Treatment Failure of Chlamydial Infection, Essay Example

Background

Chlamydia is a sexually transmitted disease caused by the bacteria Chlamydia trachomatis (Hocking et al., 2013). This disease is the most common sexually transmitted infection in the United States, and is more prevalent in females than males (Hocking et al., 2013). More than 1.4 million new cases of chlamydia were documented in the United States in 2012, and an estimated 456.7 in 100,000 people currently carry the bacteria (Centers for Disease Control and Prevention, CDC, 2014). The disease is spread through an exchange of bodily fluids, normally occuring through sexual activity, and symptoms include abnormal vaginal or penile discharge, burning sensation during urination, rectal and testicular pain, and bleeding (Somani, Bhullar, Workowski, Farshy, & Black, 2000). Men and women under the age of 25 face the highest risk of infection (Somani et al., 2000; Geisler, Lensing, Press, & Hook, 2013). If left untreated, chlamydia infection can spread throughout the reproductive system and cause more severe, problems such as inflammatory disease, epididymis, and reproductive failure (Wang et al., 2005).

Chlamydia can be easily cured through proper treatment (Ison, 2012). As chlamydia is caused by bacteria, the disease is most commonly treated with antibiotics (Hocking et al., 2013). Azithromycin (prescribed in single doses) and doxycycline (prescribed in multiple doses) are commonly administered to treat these infections, although alternative antibiotics may be utilized as well (Somani et al., 2000; Kong et al., 2014). Depending on the severity, chlamydia infection is typically treated within two weeks (Wang et al., 2005). However, cases of treatment failure and treatment resistance have been documented (Hocking et al., 2013). Azithromycin-resistant chlamydia is rare, but is difficult to treat and can lead to residual infections.

Unfortunately, little is known about such infections and the persistence of treatment failures. Randomized trials are being conducted in the United States to identify the causes and clinical management of treatment failures (Regan, Wilson, & Hocking, 2013; Chesson, Sternberg, Leichliter, & Aral, 2010).  However, researchers are currently uncertain as to how resistance is developed, as examples of stable antibiotic resistance strains have yet to be collected in humans (Kretzschmar, Schmid, Low, & Heijne, 2011). Though isolates in human samples have exhibited resistance, it has been concluded that these strains lost their resistance phenotype in vitro (Sandoz & Rockey, 2011; O’Neill et al., 2013). Furthermore, little is known about geographic implications of chlamydia infection, or rates of treatment failure based on environmental characteristics (Rodel et al., 2012). This is unfortunate, as chlamydia prevalence varies considerably based on geographic region, and environmental factors may play a key role in identifying the most efficacious treatment and prevention strategies (Horner, 2012; Regan et al., 2013). Therefore, the purpose of this study is to collect data regarding chlamydia rates and treatment failures within one particular county in the United States.

Significance

This study will help fill a significant gap in the literature by providing region-specific data regarding chlamydia rates and treatment failures within a specific county in the United States. Understanding these rates is critical for identifying environmental underpinnings of chlamydia infection, as well as resistance to contemporary treatments within specific areas. By correlating this data with demographic and lifestyle factors, this study may also provide information about genetic and modifiable risk factors for treatment resistance (West et al., 2014). Furthermore, Chlamydia is one of the most costly diseases in the United States, reaching nearly $16 billion each year to treat (CDC, 2014). Understanding the geographic, environmental, and genetic underpinnings of this disease may prove useful for developing more efficacious and targeted treatments, ultimately reducing healthcare costs by a considerable amount.

References

Centers for Disease Control and Prevention (2014). Reported STDS in the United States. Retrieved from: http://www.cdc.gov/nchhstp/newsroom/docs/STD-Trends-508.pdf. Accessed 17 September 2014.

Chesson, H. W., Sternberg, M., Leichliter, J. S., & Aral, S. O. (2010). The distribution of chlamydia, gonorrhoea and syphilis cases across states and counties in the USA, 2007. Sexually Transmitted Infections, 86(S3), iii52-iii57.

