Determinants of cervical chlamydia trichomatis infection and efficacy of the treatment with josamycin: Results from an Italian multicenter study: MEGIC Italian group

The prevalence of cervical Chlamydia trachomatis infection in various gynecological conditions has been analyzed in a large multicenter cross-sectional study at 7 university clinics in northern (3 centers), central (3 centers), and southern (1 center) Italy. Women observed at the participating centers for the following conditions were eligible for the study: low gynecological tract infection (2071 subjects), recurrent abortions (≥ 2 abortions and no livebirths, 416 subjects), sterility (371 subjects), and a random sample of asymptomatic women observed at routine gynecological visits (1321 subjects). Diagnosis of C. trachomatis infection was based on IFAT results. Out of 2071 women with genital infections 104 (5.0 %) had cervical Chlamydia infection. The corresponding percentages were 4.6 % (19/416), 5.4 % (20/371), and 3.9 % (51/1321) in women with recurrent abortions, sterility, and asymptomatic subjects, respectively. After taking into account the potential confounding effect of diagnostic group, age, and center, the risk of cervical Chlamydia infection was slightly higher in women with previous history of low genital tract infection (relative risk 1.4), and lower in users of barrier methods of contraception (relative risk 0.6). These findings, however, were only of borderline statistical significance. No relationship emerged between cervical Chlamydia infection and age, reproductive history, and reported number of sexual partners over the last 12 months. The 104 positive subjects for cervical Chlamydia infection identified in this cross sectional study plus 105 subjects observed in the participating centers over the study period with proven urethral and/or endometrial and/or peritoneal Chlamydia infection were treated with a standard dose of 1 g of josamycin (Iosalide®-Schering) every 12 h for 10 days. Therapeutic efficacy was assessed at the end of treatment on the basis of both disappearance of clinical symptoms and eradication of C. trachomatis. In 89 % of 258 cases with reliable microbiological evaluation eradication was achieved after the first treatment cycle. From the clinical point of view, total elimination of symptoms was achieved after only 1 treatment cycle in 94 % of 299 Chlamydia positive women. Drug tolerance was satisfactory. Antibiotic treatment was discontinued in only 5 of 299 cases because of nausea and/or gastralgia. The high percentage of pathogen eradication is of particular significance and will prevent severe sequelae of 'false recovery' from C. trachomatis infection.