Made available in DSpace on 2015-04-22T22:14:17Z (GMT). No. of bitstreams: 1 Evelyn Costa Lira.pdf: 1005417 bytes, checksum: 3bedf4425cb61a6cb9ef7da53b2dd67f (MD5) Previous issue date: 2010-12-10 / Fundação de Amparo à Pesquisa do Estado do Amazonas / The cervical cancer is the second most common type of cancer between women worldwide. In Brazil, 18.430 new cases of the disease are expected through 2010. Its incidence is greater in the North region. One of the most crucial factors to the spawning of this kind of cancer is the presence of an infection caused by the HPV (Human Papillomavirus). By itself, this virus can t lead to carcinogenesis. Some studies suggest the presence of Chlamydia trachomatis as a co-factor in its development. This study s goal was to investigate the co-infection of HPV and C. trachomatis in cervical samples with normal and altered cell biologies. Its consisted of a transversal study, where two groups were applied: GROUP I, made of 152 women who showed pre-malignant and malignant cervical injuries, and GROUP II, of 164 women who showed inflammatory cell biology. The HPV/C. trachomatis co-infection was detected through PCR and the two HPV types were detected by sequencing. Co-infection was found in 27,1% (41/152) of women in GROUP I and 3,75% in GROUP II s. The connection between the co-infection and the environmental, socio-economic and clinical factors was observed only to the variable HPV type (p=0,0424) which associates HPV 16 to 64,1% of co-infected women. / O câncer de colo do útero é o segundo tipo de câncer mais comum entre as mulheres no mundo inteiro. Para o Brasil, o número de novos casos esperados, em 2010, é de 18.430. Na região Norte é o mais incidente. Um dos fatores mais importantes para o surgimento deste tipo de câncer é a presença da infecção pelo Papilomavírus Humano (HPV). Sozinho, este vírus não pode levar à carcinogênese. Alguns estudos sugerem a presença da Chlamydia trachomatis como co-fator em seu desenvolvimento. Este estudo teve como objetivo investigar a co-infecção de HPV e C. trachomatis em amostras cervicais com citologia normal e alterada. Trata-se de um estudo transversal, onde foram utilizados dois grupos: o GRUPO I, constituído de 152 mulheres que apresentaram lesões pré-malignas e malignas do colo do útero e o GRUPO II, constituído de 164 mulheres que apresentaram citologia inflamatória. A co-infecção HPV/C. trachomatis foi detectada através da PCR e os tipos de HPV foram identificados via seqüenciamento. Foi encontrada co-infecção em 27,1% (41/152) das mulheres do GRUPO I e em 3,75% das mulheres do GRUPO II. A associação entre a co-infecção e os fatores sócio-econômicos-ambientais e clínicos foi observada apenas para a variável Tipo de HPV (p=0,0424) que associa o HPV 16 a 64,1% das mulheres co-infectadas.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-05-18T14:24:57Z No. of bitstreams: 2 Dissertação - Yanna Andressa Ramos de Lima - 2008.pdf: 2239008 bytes, checksum: 3ab85104a87e488ca8643adcc2cd10fb (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-05-18T14:44:19Z (GMT) No. of bitstreams: 2 Dissertação - Yanna Andressa Ramos de Lima - 2008.pdf: 2239008 bytes, checksum: 3ab85104a87e488ca8643adcc2cd10fb (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-05-18T14:44:19Z (GMT). No. of bitstreams: 2 Dissertação - Yanna Andressa Ramos de Lima - 2008.pdf: 2239008 bytes, checksum: 3ab85104a87e488ca8643adcc2cd10fb (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2008-08-29 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Genital infections caused by Chlamydia trachomatis are frequent among adolescents and young people. In most cases chlamydial infections are asymptomatic and may cause serious complications such as pelvic inflammatory disease, ectopic pregnancy and infertility. In Brazil there are no