Download PDF
Semin Reprod Med 2018; 36(06): 340-350
DOI: 10.1055/s-0039-1678752
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Gynecologic Health Consequences of Chlamydia trachomatis Infection in Military Servicewomen

Christine Nadeau
1   Department of Clinical Investigation, Madigan Army Medical Center, Tacoma, Washington
,
Dennis Fujii
2   Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington
,
Jessica Lentscher
2   Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington
,
Amanda Haney
3   Department of Obstetrics and Gynecology, Tripler Army Medical Center, Honolulu, Hawaii
,
Richard O. Burney
1   Department of Clinical Investigation, Madigan Army Medical Center, Tacoma, Washington
2   Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington
› Author Affiliations
Further Information

Publication History

Publication Date:
19 April 2019 (online)

    Permissions and Reprints

Abstract

Chlamydia trachomatis is the most common sexually transmitted bacterial infection in the United States. Within the U.S. military, the age- and race-adjusted chlamydia infection rates among female service members are consistently higher than civilian rates, with a 20% annual acquisition rate among young active-duty women. The sequelae of chlamydia disproportionately impact women in terms of severity and cost. Untreated chlamydia progresses to pelvic inflammatory disease in 40% of cases, and is a leading cause of fallopian tube damage and pelvic adhesive disease resulting in ectopic pregnancy, tubal infertility, and acute and chronic pelvic pain. Tubal infertility is among the leading indications for in vitro fertilization (IVF) nationally and rates among couples undergoing IVF at military treatment centers are double the national average. Collectively, chlamydia infection represents a significant resource burden to the military health care system and, in view of the serious gynecologic health sequelae, a significant threat to the readiness of servicewomen. In this review, we discuss the gynecologic impact of chlamydia infection within the military, the critical gaps for research funding, and opportunities for intervention.

Keywords

chlamydia - salpingitis - tubal - infertility - ectopic - military

Note

The views expressed herein are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, the U.S. Government, or any organization listed.


 

  • References

  • 1 Armed Forces Health Surveillance Center. Sexually transmitted infections, active component, U.S. Armed Forces, 2000-2012. MSMR 2013; 20 (02) 5-10
    PubMedGoogle Scholar
  • 2 Seña AC, Miller WC, Hoffman IF. , et al. Trends of gonorrhea and chlamydial infection during 1985-1996 among active-duty soldiers at a United States Army installation. Clin Infect Dis 2000; 30 (04) 742-748
    CrossrefPubMedGoogle Scholar
  • 3 Stahlman S, Oetting AA. Sexually transmitted infections, active component, U.S. Armed Forces, 2007-2016. MSMR 2017; 24 (09) 15-22
    PubMedGoogle Scholar
  • 4 Goyal V, Mattocks KM, Sadler AG. High-risk behavior and sexually transmitted infections among U.S. active duty servicewomen and veterans. J Womens Health (Larchmt) 2012; 21 (11) 1155-1169
    CrossrefPubMedGoogle Scholar
  • 5 Deiss R, Bower RJ, Co E. , et al. The association between sexually transmitted infections, length of service and other demographic factors in the U.S. Military. PLoS One 2016; 11 (12) e0167892
    CrossrefPubMedGoogle Scholar
  • 6 Shafer MA, Boyer CB, Pollack LM, Moncada J, Chang YJ, Schachter J. Acquisition of Chlamydia trachomatis by young women during their first year of military service. Sex Transm Dis 2008; 35 (03) 255-259
    CrossrefPubMedGoogle Scholar
