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      Sexually Transmitted Infections and Behavioral Determinants of Sexual and Reproductive Health in the Allahabad District (India) Based on Data from the ChlamIndia Study

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          Abstract

          Background: Sexually transmitted infections (STIs), like Chlamydia trachomatis and Neisseria gonorrhoeae (CT and NG, respectively) are linked to an important sexual and reproductive health (SRH) burden worldwide. Behavior is an important predictor for SRH, as it dictates the risk for STIs. Assessing the behavior of a population helps to assess its risk profile. Methods: Study participants were recruited at a gynecology outpatient department (OPD) in the Allahabad district in Uttar Pradesh India, and a questionnaire was used to assess demographics, SRH, and obstetric history. Patients provided three samples (urine, vaginal swab, and whole blood). These samples were used to identify CT and NG using PCR/NAAT and CT IgG ELISA. Results: A total of 296 women were included for testing; mean age was 29 years. No positive cases of CT and NG were observed using PCR/NAAT. A 7% (22/296) positivity rate for CT was observed using IgG ELISA. No positive association was found between serology and symptoms (vaginal discharge, abdominal pain, dysuria, and dyspareunia) or adverse pregnancy outcomes (miscarriage and stillbirth). Positive relations with CT could be observed with consumption of alcohol, illiteracy, and tenesmus ( p-value 0.02–0.03). Discussion: STI prevalence in this study was low, but a high burden of SRH morbidity was observed, with a high symptomatic load. High rates of miscarriage (31%) and stillbirth (8%) were also observed among study subjects. No associations could be found between these ailments and CT infection. These rates are high even for low- and middle-income country standards. Conclusion: This study puts forward high rates of SRH morbidity, and instances of adverse reproductive health outcomes are highlighted in this study, although no associations with CT infection could be found. This warrants more investigation into the causes leading to these complaints in the Indian scenario and potential biases to NAAT testing, such as consumption of over-the-counter antimicrobials.

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          Pathogenesis of genital tract disease due to Chlamydia trachomatis.

          Toni Darville, Thomas J. Hiltke (2010)
          Although the pathologic consequences of C. trachomatis genital infection are well-established, the mechanism(s)that result in chlamydia-induced tissue damage are not fully understood. We reviewed in vitro, animal, and human data related to the pathogenesis of chlamydial disease to better understand how reproductive sequelae result from C. trachomatis infection. Abundant in vitro data suggest that the inflammatory response to chlamydiae is initiated and sustained by actively infected nonimmune host epithelial cells. The mouse model indicates a critical role for chlamydia activation of the innate immune receptor, Toll-like receptor 2, and subsequent inflammatory cell influx and activation, which contributes to the development of chronic genital tract tissue damage. Data from recent vaccine studies in the murine model and from human immunoepidemiologic studies support a role for chlamydia-specific CD4 Th1-interferon-g-producing cells in protection from infection and disease. However, limited evidence obtained using animal models of repeated infection indicates that, although the adaptive T cell response is a key mechanism involved in controlling or eliminating infection, it may have a double-edged nature and contribute to tissue damage. Important immunologic questions include whether anamnestic CD4 T cell responses drive disease rather than protect against disease and the role of specific immune cells and inflammatory mediators in the induction of tissue damage with primary and repeated infections. Continued study of the complex molecular and cellular interactions between chlamydiae and their host and large-scale prospective immunoepidemiologic and immunopathologic studies are needed to address gaps in our understanding of pathogenesis that thwart development of optimally effective control programs, including vaccine development.
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            A systematic review to calculate background miscarriage rates using life table analysis.