Geisler, W. M., Lensing, S. Y., Press, C. G., & Hook, E. W. (2013). Spontaneous resolution of genital Chlamydia trachomatis infection in women and protection from reinfection. Journal of Infectious Diseases, 207(12), 1850-1856.

Hocking, J. S., Vodstrcil, L., Huston, W. M., Timms, P., Chen, M., Worthington, K., … & Tabrizi, S. N. (2013). A cohort study of Chlamydia trachomatis treatment failure in women: a study protocol. BMC Infect Dis, 13(1), 379. Retrieved from: http://www.biomedcentral.com/1471-2334/13/379. Accessed 18 Sept. 2014.

Horner, P. J. (2012). Azithromycin antimicrobial resistance and genital Chlamydia trachomatis infection: duration of therapy may be the key to improving efficacy. Sexually Transmitted Infections, 88(3), 154-156.

Ison, C. A. (2012). Antimicrobial resistance in sexually transmitted infections in the developed world: implications for rational treatment. Current Opinion in Infectious Diseases, 25(1), 73-78.

Kong, F. Y. S., Tabrizi, S. N., Law, M., Vodstrcil, L. A., Chen, M., Fairley, C. K., … & Hocking, J. S. (2014). Azithromycin versus doxycycline for the treatment of genital chlamydia infection: a meta-analysis of randomized controlled trials. Clinical Infectious Diseases, 59(2), 193-205.

Kretzschmar, M., Schmid, B., Low, N., & Heijne, J. (2011). P1-S5. 41 Quantifying the contribution of re-infection within partnerships to persistent spread of Chlamydia. Sexually Transmitted Infections, 87(S1), A193-A194.

O’Neill, C. E., Seth-Smith, H. M., Van Der Pol, B., Harris, S. R., Thomson, N. R., Cutcliffe, L. T., & Clarke, I. N. (2013). Chlamydia trachomatis clinical isolates identified as tetracycline resistant do not exhibit resistance in vitro: whole-genome sequencing reveals a mutation in porB but no evidence for tetracycline resistance genes. Microbiology, 159(4), 748-756.

Regan, D. G., Wilson, D. P., & Hocking, J. S. (2013). P3. 374 Treatment failure has important implications for chlamydia transmission and the effectiveness of screening programmes. Sexually Transmitted Infections, 89(S1), A266-A266.

Rödel, J., Grobe, C., Yu, H., Wolf, K., Otto, G. P., Liebler-Tenorio, E., … & Straube, E. (2012). Persistent Chlamydia trachomatis infection of HeLa cells mediates apoptosis resistance through a Chlamydia protease-like activity factor-independent mechanism and induces high mobility group box 1 release. Infection and Immunity, 80(1), 195-205.

Sandoz, K. M., & Rockey, D. D. (2011). Antibiotic resistance in chlamydiae. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075073/. Accessed 17 Sept. 2014.

Somani, J., Bhullar, V. B., Workowski, K. A., Farshy, C. E., & Black, C. M. (2000). Multiple drug-resistant chlamydia trachomatis associated with clinical treatment failure. Journal of Infectious Diseases, 181(4), 1421-1427.

Wang, S. A., Papp, J. R., Stamm, W. E., Peeling, R. W., Martin, D. H., & Holmes, K. K. (2005). Evaluation of antimicrobial resistance and treatment failures for Chlamydia trachomatis: a meeting report. Journal of Infectious Diseases, 191(6), 917-923.

West, S., Moncada, J., Munoz, B., Mkocha, H., Storey, P., Hardick, J., … & Schachter, J. (2014). Is there evidence for resistance of ocular Chlamydia trachomatis to azithromycin after mass treatment for trachoma control? Journal of Infectious Diseases, 210(1), 65-71.