  • 7 Zenilman JM, Glass G, Shields T, Jenkins PR, Gaydos JC, McKee Jr KT. Geographic epidemiology of gonorrhoea and chlamydia on a large military installation: application of a GIS system. Sex Transm Infect 2002; 78 (01) 40-44
    CrossrefPubMedGoogle Scholar
  • 8 Stahlman S, Garges EC, Ying S, Clark LL. Rates of Chlamydia trachomatis infections across the deployment cycle, active component, U.S. Armed Forces, 2008-2015. MSMR 2017; 24 (01) 12-18
    PubMedGoogle Scholar
  • 9 Gaydos CA, Howell MR, Pare B. , et al. Chlamydia trachomatis infections in female military recruits. N Engl J Med 1998; 339 (11) 739-744
    CrossrefPubMedGoogle Scholar
  • 10 Army Medical Command. Health of the Force. U.S. Army; 2015
    Google Scholar
  • 11 Yablonsky AM, Martin RC, Highfill-McRoy RM. , et al. Military Women's Health: A Scoping Review and Gap Analysis, 2000–2015. Silver Spring: Naval Medical Research Center; 2017
    Google Scholar
  • 12 Gaydos CA, Howell MR, Quinn TC, McKee Jr KT, Gaydos JC. Sustained high prevalence of Chlamydia trachomatis infections in female army recruits. Sex Transm Dis 2003; 30 (07) 539-544
    CrossrefPubMedGoogle Scholar
  • 13 Centers for Disease Control and Prevention. Chlamydia. National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention 2017 ; Available at: https://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm . Accessed September 30, 2018
    PubMedGoogle Scholar
  • 14 Catterson ML, Zadoo V. Prevalence of asymptomatic chlamydial cervical infection in active duty Army females. Mil Med 1993; 158 (09) 618-619
    CrossrefPubMedGoogle Scholar
  • 15 Haggerty CL, Gottlieb SL, Taylor BD, Low N, Xu F, Ness RB. Risk of sequelae after Chlamydia trachomatis genital infection in women. J Infect Dis 2010; 201 (Suppl. 02) S134-S155
    CrossrefPubMedGoogle Scholar
  • 16 Linhares IM, Witkin SS. Immunopathogenic consequences of Chlamydia trachomatis 60 kDa heat shock protein expression in the female reproductive tract. Cell Stress Chaperones 2010; 15 (05) 467-473
    CrossrefPubMedGoogle Scholar
  • 17 Witkin SS, Minis E, Athanasiou A, Leizer J, Linhares IM. Chlamydia trachomatis: the persistent pathogen. Clin Vaccine Immunol 2017; 24 (10) e00203-17
    CrossrefPubMedGoogle Scholar
  • 18 Peter NG, Clark LR, Jaeger JR. Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain. Cleve Clin J Med 2004; 71 (03) 233-239
    CrossrefPubMedGoogle Scholar
  • 19 Bautista CT, Hollingsworth BP, Sanchez JL. Repeat chlamydia diagnoses increase the hazard of pelvic inflammatory disease among US Army women: a retrospective cohort analysis. Sex Transm Dis 2018; 45 (11) 770-773
    CrossrefPubMedGoogle Scholar
  • 20 Baud D, Goy G, Jaton K. , et al. Role of Chlamydia trachomatis in miscarriage. Emerg Infect Dis 2011; 17 (09) 1630-1635
    CrossrefPubMedGoogle Scholar
  • 21 Kavanagh K, Wallace LA, Robertson C, Wilson P, Scoular A. Estimation of the risk of tubal factor infertility associated with genital chlamydial infection in women: a statistical modelling study. Int J Epidemiol 2013; 42 (02) 493-503
    CrossrefPubMedGoogle Scholar
  • 22 Karaer A, Mert I, Cavkaytar S, Batioglu S. Serological investigation of the role of selected sexually transmitted infections in the aetiology of ectopic pregnancy. Eur J Contracept Reprod Health Care 2013; 18 (01) 68-74
    CrossrefPubMedGoogle Scholar
  • 23 Greenberg JH. Venereal disease in the armed forces. Med Clin North Am 1972; 56 (05) 1087-1100
    CrossrefPubMedGoogle Scholar
  • 24 Sternberg T, Howard EB, Dewey LA, Padget P. Preventive Medicine in World War II, Communicable Diseases. Vol 5. Washington, DC: Department of the Army; 1962
    Google Scholar
