H. Robert Harrison

Cervical Chlamydia trachomatis infection in university women: relationship to history, contraception, ectopy, and cervicitis

Endocervical Chlamydia trachomatis infection was found in 13 of 162 volunteer female university students (8%). Infection was correlated with younger age (p less than 0.05), less than or equal to 4 years of intercourse (p less than 0.05), a history of gonorrhea (p less than 0.01), and exposure to a partner with urethritis (p less than 0.01). Women who used intrauterine or barrier contraception had less infection (2%) than did women who used oral contraception (14.3%, p less than 0.05) or none at all (10.7%, p less than 0.05). Infection was strongly associated with a cervicitis score calculated from erythema, ectopy, discharge, and secretions that contained white blood cells (p less than 0.0001). By multivariate analysis, a proposed clinical approach was arrived at for testing for chlamydial organisms all women with cervicitis who were not using barrier contraception. The positive predictive value of this approach for chlamydial infection was 28%, and the negative predictive value 98.4%. Cervical ectopy was increased in women who used oral contraception (p less than 0.01), and infection was increased in women with ectopy, regardless of their contraceptive method (p less than 0.001). These results will aid in more rapid diagnosis of endocervical chlamydial infection and in the choice of contraception in young women and high-prevalence groups.

In vitro activity of clindamycin against strains of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum isolated from pregnant women

Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum are genital agents that are being increasingly implicated in infectious pregnancy complications and abnormal pregnancy outcomes. We measured the in vitro activity of clindamycin against strains of these three agents which were isolated from pregnant women. For 30 strains of C. trachomatis, the median minimal inhibitory concentration was 1.0 microgram/ml (range, 0.25 to 2.0 micrograms/ml). For 27 strains of M. hominis, the median minimal inhibitory concentration was 0.12 microgram/ml (range, 0.06 to 0.25 microgram/ml) and the median minimal bactericidal concentration was 0.5 microgram/ml (range, 0.06 to 2.0 micrograms/ml). For 27 strains of U. urealyticum, the mean minimal inhibitory concentration was 4 micrograms/ml (range, 1.0 to 32.0 micrograms/ml) and the mean minimal bactericidal concentration was 32.0 micrograms/ml (range, 4.0 to 128 micrograms/ml). Thus in vitro clindamycin would appear to be highly active against pregnancy-associated strains of M. hominis, less active against strains of C. trachomatis, and least active against strains of U. urealyticum. Since M. hominis has been strongly linked to postabortal fever and to postpartum fever and endometritis, our results indicate that clindamycin should be evaluated in treatment trials in pregnancy aimed at prevention of M. hominis-induced morbidity as well as in treatment of the complications themselves.