screening programs for this infection, with few data about chlamydial prevalence, especially in young women. Objectives: To estimate the prevalence and risk factors for C. trachomatis infection in adolescents and young women, in two cities, Ceres and Catalão, Goiás; to describe the sexual behavior of this population. Methods: The investigation was designed as a cross-sectional survey. Female adolescents and young women between 15 and 24 years old attending the Family Health Program in Ceres and Catalão were randomly assigned. Sociodemographic and sexual behavior data was obtained through a face-to-face interview. Urine samples from young sexually active women were collected and analyzed for the presence of C. trachomatis DNA, using PCR. To identify potential risk factors, univariate analysis was performed. Results: Among the 406 women recruited, 253 were sexually active and eligible for the study. The mean age was 18.7 years (SD=2.9), 58.1% were single, 24.5% initiated sexual life before age 15 and 67% reported inconsistent use of condoms. The overall prevalence of C. trachomatis was 10.9% (CI 95%, 7.0% - 16.1%). Chlamydial infection was more frequent among adolescents and young women who was younger than 15 years at first intercourse (p<0.03), and those who reported less than three partners in life were less likely of being infected with C. trachomatis (p<0.001). Conclusions: This study showed a high frequency of chlamydial infection in an asymptomatic population at Ceres and Catalão, Goiás. Participants reported unsafe sexual behaviors, like early onset of sexual activity without protection and with multiple partners. It is a vulnerable high risk population for sexually transmitted diseases. / A infecção genital causada pela bactéria Chlamydia trachomatis é freqüente na população de adolescentes e jovens, na maioria dos casos é assintomática e pode causar complicações graves como a doença inflamatória pélvica, gravidez ectópica e infertilidade. No Brasil não existem programas de rastreamento para a infecção clamidial e os dados sobre sua prevalência são escassos, principalmente na população de mulheres jovens. Objetivos: Estimar a prevalência e identificar os fatores de risco para a infecção por C. trachomatis em jovens do sexo feminino nos municípios de Ceres e Catalão, Goiás; descrever o comportamento sexual dessa população. Metodologia: A investigação foi delineada como um estudo de prevalência. Foi realizado um sorteio aleatório entre as 2100 adolescentes e jovens de 15 a 24 anos cadastradas no Programa de Saúde da Família (PSF) em Ceres e Catalão. Os dados sócio-demográficos e de comportamento sexual foram obtidos por entrevista com enfermeira treinada. Foram coletadas amostras de urina para a detecção de DNA de C. trachomatis através de PCR. Para a identificação de potenciais fatores de risco, foi realizada uma análise univariada do tipo caso-controle. Resultados: Compareceram aos postos 406 jovens, sendo 253 elegíveis. A média de idade entre elas foi de 18,7 (dp=2,9) anos, 58,1% eram solteiras, 24,5% iniciaram vida sexual antes de 15 anos e 67% relataram uso inconsistente de preservativo. A prevalência estimada de C. trachomatis foi de 10,9% (IC95% 7,0% – 16,1%). A infecção clamidial foi mais freqüente nas adolescentes e jovens que iniciaram a vida sexual antes dos 15 anos (p<0,03), e aquelas que referiram menos de três parceiros na vida tiveram menos chances de estarem infectadas (p<0,001). Conclusões: O presente estudo evidenciou uma elevada freqüência de infecção clamidial em jovens assintomáticas, em Ceres e Catalão. As jovens relataram comportamento sexual não seguro, caracterizado por início precoce da atividade sexual, sem proteção e com múltiplos parceiros. Trata-se de um grupo populacional vulnerável e de alto risco para doenças sexualmente transmissíveis.

