotypes of C. trachomatis. The association of genotypes with age, spermatic parameters and gynecological data of sexual partners was further analyzed. RESULTS: Forty-nine urine samples were positive infection (7.4%). The Chlamydia infection was significantly associated with teratozoospermia, azoospermia, hypospermia, and oligozoospermia. Five genotypes (F 51%; 12.2% to D; 12.2% to E; 6.1% to L2 and 4.1% Ia) were correctly identified. None genotypes identified in this comparative study were positively associated with changes in some of the spermatic values because all of them typically produce some considerable damage to these cells. CONCLUSIONS: The F genotype was the most frequent genotype identified in infertile men from Mexico City and all genotypes play an important role in the seminal alteration of Mexican men whose female partners are infertile.

Detección de Chlamydia spp. en leucocitos de sangre periférica de ovinos sin aborto previo / Detection of Chlamydia spp. In Peripheral Blood Leukocytes in Ewes without any Previous Abortion

Resumen El aborto enzootico ovino es una enfermedad causada por Chlamydia abortus. Es considerada una zoonosis y una de las principales causas de pérdidas económicas en estas explotaciones. Este trabajo se enfocó en utilizar el cultivo de leucocitos de animales sin signos de abortos y la detección de anticuerpos para determinar la posible presencia de C. abortus en explotaciones de traspatio. Se obtuvieron 42 muestras de sangre periférica de ovejas de diferentes poblaciones. La detección de Chlamydia abortus se realizó mediante la tinción de Giemsa y la técnica de PCR. La detección de anticuerpos anti-C. abortus se dio mediante una técnica de ELISA comercial. Los resultados mostraron 21 muestras positivas mediante la técnica de PCR, de las cuales solo 10 fueron positivas mediante la técnica de Giemsa, mientras que 22 sueros mostraron anticuerpos anti-C. abortus. En este estudio el 38,1 % de las muestras fueron positivas a la infección por C. abortus, como se confirmó mediante PCR y serología. En conclusión, los leucocitos de sangre periférica pueden ser útiles para detectar una infección por Chlamydia spp. en explotaciones sin historial de abortos, con lo que se puede conocer la prevalencia real del aborto enzootico ovino en México.

Abstract The Ewes Enzootic Abortion is a disease caused byChlamydia abortus. It is deemed a zoonosis and one of the leading causes of financial losses in this type of business. This article focuses on using the culture of leukocytes from animals without any abortion symptoms and antibody detection to determine the potential presence ofC. abortusin backyard exploitations. Forty-two samples of peripheral blood were obtained from ewes in different populations. The detection ofChlamydia abortuswas carried out by using the Giemsa dye and PCR technique. Anti-C. Abortusantibody detection was performed through a commercial ELISA technique. Results showed 21 positive samples using the PCR, and only ten were positive according to the Giemsa dye, while 22 serum samples showed anti-C. abortusantibody. In this study, 38.1% of the samples were positive for theC. abortusinfection, as verified with the PCR and serology. In conclusion, peripheral blood leukocytes can be helpful to detect an infection caused byChlamydiaspp. Animal exploitation without any previous abortion allows knowing the real prevalence of ewes' enzootic abortion in Mexico.

Prevalencia de Chlamydia trachomatis en mujeres del Hospital General de Zona No. 29 / Chlamydia trachomatis prevalence in women from the Hospital General de Zona No. 29

