Aspects of human chlamydial infections

This thesis takes a closer look at three aspects of human chlamydial infections. With regard to diagnosis the influence of logistics on the sensitivity of the culture method is discussed, along with optimalization of the culture itself and an evaluation of new diagnostic methods. Next, epidemiological data are discussed with regard to the prevalence and role of Chlamydia, on the one hand in asymptomatic persons from low-risk groups and on the other hand in women with postinflammatory tubal infertility. Finally the therapeutic problems are considered with reference to measurements of the in-vitro sensitivity of various chlamydial strains to tetracycline and some recently developed chemotherapeutic agents. The significance of Chlamydia for some of the sexually transmitted nongonococcal oculogeni tal infections was not generally recognised until relatively recently. One of the reasons for this was undou~tedly the lack of a culture method to isolate the organism for study of its biological characteristics. Even after the introduction of a technique to culture Chlamydia on cell lines, large scale epidemiological research was impeded by lack of adequately equipped laboratories where the complicated method might be employed. The manner of collecting patient material for culture, transport from outpatient clinic to laboratory, and the culture method employed are critical parameters which determine the ultimate result. A disadvantage of the culture method is the relatively long time required (6 days). Rapid diagnosis and if necessary treatment, especially of asymptomatic persons, is of great epidemiological importance. Chlamydial antigen-detecting methods have recently been developed which can present results within a few hours. They are based on the immunofluorescence (IF) technique and on the enzyme immunoassay (EIA). Both techniques employ monoclonal antibodies against genus-specific epitopes of the Major Outer Membrane Protein (IF technique) or of the lipopolysaccharide (EIA). The chlamydiae in patient material need no longer be alive for analysis, and transport to the laboratory therefore no longer influences the sensitivity of detection.