Submitted by Cláudia Bueno (claudiamoura18@gmail.com) on 2015-10-27T17:20:50Z No. of bitstreams: 2 Dissertação - Fernanda Alves de Brito e Cardoso - 2010.pdf: 3862835 bytes, checksum: bac9d567036b30752cd19dc0042891c0 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-10-28T14:25:41Z (GMT) No. of bitstreams: 2 Dissertação - Fernanda Alves de Brito e Cardoso - 2010.pdf: 3862835 bytes, checksum: bac9d567036b30752cd19dc0042891c0 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-10-28T14:25:41Z (GMT). No. of bitstreams: 2 Dissertação - Fernanda Alves de Brito e Cardoso - 2010.pdf: 3862835 bytes, checksum: bac9d567036b30752cd19dc0042891c0 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2010-12-14 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / The introduction of the nucleic acid amplification tests (NAATs) was a major breakthrough in the screening for the sexually transmitted diseases (STD) caused by Chlamydia trachomatis and Neisseria gonorrhoeae because they are highly sensitive and they can be used with noninvasive specimens, such as urine. The use of urine has made it far easier to test asymptomatic individuals and has also made it possible to perform epidemiological studies in places other than clinical settings. Many studies have shown also that vaginal swab can be used for detection of both infections, however, just the NAAT Aptima Combo 2 has been cleared by Food and Drug Administration for this specimen use. In Brazil, the most widely used NAAT for the diagnosis of chlamydia and neisseria is the kit Amplicor CT/NG (Roche) and, up to date, there isn’t any study which evaluates the use of vaginal swabs. Objectives: To evaluate the performance of the kit AMPLICOR CT/NG (Roche) in the diagnosis of C. trachomatis and N. gonorrhoeae using urine, endocervical and vaginal swabs and to analyze the agreement of results between the different biological specimens. Methods: The target population was sexually active adolescents and young women between 15 and 24 years from Inhumas, Goias. Socio-demographic and sexual behavior were obtained through a face-to-face interview. The diagnosis was performed by PCR using the AMPLICOR CT/NG (Roche) assay in urine, vaginal swab (VS) and endocervical swab (ES) specimens. For the performance evaluation were calculated the sensitivity, specificity, positive predictive value and negative predictive value. The kappa coefficient was calculated to assess agreement between the samples. It was considered a true-positive result when at least two of three biological samples from the same patient were positive for chlamydia and/or gonococcus. Results:Among the 428 participants the mean age was 19,4 years. The three biological specimens were collected from 309 adolescents (72.2%). Among these, the prevalence rates were 8.7% (IC95% 5,8-12,4) for C. trachomatis and 2.3% (IC95% 0,9-4,6) for N. gonorrhoeae.For chlamydia the sensitivities observed with the different samples were above 80% and specificities exceeding 97% with positive predictive values (PPV) between 78.8% and 84.6% and negative predictive values (VPNs) >98%. For the gonococcus the sensitivities were 42.8% for urine, 71.4% for ES and 100% for VS with specificities >96% for the three samples. The two types of swab showed low PPVs for gonococcus (≈40%) and urine showed PPV of 100%. VPNs were >98%. The agreement of results between specimens was around 94% for the detection of both infections. However, the values of kappa (κ) coefficient ranged from 0.68 to 0.73 for chlamydia, which means substantial agreement between samples. For gonococcal infection, the agreement was slight or fair with κ coefficients ranging from 0.13 to 0.33. Conclusions:The performances of the specimens and the κ values suggest that the