Introducción: la Chlamydia trachomatis es la principal causa de infecciones bacterianas de transmisión sexual a nivel mundial. Se estima que cada año se producen 131 millones de casos. Cursa de manera asintomática, pero la infección ascendente en mujeres puede conducir a la enfermedad inflamatoria pélvica, embarazo ectópico e infertilidad. Objetivo: determinar la prevalencia de C. trachomatis en mujeres de población abierta que acuden al Hospital General de Zona No. 29. Material y métodos: se realizó la identificación de C. trachomatis por pruebas de PCR a 200 muestras de exudado vaginal y se determinó su genotipo. Paralelamente, se realizó el diagnóstico microbiológico de rutina. Resultados: la prevalencia de C. trachomatis fue del 8.5% (17/200) con una concomitancia significativa de p = 0.006 con Gardnerella vaginalis (riesgo relativo de 2.871, IC95%: 1.574-5.236). Asimismo, se identificó C. trachomatis en cinco muestras como el único agente etiológico. Dieciséis cepas de C. trachomatis pertenecieron al genotipo F. Una cepa identificada de C. trachomatis presentó motivos genéticos similares a la variante mexicana reportada en 2019. Conclusiones: la prevalencia de C. trachomatis en la población estudiada nos indica la necesidad de implementar técnicas de diagnóstico para esta bacteria. El uso de la PCR permite realizar una determinación genotípica rápida, que explicaría el comportamiento epidemiológico de la C. trachomatis y representaría una mejora significativa de la calidad de vida de la paciente.

Background: Chlamydia trachomatis is the main cause of sexually transmitted bacterial infections worldwide. An estimated of 131 million cases occur each year. It is asymptomatic, but ascending infection in women can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility. Objective: To determine the prevalence of C. trachomatis in open population women who attend the Hospital General de Zona No. 29. Material and methods: Identification of C. trachomatis was carried out by PCR testing of 200 vaginal exudate samples and its genotype was determined. In parallel, a routine microbiological diagnosis was carried out. Results: The prevalence of C. trachomatis was 8.5% (17/200) with a significant concomitance of p = 0.006 with Gardnerella vaginalis (relative risk of 2.871, 95%CI: 1.574- 5.236). Likewise, C. trachomatis was identified in 5 samples as the only etiological agent. Sixteen strains of C. trachomatis belong to genotype F. An identified strain of C. trachomatis presented genetic motifs similar to the Mexican variant repor- ted in 2019. Conclusions: The prevalence of C. trachomatis in the studied population indicates the need to implement diagnostic techniques for this bacterium. The use of PCR allows a rapid genotypic determination that would explain the epidemiological behavior of C. trachomatis and would represent a sig- nificant improvement in the quality of life of the patient.

Identification of Chlamydia trachomatis genotypes in Mexican men with infertile women as sexual partners.

BACKGROUND: Chlamydia trachomatis is considered a public health problem due to the high prevalence in sexually active women and men. The distribution of genital Chlamydia genotypes among Mexican men is unknown. OBJECTIVE: To assess the prevalence of Chlamydia genotypes in men with infertile women as sexual partners. METHODS: A total of 659 urine samples were collected from men whose sexual partners were infertile women; the identifying Chlamydia infection was by means of a real-time nucleic acid amplification test (qPCR). OmpA gene PCR-RFLP and sequencing were used to confirm the genotypes of C. trachomatis. The association of genotypes with age, spermatic parameters and gynecological data of sexual partners was further analyzed. RESULTS: Forty-nine urine samples were positive infection (7.4%). The Chlamydia infection was significantly associated with teratozoospermia, azoospermia, hypospermia, and oligozoospermia. Five genotypes (F 51%; 12.2% to D; 12.2% to E; 6.1% to L2 and 4.1% Ia) were correctly identified. None genotypes identified in this comparative study were positively associated with changes in some of the spermatic values because all of them typically produce some considerable damage to these cells. CONCLUSIONS: The F genotype was the most frequent genotype identified in infertile men from Mexico City and all genotypes play an important role in the seminal alteration of Mexican men whose female partners are infertile.

[Chlamydia trachomatis prevalence in women from the Hospital General de Zona No. 29]. / Prevalencia de Chlamydia trachomatis en mujeres del Hospital General de Zona No. 29.