  • 25 Pusey W. Handling of the venereal problem in United States Army in the present crisis. J Am Med Assoc 1918; 71: 1017-1023
    CrossrefPubMedGoogle Scholar
  • 26 Army Office of the Surgeon General. Sex Hygiene and Venereal Disease. Washington, DC: U.S. Government Printing Office; 1942
    Google Scholar
  • 27 Mueller A. Prostitutes, Prophylactics, and Propaganda: The Venereal Disease Campaign and the Fight for Control of Female Sexuality During WWII: History. Colorado: University of Colorado; 2018
    Google Scholar
  • 28 Hibben MC. Venereal Disease in the Armed Forces. Vol 1. Washington, DC: CQ Press; 1943
    Google Scholar
  • 29 Broughton P. Behind the Syphilis Campaign. Public Affairs Committee; 1938
    Google Scholar
  • 30 Leder J. Thanks for the Memories: Love, Sex, and World War II. Washington, DC: Potomac; 2009
    Google Scholar
  • 31 Morse S. Emerging Infections: Condemned to Repeat?. Washington, DC: The National Academies Press; 2009
    Google Scholar
  • 32 Deller J, Smith DE, English DT, Southwick EG. Venereal Diseases. Vol II. Washington, DC: Office of the Surgeon General; 1982
    Google Scholar
  • 33 Worboys M. Chlamydia: A Disease Without a History. In: Global Health Histories. World Health Organization; 2012
    Google Scholar
  • 34 Redgrove KA, McLaughlin EA. The role of the immune response in Chlamydia trachomatis infection of the male genital tract: a double-edged sword. Front Immunol 2014; 5: 534
    PubMedGoogle Scholar
  • 35 Sobinoff AP, Dando SJ, Redgrove KA. , et al. Chlamydia muridarum infection-induced destruction of male germ cells and Sertoli cells is partially prevented by Chlamydia major outer membrane protein-specific immune CD4 cells. Biol Reprod 2015; 92 (01) 27
    PubMedGoogle Scholar
  • 36 Cecil JA, Howell MR, Tawes JJ. , et al. Features of Chlamydia trachomatis and Neisseria gonorrhoeae infection in male Army recruits. J Infect Dis 2001; 184 (09) 1216-1219
    CrossrefPubMedGoogle Scholar
  • 37 Mackern-Oberti JP, Motrich RD, Breser ML, Sánchez LR, Cuffini C, Rivero VE. Chlamydia trachomatis infection of the male genital tract: an update. J Reprod Immunol 2013; 100 (01) 37-53
    CrossrefPubMedGoogle Scholar
  • 38 Detels R, Green AM, Klausner JD. , et al. The incidence and correlates of symptomatic and asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infections in selected populations in five countries. Sex Transm Dis 2011; 38 (06) 503-509
    CrossrefPubMedGoogle Scholar
  • 39 Patten E, Parker K. Women in the U.S. Military: Growing Share, Distinctive Profile. Washington, DC: Pew Research Center; 2011
    Google Scholar
  • 40 Office of the Deputy Assistant Secretary of Defense for Military Community and Family Policy. 2015 Demographics Profile of the Military Community. Available at: http://download.militaryonesource.mil/12038/MOS/Reports/2015-Demographics-Report.pdf . Accessed January 24, 2019
    PubMedGoogle Scholar
  • 41 Gaydos CA, Gaydos JC. Chlamydia in the United States military: can we win this war?. Sex Transm Dis 2008; 35 (03) 260-262
    CrossrefPubMedGoogle Scholar
  • 42 Jordan NN, Lee SE, Nowak G, Johns NM, Gaydos JC. Chlamydia trachomatis reported among U.S. active duty service members, 2000-2008. Mil Med 2011; 176 (03) 312-319
    CrossrefPubMedGoogle Scholar
  • 43 Bloom MS, Hu Z, Gaydos JC, Brundage JF, Tobler SK. Incidence rates of pelvic inflammatory disease diagnoses among Army and Navy recruits potential impacts of Chlamydia screening policies. Am J Prev Med 2008; 34 (06) 471-477
    CrossrefPubMedGoogle Scholar
  • 44 Belland RJ, Zhong G, Crane DD. , et al. Genomic transcriptional profiling of the developmental cycle of Chlamydia trachomatis . Proc Natl Acad Sci U S A 2003; 100 (14) 8478-8483