vaginal swab appears to be equivalent to urine and endocervical swab for detection of chlamydia and may be suitable for screening studies. The three samples showed different performance in the detection of gonococcus and did not present good agreement of results, suggesting that they are not equivalent in the diagnosis of this infection with the PCR kit used. / A introdução dos testes de amplificação de ácidos nucléicos (NAATs) foi um grande avanço no rastreamento das doenças sexualmente transmissíveis (DST) causadas por Chlamydia trachomatis e Neisseria gonorrhoeae, pois apresentam alta sensibilidade e permitem a utilização de amostras de coleta não invasiva, como a urina. O uso da urina facilitou o diagnóstico em indivíduos assintomáticos e possibilitou a realização de estudos epidemiológicos em locais fora do ambiente clínico. Vários estudos mostram que o swab vaginal também pode ser utilizado na detecção de ambas as infecções, porém a Food and Drug Administration restringe o seu uso apenas pelo NAAT Aptima Combo 2. No Brasil, o NAAT mais utilizado no diagnóstico de clamídia e neisseria é o kit Amplicor CT/NG (Roche) e, até o momento, nenhum estudo avaliou a utilização do swab vaginal. Objetivos:Avaliar o desempenho do kit AMPLICOR CT\NG (Roche) no diagnóstico de C. trachomatis e N. gonorrhoeae empregando urina, swabs endocervical e vaginal e analisar a concordância de resultados entre as diferentes amostras biológicas. Métodos: A população alvo foi constituída de adolescentes e jovens sexualmente ativas, com idade entre 15 e 24 anos, residentes em Inhumas, Goiás. Os dados sócio-demográficos e de comportamento sexual foram obtidos através de entrevista. O diagnóstico foi realizado empregando o kit Amplicor CT/NG (Roche) em amostras de urina, swab endocervical (SE) e swab vaginal (SV). Para avaliação do desempenho foram calculadas a sensibilidade, especificidade, valor preditivo positivo e negativo dos testes. O coeficiente kappa foi calculado para avaliar a concordância entre as amostras. Considerou-se um resultado como verdadeiro-positivo quando pelo menos duas das três amostras biológicas da mesma paciente fossem positivas para clamídia e/ou gonococo. Resultados: Entre as 428 participantes a média de idade foi de 19,4 anos. Os três espécimes biológicos foram coletados de 309 adolescentes (72,2%). Entre estas, as prevalências foram de 8,7% (IC95% 5,8-12,4)para C. trachomatis e de 2,3% (IC95% 0,9-4,6) para N. gonorrhoeae. Para clamídia as sensibilidades observadas com as diferentes amostras foram superiores a 80% e as especificidades superiores a 97%, com valores preditivos positivos (VPPs) entre 78,8% e 84,6% e valores preditivos negativos (VPNs) >98%. Para o gonococo as sensibilidades foram de 42,8% na urina, 71,4% no SE e de 100% no SV com especificidades >96% nas três amostras. Os dois tipos de swab apresentaram baixos VPPs para o gonococo (≈ 40%) e a urina apresentou VPP de 100%. Os VPNs foram >98%. A concordância de resultados da PCR empregando as diferentes amostras foi de cerca de 94% para ambas as infecções. Entretanto, os valores do coeficiente kappa (κ) variaram de 0,68 a 0,73 para clamídia, o que significa concordância substancial entre as amostras. Para a infecção gonocócica, a concordância foi fraca ou razoável com valores de κ variando de 0,13 a 0,33. Conclusões: Os desempenhos das amostras e os valores do κ sugerem que o swab vaginal parece ser equivalente à urina e ao swab endocervical na detecção da clamídia podendo ser recomendado para estudos de triagem. As três amostras diferiram quanto ao desempenho na detecção da infecção gonocócica e não apresentaram boa concordância de resultados sugerindo que não são equivalentes no diagnóstico desta infecção com o kit de PCR utilizado.

