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Duration of untreated genital infections with Chlamydia
trachomatis: A review of the literature.
Sexually Transmitted Diseases 2000;27(6):329-337.
Golden MR, Schillinger JA, Markowitz L, St. Louis ME.
Abstract
BACKGROUND: Estimates of the duration of untreated genital infections with
Chlamydia trachomatis vary. Accurately estimating the distribution of the
duration of infection would be useful in the counseling patients, and is
essential when modeling the burden of chlamydial disease and the potential
impact of prevention programs. GOAL: The authors review the scientific literature
to summarize what is known about the duration of genital chlamydial infection
and the factors that affect it. STUDY DESIGN: Literature review of animal
and human studies. RESULTS: Animal studies document a longer duration of
infection in primates than in mice or guinea pigs. Although animals spontaneously
become culture negative over time, numerous studies document persistent
nonculture evidence of chlamydiae in the upper genital tract. Studies in
which women have been serially cultured suggest that most untreated infections
remain culture positive for more than 60 days. Small series report that
some infections may persist for years. Most infections eventually become
culture negative; however, non-culture evidence of chlamydiae often persist
in women with negative cultures. The duration of chlamydial infection is
reduced in animals previously exposed to chlamydiae and in older humans,
suggesting that partial immunity may result from exposure. Data are inadequate
to define the median duration of untreated infection or to derive a curve
that describes the natural history of untreated genital chlamydial infections.
CONCLUSION: Current data do not allow one to reliably estimate the duration
of genital infections with C trachomatis. Systematic retesting could help
to better define the duration of infection in patients who, against medical
advice, delay treatment for genital chlamydial infections.