    CrossrefPubMedGoogle Scholar
  • 45 Mylonas I. Female genital Chlamydia trachomatis infection: where are we heading?. Arch Gynecol Obstet 2012; 285 (05) 1271-1285
    CrossrefPubMedGoogle Scholar
  • 46 Bastidas RJ, Elwell CA, Engel JN, Valdivia RH. Chlamydial intracellular survival strategies. Cold Spring Harb Perspect Med 2013; 3 (05) a010256
    PubMedGoogle Scholar
  • 47 Abdelrahman YM, Belland RJ. The chlamydial developmental cycle. FEMS Microbiol Rev 2005; 29 (05) 949-959
    CrossrefPubMedGoogle Scholar
  • 48 Belland RJ, Nelson DE, Virok D. , et al. Transcriptome analysis of chlamydial growth during IFN-gamma-mediated persistence and reactivation. Proc Natl Acad Sci U S A 2003; 100 (26) 15971-15976
    CrossrefPubMedGoogle Scholar
  • 49 Hybiske K, Stephens RS. Mechanisms of host cell exit by the intracellular bacterium Chlamydia. Proc Natl Acad Sci U S A 2007; 104 (27) 11430-11435
    CrossrefPubMedGoogle Scholar
  • 50 Finethy R, Coers J. Sensing the enemy, containing the threat: cell-autonomous immunity to Chlamydia trachomatis . FEMS Microbiol Rev 2016; 40 (06) 875-893
    CrossrefPubMedGoogle Scholar
  • 51 Rasmussen SJ, Eckmann L, Quayle AJ. , et al. Secretion of proinflammatory cytokines by epithelial cells in response to Chlamydia infection suggests a central role for epithelial cells in chlamydial pathogenesis. J Clin Invest 1997; 99 (01) 77-87
    CrossrefPubMedGoogle Scholar
  • 52 Stephens RS. The cellular paradigm of chlamydial pathogenesis. Trends Microbiol 2003; 11 (01) 44-51
    CrossrefPubMedGoogle Scholar
  • 53 Wølner-Hanssen P, Mårdh PA. In vitro tests of the adherence of Chlamydia trachomatis to human spermatozoa. Fertil Steril 1984; 42 (01) 102-107
    CrossrefPubMedGoogle Scholar
  • 54 Friberg J, Confino E, Suarez M, Gleicher N. Chlamydia trachomatis attached to spermatozoa recovered from the peritoneal cavity of patients with salpingitis. J Reprod Med 1987; 32 (02) 120-122
    PubMedGoogle Scholar
  • 55 IJland MM, Evers JL, Dunselman GA, Hoogland HJ. ; MM IJ. Subendometrial contractions in the nonpregnant uterus: an ultrasound study. Eur J Obstet Gynecol Reprod Biol 1996; 70 (01) 23-24
    CrossrefPubMedGoogle Scholar
  • 56 Zhu H, Shen Z, Luo H, Zhang W, Zhu X. Chlamydia trachomatis infection-associated risk of cervical cancer: a meta-analysis. Medicine (Baltimore) 2016; 95 (13) e3077
    PubMedGoogle Scholar
  • 57 Heinonen PK, Miettinen A. Laparoscopic study on the microbiology and severity of acute pelvic inflammatory disease. Eur J Obstet Gynecol Reprod Biol 1994; 57 (02) 85-89
    CrossrefPubMedGoogle Scholar
  • 58 Haggerty CL, Schulz R, Ness RB. ; PID Evaluation and Clinical Health Study Investigators. Lower quality of life among women with chronic pelvic pain after pelvic inflammatory disease. Obstet Gynecol 2003; 102 (5, Pt 1): 934-939
    PubMedGoogle Scholar
  • 59 Kimani J, Maclean IW, Bwayo JJ. , et al. Risk factors for Chlamydia trachomatis pelvic inflammatory disease among sex workers in Nairobi, Kenya. J Infect Dis 1996; 173 (06) 1437-1444
    CrossrefPubMedGoogle Scholar
  • 60 Kosseim M, Brunham RC. Fallopian tube obstruction as a sequela to Chlamydia trachomatis infection. Eur J Clin Microbiol 1986; 5 (05) 584-590
    CrossrefPubMedGoogle Scholar
  • 61 Armed Forces Health Surveillance Center (AFHSC). Acute pelvic inflammatory disease, active component, U.S. Armed Forces, 2002-2011. MSMR 2012; 19 (07) 11-13
    PubMedGoogle Scholar
  • 62 Owings AJ, Clark LL, Rohrbeck P. Incident and recurrent Chlamydia trachomatis and Neisseria gonorrhoeae infections, active component, U.S. Armed Forces, 2010-2014. MSMR 2016; 23 (02) 20-28