p. 1-52 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-23T17:53:38Z No. of bitstreams: 2 4444.pdf: 585288 bytes, checksum: b3179dbaa326bb4bcff97b3b9628f51b (MD5) 3333.pdf: 585288 bytes, checksum: b3179dbaa326bb4bcff97b3b9628f51b (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T16:55:17Z (GMT) No. of bitstreams: 2 4444.pdf: 585288 bytes, checksum: b3179dbaa326bb4bcff97b3b9628f51b (MD5) 3333.pdf: 585288 bytes, checksum: b3179dbaa326bb4bcff97b3b9628f51b (MD5) / Made available in DSpace on 2013-05-04T16:55:17Z (GMT). No. of bitstreams: 2 4444.pdf: 585288 bytes, checksum: b3179dbaa326bb4bcff97b3b9628f51b (MD5) 3333.pdf: 585288 bytes, checksum: b3179dbaa326bb4bcff97b3b9628f51b (MD5) Previous issue date: 2008 / O tracoma é uma cerato-conjuntivite crônica transmitida pela bactéria Chlamydia trachomatis. É a principal causa de cegueira evitável do mundo. O objetivo deste estudo é conhecer a extensão e distribuição do tracoma no Brasil. Foram analisados dados do inquérito de tracoma realizado pelo Ministério da Saúde em 18 estados e no Distrito Federal, no período de 2002 a 2007. Foi selecionada uma amostra de escolares, em municípios com Índice de Desenvolvimento Humano–Municipal menor que a média nacional. Foi realizado exame ocular externo com lupa (2,5X) para detecção de casos de tracoma segundo critérios da OMS. Foram examinados 119.837 alunos, distribuídos em 2.200 escolas localizadas em 1.130 municípios e detectados 5.851 casos de tracoma ativo (TF/TI), obtendo-se a prevalência de 4,9%. Não foi encontrada diferença significativa entre os sexos. A maior prevalência de tracoma por faixa etária foi verificada nos menores de 5 anos de idade (10,4%), com diferença significativa entre as faixas etárias (X2 de tendência= 35,06, p <0,01). A prevalência de tracoma por zona urbana foi de 4,2% e por zona rural de 6,0% com diferença significativa, com mais risco de ocorrer o tracoma entre moradores de zona rural (X2 = 177,688 - p <0,01). Foram detectados casos em 888 municípios (78,6% da amostra), em todas as regiões do país, contradizendo a expectativa de que a endemia estaria controlada no país. Este estudo demonstra que o tracoma é um importante problema de saúde pública no Brasil / Salvador

Made available in DSpace on 2014-12-17T14:10:23Z (GMT). No. of bitstreams: 1 ValeskaSSP_DISSERT.pdf: 1719910 bytes, checksum: a382c3b69b1e4909a64666f4822bff10 (MD5) Previous issue date: 2011-04-25 / Sexually transmitted diseases (STDs) are among the largest public health problems, especially in developing countries. The acquisition of these infections during early sexual activity is common and many infections have a benign course. However, in some pathogens remain in the state of latency can be reactivated and cause productive infection that may progress to severe forms. In addition, some of them are transmitted vertically resulting in congenital infection, causing immediate damage or long-term child. The classic risk factors for sexually transmitted agents are: early onset of sexual and reproductive health, multiple sexual partners throughout life, use of oral contraceptives and co-infections with different pathogens. We present the results of a cross-sectional study aimed to estimate the prevalence of genital infection by human papillomavirus (HPV), Herpes simplex virus (HSV) and Chlamydia trachomatis (CT) in a segment of the female population of the metropolitan area Christmas, among those who enrolled voluntarily sought, Basic Health Units for the examination of cancer screening cervix in the period 2008 to 2010. All participants, a total of 261 women answered a standard questionnaire by which identified the socio-demographic characteristics, classical risk factors for STDs, reproductive and sexual activity and smoking. Of each patient were obtained two samples, one for the completion of the Pap test for detection of cellular changes and the other processed for DNA extraction and analyzed by PCR (polymerase chain reaction) to detect the three pathogens studied. The population of the study was composed of sexually active women aged between 13 and 79 years, mean 38.7 years, most of them being married, low education levels and low incomes. The majority (87%) had normal