Long-term eradication of Chlamydia trachomatis genital infection after antimicrobial therapy. Evidence against persistent infection

JAMA. 1993 Nov 3;270(17):2071-5.


Objective: To determine whether Chlamydia trachomatis urogenital infections persist or relapse after antimicrobial therapy by serial measurement of chlamydial-specific DNA using the polymerase chain reaction (PCR), cell cultures, and serological studies.

Design: Prospective evaluation of an inception cohort.

Setting: University student health clinic.

Participants: Twenty women with culture-proven and PCR-proven C trachomatis urogenital infections.

Measurements: Incidence of persistent infection as determined by PCR, culture, and serial measurement of local and systemic antibody to C trachomatis for 5 months after doxycycline therapy.

Results: Prior to therapy, C trachomatis was isolated in cell culture from the cervix in 19 of 20 women, from the urethra in 13 women, and from the rectum in 13 women. All culture-positive specimens were also PCR-positive. Immediately after completion of antimicrobial therapy, all women had negative cell cultures for chlamydia. Ten of 20 culture-negative cervical specimens and two culture-negative urethral specimens had chlamydial DNA present immediately after treatment. In addition, three women had detectable DNA from cervical specimens 1 week after treatment. The presence of cervicitis (P = .01), high inclusion counts (P = .004), and serological evidence of recent infection (P = .0004) were each significantly associated with PCR positivity after treatment. All 384 subsequent cervical, rectal, and urethral specimens collected over 5 months were negative by both PCR and culture with the exception of one woman who was reinfected. Serum immunoglobulin M (IgM) titers, geometric mean serum immunoglobulin G (IgG) titers, and prevalence of local antibody to chlamydia progressively declined after treatment.

Conclusions: Standard antimicrobial therapy is effective in the long-term microbiologic eradication of uncomplicated C trachomatis urogenital infections. The presence of chlamydial DNA after antimicrobial therapy is of short duration and reflects excretion of nonviable organisms rather than persistent infection.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Antibodies, Fungal / blood
  • Chlamydia Infections / diagnosis
  • Chlamydia Infections / drug therapy*
  • Chlamydia Infections / immunology
  • Chlamydia trachomatis / isolation & purification*
  • Cohort Studies
  • DNA, Fungal / analysis
  • Doxycycline / therapeutic use*
  • Female
  • Female Urogenital Diseases / diagnosis
  • Female Urogenital Diseases / drug therapy
  • Female Urogenital Diseases / microbiology*
  • Humans
  • Polymerase Chain Reaction
  • Prospective Studies
  • Recurrence


  • Antibodies, Fungal
  • DNA, Fungal
  • Doxycycline