    PubMedGoogle Scholar
  • 63 Hillis SD, Joesoef R, Marchbanks PA, Wasserheit JN, Cates Jr W, Westrom L. Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility. Am J Obstet Gynecol 1993; 168 (05) 1503-1509
    CrossrefPubMedGoogle Scholar
  • 64 Weström L, Bengtsson LP, Mårdh PA. Incidence, trends, and risks of ectopic pregnancy in a population of women. Br Med J (Clin Res Ed) 1981; 282 (6257): 15-18
    CrossrefPubMedGoogle Scholar
  • 65 Lyons RA, Saridogan E, Djahanbakhch O. The reproductive significance of human Fallopian tube cilia. Hum Reprod Update 2006; 12 (04) 363-372
    CrossrefPubMedGoogle Scholar
  • 66 Ajonuma LC, Ng EH, Chan HC. New insights into the mechanisms underlying hydrosalpinx fluid formation and its adverse effect on IVF outcome. Hum Reprod Update 2002; 8 (03) 255-264
    CrossrefPubMedGoogle Scholar
  • 67 Hafner LM. Pathogenesis of fallopian tube damage caused by Chlamydia trachomatis infections. Contraception 2015; 92 (02) 108-115
    CrossrefPubMedGoogle Scholar
  • 68 Weström L, Joesoef R, Reynolds G, Hagdu A, Thompson SE. Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis 1992; 19 (04) 185-192
    CrossrefPubMedGoogle Scholar
  • 69 Zeyneloglu HB, Arici A, Olive DL. Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization-embryo transfer. Fertil Steril 1998; 70 (03) 492-499
    CrossrefPubMedGoogle Scholar
  • 70 Camus E, Poncelet C, Goffinet F. , et al. Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies. Hum Reprod 1999; 14 (05) 1243-1249
    CrossrefPubMedGoogle Scholar
  • 71 Berg CJ, Callaghan WM, Syverson C, Henderson Z. Pregnancy-related mortality in the United States, 1998 to 2005. Obstet Gynecol 2010; 116 (06) 1302-1309
    CrossrefPubMedGoogle Scholar
  • 72 Creanga AA, Shapiro-Mendoza CK, Bish CL, Zane S, Berg CJ, Callaghan WM. Trends in ectopic pregnancy mortality in the United States: 1980-2007. Obstet Gynecol 2011; 117 (04) 837-843
    CrossrefPubMedGoogle Scholar
  • 73 Donnez J, Nisolle M. Endoscopic management of ectopic pregnancy. Baillieres Clin Obstet Gynaecol 1994; 8 (04) 707-722
    CrossrefPubMedGoogle Scholar
  • 74 Female infertility, active component service women, U.S. Armed Forces, 2000-2012. MSMR 2013; 20 (09) 8-12
    PubMedGoogle Scholar
  • 75 Rivera-Alsina ME, Crisan LS. Management of ectopic pregnancy in the military during deployment to Southwest Asia. Mil Med 2008; 173 (01) 97-99
    CrossrefPubMedGoogle Scholar
  • 76 Stamilio DM, McReynolds T, Endrizzi J, Lyons RC. Diagnosis and treatment of a ruptured ectopic pregnancy in a combat support hospital during Operation Iraqi Freedom: case report and critique of a field-ready sonographic device. Mil Med 2004; 169 (09) 681-683
    CrossrefPubMedGoogle Scholar
  • 77 Barnhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med 2009; 361 (04) 379-387
    CrossrefPubMedGoogle Scholar
  • 78 Wedderburn CJ, Warner P, Graham B, Duncan WC, Critchley HO, Horne AW. Economic evaluation of diagnosing and excluding ectopic pregnancy. Hum Reprod 2010; 25 (02) 328-333
    CrossrefPubMedGoogle Scholar
  • 79 Mol BW, Hajenius PJ, Engelsbel S. , et al. Treatment of tubal pregnancy in the Netherlands: an economic comparison of systemic methotrexate administration and laparoscopic salpingostomy. Am J Obstet Gynecol 1999; 181 (04) 945-951
    CrossrefPubMedGoogle Scholar
  • 80 Yeh JM, Hook III EW, Goldie SJ. A refined estimate of the average lifetime cost of pelvic inflammatory disease. Sex Transm Dis 2003; 30 (05) 369-378
    CrossrefPubMedGoogle Scholar
  • 81 Haggerty CL, Peipert JF, Weitzen S. , et al; PID Evaluation and Clinical Health (PEACH) Study Investigators. Predictors of chronic pelvic pain in an urban population of women with symptoms and signs of pelvic inflammatory disease. Sex Transm Dis 2005; 32 (05) 293-299