BACKGROUND: Chlamydia trachomatis is the main cause of sexually transmitted bacterial infections worldwide. An estimated of 131 million cases occur each year. It is asymptomatic, but ascending infection in women can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility. OBJECTIVE: To determine the prevalence of C. trachomatis in open population women who attend the Hospital General de Zona No. 29. MATERIAL AND METHODS: Identification of C. trachomatis was carried out by PCR testing of 200 vaginal exudate samples and its genotype was determined. In parallel, a routine microbiological diagnosis was carried out. RESULTS: The prevalence of C. trachomatis was 8.5% (17/200) with a significant concomitance of p = 0.006 with Gardnerella vaginalis (relative risk of 2.871, 95%CI: 1.574-5.236). Likewise, C. trachomatis was identified in 5 samples as the only etiological agent. Sixteen strains of C. trachomatis belong to genotype F. An identified strain of C. trachomatis presented genetic motifs similar to the Mexican variant reported in 2019. CONCLUSIONS: The prevalence of C. trachomatis in the studied population indicates the need to implement diagnostic techniques for this bacterium. The use of PCR allows a rapid genotypic determination that would explain the epidemiological behavior of C. trachomatis and would represent a significant improvement in the quality of life of the patient.

INTRODUCCIÓN: la Chlamydia trachomatis es la principal causa de infecciones bacterianas de transmisión sexual a nivel mundial. Se estima que cada año se producen 131 millones de casos. Cursa de manera asintomática, pero la infección ascendente en mujeres puede conducir a la enfermedad inflamatoria pélvica, embarazo ectópico e infertilidad. OBJETIVO: determinar la prevalencia de C. trachomatis en mujeres de población abierta que acuden al Hospital General de Zona No. 29. MATERIAL Y MÉTODOS: se realizó la identificación de C. trachomatis por pruebas de PCR a 200 muestras de exudado vaginal y se determinó su genotipo. Paralelamente, se realizó el diagnóstico microbiológico de rutina. RESULTADOS: la prevalencia de C. trachomatis fue del 8.5% (17/200) con una concomitancia significativa de p = 0.006 con Gardnerella vaginalis (riesgo relativo de 2.871, IC95%: 1.574-5.236). Asimismo, se identificó C. trachomatis en cinco muestras como el único agente etiológico. Dieciséis cepas de C. trachomatis pertenecieron al genotipo F. Una cepa identificada de C. trachomatis presentó motivos genéticos similares a la variante mexicana reportada en 2019. CONCLUSIONES: la prevalencia de C. trachomatis en la población estudiada nos indica la necesidad de implementar técnicas de diagnóstico para esta bacteria. El uso de la PCR permite realizar una determinación genotípica rápida, que explicaría el comportamiento epidemiológico de la C. trachomatis y representaría una mejora significativa de la calidad de vida de la paciente.

Detección atípica de Chlamydia pneumoniae no humana en una muestra endocervical. Reporte de caso / Atypical detection of non-human Chlamydia pneumoniae in an endocervical sample. Case Report

Resumen ANTECEDENTES: Chlamydia trachomatis es uno de los principales microorganismos de trasmisión sexual asociado de manera importante con infertilidad femenina. La detección de genotipos y nuevas variantes de Chlamydia trachomatis permite conocer su prevalencia, distribución geográfica, identificar la aparición de resistencia antimicrobiana y las asociaciones clínicas o comportamientos sexuales y desarrollar vacunas. Este caso clínico es el primer informe de infección endocervical por una cepa diferente a C trachomatis. CASO CLÍNICO: Paciente de 25 años, con diagnóstico de infertilidad primaria de 2 años de evolución por factor endocrino-ovárico (sobrepeso e hipotiroidismo subclínico) y por factor masculino de hipospermia y teratozoospermia. El cultivo microbiológico endocervical detectó la infección por Ureaplasma spp y Chlamydia spp. La identificación de la cepa de Chlamydia mediante secuenciación del gen 16S del ARNr informó que era Chlamydia pneumoniae. La existencia de un plásmido en esta cepa de C pneumoniae confirmó que la infección endocervical fue por una cepa de Chlamydia pneumoniae no humana. CONCLUSIÓN: Este caso clínico sugiere la posibilidad de que una cepa de C pneumoniae no humana sea capaz de trasmitirse sexualmente a los humanos, estar circulando en la población mexicana y causar infertilidad, aunque aún se desconocen el origen y la dirección de la trasmisión.