results on cytology and only 2.7% had low-grade cytological abnormalities. Prevalence rates were 37.9% for HPV, 4.6% for CT and 26% for HSV. HPV prevalence was higher in women under 25, unmarried and in those who had multiple sexual partners. Women with simultaneous infection by HSV-1 and 2 had higher prevalence of HPV infection. The prevalence of HSV infection showed no association whatsoever with the risk factors analyzed and HSV-1 was the predominant type among the cases of genital HSV infection. The overall prevalence of C. Trachomatis was relatively low, thus providing greater value in younger women aged less than or equal to 20 years / As doen?as sexualmente transmiss?veis (DSTs) est?o entre os maiores problemas de sa?de p?blica, especialmente em pa?ses em desenvolvimento. A aquisi??o dessas infec??es durante o in?cio da atividade sexual ? freq?ente, por?m muitas dessas infec??es t?m curso benigno. Entretanto, em algumas o pat?geno permanecer em estado de lat?ncia podendo ser reativado e causar infec??o produtiva que podem evoluir para formas graves. Al?m disso, alguns delas se transmitem verticalmente, resultando em infec??o cong?nita, causando danos imediatos ou em longo prazo ? crian?a. Os fatores de risco cl?ssicos para agentes sexualmente transmiss?veis s?o: in?cio precoce da vida sexual e reprodutiva, m?ltiplos parceiros sexuais ao longo da vida, uso de contraceptivos orais e co-infec??es por diferentes pat?genos. N?s apresentados os resultados de um estudo transversal, que teve como objetivo, estimar a preval?ncia de infec??o genital pelo Papilomav?rus humano (HPV), pelo v?rus Herpes simples (HSV) e por Chlamydia trachomatis (CT) em um segmento da popula??o feminina da regi?o metropolitana de Natal, arroladas entre aquelas que procuraram voluntariamente, Unidades B?sicas de Sa?de para a realiza??o do exame de rastreamento do c?ncer de colo do ?tero no per?odo de 2008 a 2010. Todas as participantes, num total de 261 mulheres, responderam a um question?rio padronizado por meio do qual foram identificadas ?s caracter?sticas s?cio-demogr?ficas, fatores de risco cl?ssicos para DSTs, atividade sexual e reprodutiva e tabagismo. Foram obtidas duas amostras de cada paciente, uma destinada a realiza??o do exame citol?gico de Papanicolaou para a detec??o de altera??es celulares e a outra processada para a extra??o de DNA, e analisadas por PCR (rea??o em cadeia de polimerase) para a detec??o dos tr?s pat?genos estudados. A popula??o alvo do estudo foi composta por mulheres sexualmente ativas, com idade entre 13 e 79 anos, m?dia de 38,7 anos, sendo a maioria delas casadas, com baixo grau de instru??o e baixa renda. A maioria (87%) apresentou resultado normal no exame citol?gico e apenas 2,7% apresentaram altera??es citol?gicas de baixo grau. Foram encontradas taxas de preval?ncia de 37,9% para HPV, 4,6% para CT e 26% para o HSV. A preval?ncia do HPV foi maior nas mulheres com at? 25 anos, nas solteiras e naquelas que tiveram m?ltiplos parceiros sexuais. As mulheres com infec??o simult?nea por HSV-1 e 2 aprestaram maior preval?ncia de infec??o por HPV. A preval?ncia da infec??o pelo HSV n?o apresentou ind?cio de associa??o com os fatores de risco analisados e o HSV-1 foi o tipo predominante entre os casos de infec??o genital pelo HSV. A preval?ncia geral da C. Trachomatis foi relativamente baixa, apresentado maior valor nas mulheres mais jovens, com idade menor ou igual a 20 anos

Abstract Chlamydia trachomatis epidemic continues at a slowly, albeit steadily increasing rate in the Western world despite health education, easy/user-friendly diagnostic measures, and effective treatment. In Finland, 8,031 and 13,227 C.trachomatis infections were reported in 1995 and 2012, respectively. Over half of the Chlamydia cases were diagnosed among young women, who suffer from the Chlamydia-related complications such as infertility many years after initial infection. The rates of all but first of the following major Chlamydia-related complications: cervical intraepithelial neoplasia, ectopic pregnancy, hospitalized pelvic inflammatory disease, tubal factor infertility have, however, decreased since the 1990s. The aim of this study was to clarify the discordance between the