    CrossrefPubMedGoogle Scholar
  • 82 Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol 1996; 87 (03) 321-327
    CrossrefPubMedGoogle Scholar
  • 83 Crisp CD, Hastings-Tolsma M, Jonscher KR. Mindfulness-based stress reduction for military women with chronic pelvic pain: a feasibility study. Mil Med 2016; 181 (09) 982-989
    CrossrefPubMedGoogle Scholar
  • 84 Wright Jr J, Albright TS, Gehrich AP, Dunlow SG, Lettieri CF, Buller JL. Pelvic pain presenting in a combat environment. Mil Med 2006; 171 (09) 841-843
    CrossrefPubMedGoogle Scholar
  • 85 Centers for Disease Control and Prevention. Sexually transmitted disease surveillance. Atlanta, GA: US Department of Health and Human Services; 2017
    Google Scholar
  • 86 Satterwhite CL, Torrone E, Meites E. , et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis 2013; 40 (03) 187-193
    CrossrefPubMedGoogle Scholar
  • 87 Cuffe KM, Newton-Levinson A, Gift TL, McFarlane M, Leichliter JS. Sexually transmitted infection testing among adolescents and young adults in the United States. J Adolesc Health 2016; 58 (05) 512-519
    CrossrefPubMedGoogle Scholar
  • 88 Webber BJ, Pawlak MT, Jones NM, Tchandja JN, Foster GA. Sexually transmitted infections in U.S. Air Force recruits in basic military training. MSMR 2016; 23 (02) 16-19
    PubMedGoogle Scholar
  • 89 Arcari CM, Gaydos JC, Howell MR, McKee KT, Gaydos CA. Feasibility and short-term impact of linked education and urine screening interventions for Chlamydia and gonorrhea in male army recruits. Sex Transm Dis 2004; 31 (07) 443-447
    CrossrefPubMedGoogle Scholar
  • 90 Boyer CB, Shafer MA, Shaffer RA. , et al. Evaluation of a cognitive-behavioral, group, randomized controlled intervention trial to prevent sexually transmitted infections and unintended pregnancies in young women. Prev Med 2005; 40 (04) 420-431
    CrossrefPubMedGoogle Scholar
  • 91 MacDonald MR. Sexual Health and Responsibility Program (SHARP): preventing HIV, STIs, and unplanned pregnancies in the navy and marine corps. Public Health Rep 2013; 128 (Suppl. 01) 81-88
    CrossrefPubMedGoogle Scholar
  • 92 MacDonald MR. Sexual Health and Responsibility Program (SHARP): preventing HIV, STIs and unplanned pregnancies in the navy and marine corps. Public Health Rep 2013; 128 Suppl 1: 81-88
    CrossrefPubMedGoogle Scholar
  • 93 Tourdot LE, Jordan NN, Leamer NK, Nowak G, Gaydos JC. Incidence of Chlamydia trachomatis infections and screening compliance, U.S. Army active duty females under 25 years of age, 2011-2014. MSMR 2016; 23 (02) 29-31
    PubMedGoogle Scholar
  • 94 Centers for Disease Control and Prevention. Male Chlamydia Screening Consultation: Meeting Report. Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, U.S. Department of Health and Human Services; 2006
    Google Scholar
  • 95 Jordan NN, Clemmons NS, Gaydos JC, Lee HC, Yi SH, Klein TA. Chlamydia trachomatis screening initiative among U.S. Army soldiers assigned to Korea. MSMR 2013; 20 (02) 15-16
    PubMedGoogle Scholar
  • 96 Aptima. Chlamydia trachomatis Assay Package Insert. Available at: https://www.hologic.com/sites/default/files/package-insert/502485-IFU-PI_001_01.pdf . Accessed February 8, 2019
    PubMed
  • 97 Abott. RealTime CT/NG Package Insert. Available at: https://www.molecular.abbott/sal/en-us/staticAssets/ctng-8l07-91-us-final.pdf . Accessed October 9, 2018
    PubMed
  • 98 Pai NP, Wilkinson S, Deli-Houssein R. , et al. Barriers to implementation of rapid and point-of-care tests for human immunodeficiency virus infection: findings from a systematic review (1996-2014). Point Care 2015; 14 (03) 81-87