Abstract BACKGROUND: Chlamydia trachomatis is one of the leading sexually transmitted microorganisms that is significantly associated with the development of female infertility. The detection of genotypes and new variants ofChlamydia trachomatisallows us to know their prevalence and geographic distribution, identify the appearance of antimicrobial resistance, clinical associations, or sexual behaviors, and develop vaccines. This clinical case reports for the first time endocervical infection by a strain other thanC. trachomatis. CLINICAL CASE: A 25-year-old woman with primary infertility of 2 years of evolution due to endocrine-ovarian factor (overweight and subclinical hypothyroidism) and male factor characterized by hypospermia and teratozoospermia. Endocervical microbiological culture detected infection byUreaplasma urealyticumandChlamydiaspp. Identification of theChlamydiastrain by sequencing the 16S rRNA gene reported that it wasChlamydia pneumoniae. The presence of plasmid in this strain ofC. pneumoniaeconfirmed that the endocervical infection was by a non-humanChlamydia pneumoniaestrain. CONCLUSION: This clinical case suggests that a non-human strain ofC. pneumoniaecan be sexually transmitted to humans, circulating in the Mexican population, and causing infertility, although the origin and direction of transmission are still unknown.

Co-infection between genotypes of the human papillomavirus and Chlamydia trachomatis in Mexican women.

Not all human papillomavirus (HPV) infections develop into cervical cancer (CC), so it is proposed that other factors may influence this, such as co-infection with Chlamydia trachomatis (CT). To identify the prevalence of co-infection, we included 189 women with suspicion of HPV. Viral typing was performed by carrying out the Roche HP Linear Array test, while CT detection was performed with the COBAS® TaqMan® 48 kit from Roche. Of the 189 women only 184 had an infection with HPV, CT or both: 56.6% were positive for one or several HPV genotypes, and 67.7% for CT. Clinical data showed an association between HPV and CIN I (n = 22; RR = 2.43; 95% CI 1.72-3.43, p < 0.05). CT infection was only associated with cervicitis (n = 40; RR = 1.73; 95% CI 1.34-2.23, p < 0.05). The CT-HPV co-infection rate was 28%. Co-infection revealed an association with CIN I (n = 31, RR= 3.33; 95% CI 2.08-5.34 p < 0.05), CIN III (n = 7; RR = 2.57; 95% CI 1.53-4.31, p < 0.05); and a significant risk of 2.3 (95% CI 1.08-4.90) times higher to develop CC; nevertheless, this risk was not statistically significant. CT/HPV co-infection was associated with the development of a high-grade lesion (CIN III) as well as an important risk for developing CC.

Prevalence, concordance and reproductive sequelae after Chlamydia trachomatis infection in Mexican infertile couples.

There are few concordance studies on the Chlamydia trachomatis (infection among infertile couples. The objective of this research was to know the prevalence, concordance and reproductive sequelae that couples may develop when both partners show a C. trachomatis infection. A cross-sectional study among 688 infertile couples using the C. trachomatis detection by real-time PCR was performed. The infertility causes were obtained from their medical records. The prevalence of infection was 8.68%. The percentage of concordance was 22.4% (13 couples). A presence of tubal occlusion was only associated with infected-discordant women [RR = 3.46, 95% CI (1.54-7.74), p < .003]. Seminal values were not associated with discordant men. The concordant couples showed association with the infection and tubal occlusion [RR = 3.19, 95% CI (1.09-9.34), p < .05], and oligozoospermia [RR = 12.17, 95% CI (4.29-34.54), p < .001], hypospermia [RR = 14.13, 95% CI (4.78-41.84), p < .001]. An alteration in semen quality was shown particularly in men whose sexual partners show a tubal pathology. This could occur due to a C. trachomatis infection in the testis, which underlines the need to carry out effective and efficient strategies to identify and treat all sexual partners exposed to C. trachomatis.