apparently increasing incidence of C. trachomatis and decreasing C.trachomatis IgG antibody rates (seroprevalence). The study material consisted of a random subsample of first trimester serum samples of 7,999 women from the population-based Finnish Maternity Cohort (FMC) registry from 1983 to 2005, and 147,148 women and men with a total of 177,138 C. trachomatis genital infections reported to the Finnish National Infectious Diseases Registry (NIDR) during 1995–2009. Both registries are maintained by the National Institute for Health and Welfare (THL). Serum IgG antibodies were measured by a C.trachomatis major outer membrane protein-specific peptide enzyme immunoassay (EIA) and the standard micro-immunofluorescence (MIF) method. We found that while C. trachomatis seroprevalences decreased >50% among fertile-aged women the seroconversion rates (seroincidences) were comparable to the NIDR reported rates. The numbers of annual repeated C. trachomatis infection in the NIDR increased until 2009 by 49% in women and 39% in men. In 2009, about 25% of the females and 20% of the males had had an earlier C.trachomatis infection. During the whole follow-up time, 34% of all the repeat diagnoses occurred within 12 months. Most of the first infections were observed among females and males under 25 years of age, but the numbers of repeated chlamydial infections increased up to the age of 30 years. The C. trachomatis serotype distribution changed between the 1980s and 1990s, but the leading 1980 serotypes bounced back by 2005. The numbers of women with multiple serotype infections peaked in the 1990s, and serotypes G and J were temporarily replaced by serotypes E and D. In conclusion, the serological observations fit the polymerase chain reaction (PCR) -based data on C. trachomatis epidemiology. The observed increases in the repeated chlamydial infections among young women and men comply with increasing sexual risk-taking behaviour in Finland. Our observations help to understand the discrepancy between C. trachomatis occurrence and sequelae rates as the overall C. trachomatis infection burden in the population may be decreasing despite the increasing incidence trend. / Tiivistelmä Chlamydia trachomatis -epidemia jatkuu yhä länsimaissakin terveyskasvatuksesta, helposta diagnostiikasta sekä tehokkaasta hoidosta huolimatta. Vuonna 1995 maassamme raportoitujen klamydiainfektioiden määrä oli 8 031 ja viime vuonna 13 227. Näistä yli puolet todettiin nuorilla naisilla, joilla klamydian pitkäaikaishaitat, kuten hedelmättömyysongelmat, tulevat esille usein vasta usean vuoden kuluttua. Klamydiainfektioon liittyvät komplikaatiot, eli kohdunkaulan syövän esiasteet, kohdunulkoinen raskaus, vaikea sisäsynnytintulehdus ja munanjohdinperäinen hedelmättömyys ovat ensimmäistä lukuun ottamatta olleet maassamme laskussa 1990-luvulta lähtien. Tämän väitöskirjatyön tarkoituksena oli selvittää klamydian ilmaantuvuuden nousun ja C. trachomatis IgG vasta-ainetasojen laskun välistä ristiriitaa. Väestötasoisen tutkimuksen aineisto koostui äitiseerumipankista (Finnish Maternity Cohort, FMC) vuosilta 1983–2005 satunnaistetusti poimittujen 7 999 naisen verinäytteistä ja kansalliseen tartuntatautirekisteriin vuosina 1995–2009 raportoiduista klamydiatapauksista, joita havaittiin 147&#160;148 naisella ja miehellä yhteensä 177&#160;138 tapausta. Molemmat rekisterit ovat Terveyden ja hyvinvoinnin laitoksen (THL) ylläpitämiä. Klamydia IgG vasta-aineet määritettiin entsyymi-immunologisesti (EIA) sekä mikroimmunofluoresenssimenetelmällä (MIF) verinäytteistä. Keskeisinä tuloksina havaittiin klamydian seroprevalenssin lasku > 50&#160;% hedelmällisessä iässä olevilla naisilla, vaikka infektion ilmaantuvuus serologisessa aineistossa oli samaan aikaan samankaltainen kuin tartuntatautirekisterissä. Lisäksi havaitsimme, että vuositasolla toistuvien klamydiainfektioiden määrä on tartuntatautirekisterin perusteella lisääntynyt tutkimusaikana naisilla 49&#160;% ja miehillä 39&#160;%. Vuonna 2009 neljännes naisten ja viidennes miesten klamydiainfektioista oli uusintainfektioita. Koko seuranta-aikana 34&#160;% toistuvista tapauksista ilmaantui 12 kuukauden sisällä. Suurin osa klamydiainfektioista todettiin alle 25-vuotiailla