    PubMedGoogle Scholar
  • 99 Widdice LE, Hsieh YH, Silver B, Barnes M, Barnes P, Gaydos CA. Performance of the Atlas rapid test for Chlamydia trachomatis and women's attitudes toward point-of-care testing. Sex Transm Dis 2018; 45 (11) 723-727
    CrossrefPubMedGoogle Scholar
  • 100 Gift TL, Pate MS, Hook III EW, Kassler WJ. The rapid test paradox: when fewer cases detected lead to more cases treated: a decision analysis of tests for Chlamydia trachomatis . Sex Transm Dis 1999; 26 (04) 232-240
    CrossrefPubMedGoogle Scholar
  • 101 Hack JB, Hecht C. Emergency physicians' patterns of treatment for presumed gonorrhea and chlamydia in women: one center's practice. J Emerg Med 2009; 37 (03) 257-263
    CrossrefPubMedGoogle Scholar
  • 102 Wang SA, Papp JR, Stamm WE, Peeling RW, Martin DH, Holmes KK. Evaluation of antimicrobial resistance and treatment failures for Chlamydia trachomatis: a meeting report. J Infect Dis 2005; 191 (06) 917-923
    CrossrefPubMedGoogle Scholar
  • 103 Gérard HC, Whittum-Hudson JA, Schumacher HR, Hudson AP. Differential expression of three Chlamydia trachomatis hsp60-encoding genes in active vs. persistent infections. Microb Pathog 2004; 36 (01) 35-39
    CrossrefPubMedGoogle Scholar
  • 104 Dean D, Schachter J, Dawson CR, Stephens RS. Comparison of the major outer membrane protein variant sequence regions of B/Ba isolates: a molecular epidemiologic approach to Chlamydia trachomatis infections. J Infect Dis 1992; 166 (02) 383-392
    CrossrefPubMedGoogle Scholar
  • 105 Jones RB, Van der Pol B, Martin DH, Shepard MK. Partial characterization of Chlamydia trachomatis isolates resistant to multiple antibiotics. J Infect Dis 1990; 162 (06) 1309-1315
    CrossrefPubMedGoogle Scholar
  • 106 Somani J, Bhullar VB, Workowski KA, Farshy CE, Black CM. Multiple drug-resistant Chlamydia trachomatis associated with clinical treatment failure. J Infect Dis 2000; 181 (04) 1421-1427
    CrossrefPubMedGoogle Scholar
  • 107 Lewis K. Persister cells, dormancy and infectious disease. Nat Rev Microbiol 2007; 5 (01) 48-56
    CrossrefPubMedGoogle Scholar
  • 108 Sandoz KM, Rockey DD. Antibiotic resistance in Chlamydiae. Future Microbiol 2010; 5 (09) 1427-1442
    CrossrefPubMedGoogle Scholar
  • 109 Seña AC, Lensing S, Rompalo A. , et al. Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis infections in men with nongonococcal urethritis: predictors and persistence after therapy. J Infect Dis 2012; 206 (03) 357-365
    CrossrefPubMedGoogle Scholar
  • 110 Khosropour CM, Bell TR, Hughes JP, Manhart LE, Golden MR. A population-based study to compare treatment outcomes among women with urogenital chlamydial infection in Washington State, 1992 to 2015. Sex Transm Dis 2018; 45 (05) 319-324
    CrossrefPubMedGoogle Scholar
  • 111 Kong FY, Tabrizi SN, Fairley CK. , et al. The efficacy of azithromycin and doxycycline for the treatment of rectal chlamydia infection: a systematic review and meta-analysis. J Antimicrob Chemother 2015; 70 (05) 1290-1297
    CrossrefPubMedGoogle Scholar
  • 112 CDC. Sexually Transmitted Diseases. 2015. STD Treatment Guidelines 2017. Available at: https://www.cdc.gov/std/tg2015/chlamydia.htm . Accessed October 9, 2018
    PubMedGoogle Scholar
  • 113 Rose SB, Garrett SM, Kennedy J. , et al. Partner notification and retesting for Chlamydia trachomatis and Neisseria gonorrhoeae: a case-note review in New Zealand primary care. J Prim Health Care 2018; 10 (02) 132-139
    CrossrefPubMedGoogle Scholar
  • 114 Götz HM, Hoebe CJ, Van Bergen JE. , et al. Management of Chlamydia cases and their partners: results from a home-based screening program organized by municipal public health services with referral to regular health care. Sex Transm Dis 2005; 32 (10) 625-629