When to perform the screening for Chlamydia trachomatis during pregnancy? / ¿Cuándo realizar la detección de Chlamydia trachomatis durante la gestación?

In this letter to the editor, we discuss the detection and the association between abortion and Chlamydia trachomatis infection. Further, we comment on the difficulty in selecting the appropriate gestation trimester for the diagnosis of infection by this pathogen.

En esta carta al editor se discuten la detección y la asociación entre el aborto y la infección por Chlamydia trachomatis. Además, se comenta la dificultad de seleccionar el trimestre de gestación apropiado para el diagnóstico de infección por este patógeno.

A randomized controlled trial comparing isosorbide dinitrate-oxytocin versus misoprostol-oxytocin at management of foetal intrauterine death.

BACKGROUND: The metabolic activity of endogenous nitric oxide (NO) and the medical use of nitrovasodilatory drugs like isosorbide dinitrate have been shown to be potential inducers inducers of cervical ripening prior to surgical evacuation of the uterus. OBJECTIVE: To assess the therapeutic efficacy and safety of combined isosorbide dinitrate-oxytocin in the management of intrauterine foetal death (IUFD). METHODS: Sixty women with IUFD after 20 weeks of gestation requesting uterine evacuation were randomly selected to receive isosorbide dinitrate gel solution (80 mg/1.5 mL; n = 30) or misoprostol gel solution (100 mcg/1.5 mL; n = 30) every 3 h with a maximum of four doses or until a Bishop score >7 was reached. Subsequently, patients received a high dose of intravenous oxytocin until complete uterus evacuation was achieved. Therapeutic efficacy was evaluated by mean the relative risk of the foetal expulsion based on comparison of event rates, and the proportion of women induced to labor at 7, 10 and 15 h after the administration of isosorbide dinitrate or misoprostol. Safety was assessed on the basis of woman´s vital signs and evaluation of adverse effects, including headache, abdominal pain, pelvic pain, lower back pain, nausea, dizziness and vomiting. RESULTS: The foetal expulsion rate using the isosorbide dinitrate-oxytocin combination was approximately 4.4 times, and at least 2.1 times, the foetal expulsion rate with the misoprostol-oxytocin regimen at any given point in time. The proportion of women achieved vaginal delivery at 15 hours was 100% for the isosorbide dinitrate-oxytocin group and 86.7% for the misoprostol-oxytocin group. The average delivery induction interval was significantly lower when isosorbide dinitrate-oxytocin was used (8.7 ± 3.1 h) than when misoprostol-oxytocin (11.9 ± 3.1 h) was used. A total of 20% of patients in the isosorbide dinitrate-oxytocin group recorded headache, and no cases of uterine tachysystole, haemorrhage or coagulopathy were recorded. CONCLUSION: This study indicates that intravaginal isosorbide dinitrate followed by intravenous oxytocin was more effective than the conventional method used to induce labour in the medical management of foetal death in pregnancies after 20 weeks of gestation. TRIAL REGISTRATION: Clinicaltrials.gov NCT02488642.

Obtaining an ELISA test based on a recombinant protein of Chlamydia trachomatis.