naisilla ja miehillä, mutta toistuvia infektioita havaittiin vielä runsaasti 30 ikävuoteen asti. Klamydiaserotyyppien jakaumassa tapahtui muutoksia 1980- ja 1990-lukujen välissä, mutta jakauma palautui vuoteen 2005 mennessä samankaltaiseksi kuin 1980-luvulla. Useamman serotyypin infektioiden lukumäärä oli korkeimmillaan 1990-luvulla, jolloin serotyypit G ja J korvautuivat väliaikaisesti serotyypeillä E ja D. Yhteenvetona voimme todeta, että serologiset havaintomme ovat yhteneväisiä polymeraasiketjureaktiolla (PCR) tutkittujen klamydiaepidemiologisten tulosten kanssa. Toistuvien klamydiainfektioiden määrän nousu aineistossamme sopii havaintoon nuorten naisten ja miesten lisääntyneestä seksuaalisesta riskikäyttäytymisestä maassamme. Tutkimustuloksemme auttavat ymmärtämään ristiriitaa klamydian ilmaantuvuuden nousun ja klamydiaperäisten komplikaatioiden laskun välillä, koska kaiken kaikkiaan klamydiaan liittyvä pitkäaikaissairastavuus väestötasolla voi olla vähenemässä.

In culture, exposure to penicillin and other stressors induce chlamydiae to enter a non-infectious but viable state termed persistence. Chlamydiae may reenter their normal developmental cycle after stressor removal. Though aberrant RB similar to those present in culture models of persistence have been observed within infected tissues, the existence of persistent chlamydiae has not been definitively demonstrated in vivo. As a result, the role of persistent organisms in pathogenesis is undefined. In order to establish an experimentally tractable model of in vivo persistence, Chlamydia muridarum vaginally-infected mice were gavaged with either water or amoxicillin (amox). Vaginal swabs were collected for chlamydial titration and RNA isolated for quantification of pre-16s rRNA. Uterine tissue was analyzed by transmission electron microscopy (TEM). Although amox-treatment reduced vaginal shedding by >99%, C. muridarum pre-16s rRNA accumulation was unchanged by treatment. These data indicate that the amox-exposed organisms were viable but not infectious. Furthermore, TEM analyses demonstrated that inclusions in amox-treated animals contained primarily large, aberrant RB, but those observed in untreated control animals were normal. Collectively, these data suggest that amoxicillin treatment induces C. muridarum to enter the persistent state in vivo. This model also represents the first experimentally tractable animal model of chlamydial persistence.

Objective: The clinical significance of the potential for persistent human chlamydial infections in vivo is being actively reassessed because of the increased frequency of recurrent infection with the same serovar despite compliance with an effective antibiotic regimen. The ability to extend the length of time of in vitro cultivation of polarized human endometrial epithelial cells (HEC-1B) provided the opportunity to establish a model system to determine if a persistent form of Chlamydia trachomatis had the same susceptibility as the actively growing form to a cidal concentration of azithromycin. Methods: Polarized HEC-1B cells cultivated on extracellular matrix were infected with C. trachomatis serovar E and exposed to penicillin at 24 h post-infection (hpi) to induce a persistent infection characterized by slowly metabolizing but non-dividing, ultrastructurally aberrant reticulate bodies within the chlamydial inclusion; at 48hpi, infected cultures were exposed to a bactericidal concentration of azithromycin for 72 h. Results: Persistent chlamydiae were phenotypically resistant to azithromycin; the number of chlamydial inclusions on subpassage of progeny from persistent chlamydiae following removal of penicillin and recovery was essentially the same as from progeny from persistent chlamydiae following removal of penicillin and azithromycin and recovery. Neutrophils were attracted in vitro to persistently infected HEC-1B cells that had been exposed to penicillin and azithromycin. Conclusions: Thus, this study provides evidence at the cellular microbiology level in vitro for mechanisms that could exist in vivo to create sustained, but perhaps clinically inapparent inflammation, which might eventually lead to conditions such as silent pelvic inflammatory disease.