    CrossrefPubMedGoogle Scholar
  • 115 Kachur R, Adelson S, Firenze K, Herrera M. Reaching patients and their partners through mobile: text messaging for case management and partner notification. Sex Transm Dis 2011; 38 (02) 149-150
    CrossrefPubMedGoogle Scholar
  • 116 Woodhall SC, Gorwitz RJ, Migchelsen SJ. , et al. Advancing the public health applications of Chlamydia trachomatis serology. Lancet Infect Dis 2018; 18 (12) e399-e407
    CrossrefPubMedGoogle Scholar
  • 117 de la Maza LM, Zhong G, Brunham RC. Update on Chlamydia trachomatis vaccinology. Clin Vaccine Immunol 2017; 24 (04) e00543-16
    CrossrefPubMedGoogle Scholar
  • 118 Poston TB, Darville T. Chlamydia trachomatis: protective adaptive responses and prospects for a vaccine. Curr Top Microbiol Immunol 2018; 412: 217-237
    PubMedGoogle Scholar
  • 119 Brunham RC, Rappuoli R. Chlamydia trachomatis control requires a vaccine. Vaccine 2013; 31 (15) 1892-1897
    CrossrefPubMedGoogle Scholar
  • 120 Newman L, Rowley J, Vander Hoorn S. , et al. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS One 2015; 10 (12) e0143304
    CrossrefPubMedGoogle Scholar
  • 121 Brunham RC, Rey-Ladino J. Immunology of chlamydia infection: implications for a Chlamydia trachomatis vaccine. Nat Rev Immunol 2005; 5 (02) 149-161
    CrossrefPubMedGoogle Scholar
  • 122 Roan NR, Starnbach MN. Immune-mediated control of chlamydia infection. Cell Microbiol 2008; 10 (01) 9-19
    PubMedGoogle Scholar
  • 123 Rank RG, Lacy HM, Goodwin A. , et al. Host chemokine and cytokine response in the endocervix within the first developmental cycle of Chlamydia muridarum . Infect Immun 2010; 78 (01) 536-544
    CrossrefPubMedGoogle Scholar
  • 124 Johnson RM, Yu H, Strank NO, Karunakaran K, Zhu Y, Brunham RC. B cell presentation of chlamydia antigen selects out protective CD4γ13 T cells: implications for genital tract tissue-resident memory lymphocyte clusters. Infect Immun 2018; 86 (02) e00614-17
    PubMedGoogle Scholar
  • 125 Peeling R, Maclean IW, Brunham RC. In vitro neutralization of Chlamydia trachomatis with monoclonal antibody to an epitope on the major outer membrane protein. Infect Immun 1984; 46 (02) 484-488
    CrossrefPubMedGoogle Scholar
  • 126 Megran DW, Stiver HG, Peeling R, Maclean IW, Brunham RC. Complement enhancement of neutralizing antibody to the structural proteins of Chlamydia trachomatis . J Infect Dis 1988; 158 (03) 661-663
    CrossrefPubMedGoogle Scholar
  • 127 Pal S, Theodor I, Peterson EM, de la Maza LM. Monoclonal immunoglobulin A antibody to the major outer membrane protein of the Chlamydia trachomatis mouse pneumonitis biovar protects mice against a chlamydial genital challenge. Vaccine 1997; 15 (05) 575-582
    CrossrefPubMedGoogle Scholar
  • 128 Li LX, McSorley SJ. A re-evaluation of the role of B cells in protective immunity to Chlamydia infection. Immunol Lett 2015; 164 (02) 88-93
    CrossrefPubMedGoogle Scholar
  • 129 Gottlieb SL, Deal CD, Giersing B. , et al. The global roadmap for advancing development of vaccines against sexually transmitted infections: update and next steps. Vaccine 2016; 34 (26) 2939-2947
    CrossrefPubMedGoogle Scholar
  • 130 Van Horn AS, Reed SA. Medical and psychological aspects of infertility and assisted reproductive technology for the primary care provider. Mil Med 2001; 166 (11) 1018-1022
    CrossrefPubMedGoogle Scholar
  • 131 Office for Emergency Management. “From Time Immemorial”. Available at: https://commons.wikimedia.org/wiki/File:%22From_Time_Immemorial%22_-_NARA_-_514338.jpg . Accessed November 25, 2018
    PubMed