Chlamydia trachomatis is considered as a public health problem due to its high prevalence and increased rates of gynecological disorders. The major outer membrane protein (MOMP) of this bacterium is the most abundant protein in its membrane and has been evaluated not only as a vaccine development candidate but also is used in many diagnostic tests. The MOMP weighs 69 kDa and contains four variable segments (VS 1-4) separated by constant regions. Several research groups have developed recombinant single-variable segments of MOMP expressed in Escherichia coli cytoplasm. But, all variable segments have been used minimally for the diagnosis of a chlamydial infection. In this experiment, the authors obtained the recombinant MOMP of C. trachomatis (rMOMP) in E. coli rMOMP and extracted, purified, and partially characterized it. This was later used to identify anti-Chlamydia trachomatis antibodies in sera of infertile patients by immunodetection assays, enzyme-linked immunosorbent assay (ELISA), and indirect immunofluorescence tests. The ELISA test showed high sensitivity and low specificity of 100 and 58.3%, respectively. The above results obtained were linked to the cross-reactivity of antibodies against C. pneumoniae or C. psittaci. Hence, an evaluation was performed to obtain an optimized test for the diagnosis of C. trachomatis infection.

Identification of a new variant of Chlamydia trachomatis in Mexico.

INTRODUCTION: Chlamydia trachomatis is one of the main etiological agents of sexually transmitted infections worldwide. In 2006, a Swedish variant of C. trachomatis (Swedish-nvCT), which has a deletion of 377bp in the plasmid, was reported. In Latin America, Swedish-nvCT infections have not been reported. We investigated the presence of Swedish-nvCT in women with infertility in Mexico. METHODS: Swedish-nvCT was searched in 69C. trachomatis positive samples from 2339 endocervical specimens. We designed PCR primers to identify the deletion in the plasmid in the ORF1, and the presence of a repeated 44bp in the ORF3. The sample with the deletion was genotyped with the genes of the major outer membrane protein A (ompA) and the polymorphic membrane protein (pmpH). RESULTS: The deletion was detected in one of the 69 samples positive C. trachomatis of 2339 endocervical exudates. The nucleotide sequence analysis of the ompA shows a high degree of similarity with the Swedish nvCT (98%), however the variant found belongs to serovar D. The nucleotide sequence of the pmpH gene associates to the variant found in the genitourinary pathotype of the Swedish-nvCT but in different clusters. CONCLUSIONS: Our results revealed the presence of a new variant of C. trachomatis in Mexican patients. This variant found in Mexico belongs to serovar D based on the in silico analysis of the ompA and pmpH genes and differs to the Swedish-nvCT (serovars E). For these variants of C. trachomatis that have been found it is necessary to carry out a more detailed analysis, although the role of this mutation has not been demonstrated in the pathogenesis.

[Prevalence of genital Chlamydia trachomatis infection in women attending in the National Institute of Perinatology from Mexico City]. / Prevalencia de la infección genital por Chlamydia trachomatis en mujeres que asisten al Instituto Nacional de Perinatología de la Ciudad de México.

BACKGROUND: Endocervical infection by Chlamydia trachomatis is considered one of the leading causes of infertility worldwide. During pregnancy, it can lead to serious complications such as premature rupture of membranes and premature births. AIM: To determine the prevalence of genital infection by C. trachomatis in pregnancy and infertile women from Mexico City. METHODS: The detection of C. trachomatis was performed by real-time PCR with the commercial kit COBAS® TaqMan CT Test v2.0 (Roche Molecular System). RESULTS: We analyzed 2,352 endocervical swabs; 102 were positive (4.3%). Age prevalence showed that pregnant adolescents (15 to 19 years of age) had the highest risk of infection (10.9%, RR = 3.23 [95% IC: 1.79-5.84]), followed by young women aged 20 to 24 years, with a prevalence of 5.6% (RR = 1.65 [95% IC: 0.82-3.34]). DISCUSSION: The results indicate that the prevalence is within the range reported worldwide. However, pregnant adolescents were those with a higher prevalence than infertile women were. CONCLUSION: A systematic screening of C. trachomatis infection in women younger than 24 years of age, and in pregnant women is necessary to reduce the incidence of infertility and perinatal complications.