            Lyndsay Ammon Avalos, Claudia Galindo, De-Kun Li (2012)
            The objectives of the current study were to calculate: (1) the expected rates of miscarriage by gestational week; (2) the cumulative risk of miscarriage; and (3) the remaining risk of miscarriage for gestational weeks five through 20, through a systematic review of the literature. We searched MEDLINE for articles published in English through the end of 2009. References of articles were also searched. Four studies were identified to have the three necessary pieces of information for the proposed calculations: (1) gestational age at study entry, (2) pregnancy outcome; and (3) the gestational age at which the pregnancy outcome occurred. Data were extracted from each study and Life Table Analysis Methods were conducted. Weekly miscarriage rates varied in the early gestational weeks with the highest rate documented at >20 miscarriages per 1000 women-weeks at each week of gestation prior to week 13. By week 14, the rate for all studies became relatively comparable and fell below 10 miscarriages per 1000 woman-weeks at risk and fell even lower through week 20. The cumulative risk of miscarriage for weeks 5 through 20 of gestation ranged from 11 miscarriages per 100 women to 22 miscarriages per 100 women (11-22%). Based on data from comparable study populations, a range of background miscarriage rates by week of gestation for weeks 5 through 20, the cumulative risk of miscarriage, and the remaining risk of miscarriage are presented. Wider variation of miscarriage rates and risks occurred early in gestation (<14 weeks). Copyright © 2012 Wiley Periodicals, Inc.
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              2015 European guideline on the management of Chlamydia trachomatis infections.

              E Lanjouw, S Ouburg, H J C de Vries … (2016)
              Chlamydia trachomatis infections, which most frequently are asymptomatic, are major public health concerns globally. The 2015 European C. trachomatis guideline provides: up-to-date guidance regarding broader indications for testing and treatment of C. trachomatis infections; a clearer recommendation of using exclusively-validated nucleic acid amplification tests for diagnosis; advice on (repeated) C. trachomatis testing; the recommendation of increased testing to reduce the incidence of pelvic inflammatory disease and prevent exposure to infection; and recommendations to identify, verify and report C. trachomatis variants. Improvement of access to testing, test performance, diagnostics, antimicrobial treatment and follow-up of C. trachomatis patients are crucial to control its spread. For detailed background, evidence base and discussions, see the background review for the present 2015 European guideline on the management of Chlamydia trachomatis infections (Lanjouw E, et al. Int J STD AIDS. 2015).
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                Author and article information

                Journal
                Journal ID (nlm-ta): Microorganisms
                Journal ID (iso-abbrev): Microorganisms
                Journal ID (publisher-id): microorganisms
                Title: Microorganisms
                Publisher: MDPI
                ISSN (Electronic): 2076-2607
                Publication date (Electronic): 12 November 2019
                Publication date Collection: November 2019
                Volume: 7
                Issue: 11
                Electronic Location Identifier: 557
                Affiliations
                [1 ]Institute of Public Health Genomics, Genetics and Cell Biology Cluster, GROW Research School for Oncology and Development Biology, Maastricht University, 6229 ER Maastricht, The Netherlands; e.ambrosino@ 123456maastrichtuniversity.nl (E.A.); jonathanalal@ 123456shiats.edu.in (J.A.L.)
                [2 ]Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, Uttar Pradesh 211007, India; biotech.jai@ 123456gmail.com (J.Y.); rajiv.kant@ 123456shiats.edu.in (R.K.); masih.nidhi@ 123456gmail.com (N.M.); akashpandey971997@ 123456gmail.com (A.P.)
                [3 ]Hayes Memorial Mission Hospital, Shalom Institute of Health and Allied Sciences, SHUATS Allahabad, Uttar Pradesh 211007, India; Drsmitasrivastava75@ 123456gmail.com (S.S.); gurbatra@ 123456gmail.com (G.B.); arvindayal@ 123456gmail.com (A.D.)
                [4 ]Department of Computational Biology and Bioinformatics, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, Uttar Pradesh 211007, India; saurav.saha@ 123456shiats.edu.in
                [5 ]Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU Medical Center, 1081 HV Amsterdam, The Netherlands; r.heijmans@ 123456vumc.nl
                Author notes
                Author information
                https://orcid.org/0000-0001-6975-8213
                https://orcid.org/0000-0003-4217-4677
                Article
                Publisher ID: microorganisms-07-00557
                DOI: 10.3390/microorganisms7110557
                PMC ID: 6920780
                PubMed ID: 31726703
                SO-VID: 7e585a61-ef40-46c8-87b2-d3cdc4bfd80c
                Copyright © © 2019 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 11 October 2019
                Date accepted : 07 November 2019
                Categories
                Subject: Article

                Keywords: chlamydia trachomatis,neisseria gonorrhoeae,india,sexual and reproductive health
                Data availability:
                Keywords: chlamydia trachomatis, neisseria gonorrhoeae, india, sexual and reproductive health

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