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Infection uro-génitale masculine àChlamydia trachomatis: Vers une meilleure approche diagnostique

Chlamydia trachomatis infection in men. Towards a better diagnostic approach

Andrologie volume 14, pages 206–215 (2004)Cite this article

Resume

LesChlamydia sont des bactéries intracellulaires responsables principalement d'infections sexuellement transmissibles (IST). Ces infections sont très souvent asymptomatiques et constituent un risque important de complications et de transmission. Le diagnostic direct d'une infection symptomatique àChlamydia trachomatis peut être réalisé par la mise en évidence de la bactérie vivante par culture cellulaire, de ses antigènes par immunofluorescence directe (IFD) ou par les techniques immunoenzymatiques et apparentées, de ses acides nucléiques par hybridation moléculaire ou par amplification génique. Au cours d'une infection asymptomatique, chronique ou persistante, la charge bactérienne est faible et les bactéries sont très souvent non cultivables et expriment des antigènes différents. La culture cellulaire et les techniques habituelles de mise en évidence des antigènes peuvent être négatives, ce qui implique l'utilisation des techniques de détection des acides nucléiques avec amplification associée éventuellement à un diagnostic sérologique.

L'utilisation des techniques d'amplification a considérablement amélioré le diagnostic direct des infections àChlamydia et offre, en plus, l'opportunité d'utiliser des prélèvements non invasifs (urine du premier jet, sperme) pour le déplstage des sujets asymptomatiques.

Abstract

Chlamydia trachomatis is the most frequently sexually transmitted pathogen in humans, with an estimated 92 million new cases occurring worldwide each year, However, this number is probably underestimated, particularly for men who are less likely to be screened than women.

C. trachomatis serovar D-K causes a variety of clinical syndromes in men and women.

C. trachomatis may cause urethritis, epididymitis and prostatitis in young sexually active men, less than 35 years of age. 50% of infected men remain asymptomatic. Sexually active males with asymptomatic urethritis constitute a significant reservoir of potential infection for women, in whom the consequences of lower genital tract infection are likely to be more severe.

Chlamydial infections have never been easy to diagnose.

Because Chlamydiae are obligate intracellular pathogens, the objective of specimen collection should usually be to include the host cells that harbour the organisms. The sensitivity and specificity of diagnostic tests forC. trachomatis have been shown to be directly related to the adequacy of the specimen.

Infection may be symptomatic or asymptomatic with a small number of elementary bodies present at the site of infection.

The conventional approach to laboratory diagnostic testing forC. trachomatis infections consisted of cell culture of inocula prepared from urogenital specimens. Cell culture requires appropriate collection of cell scrapings from the urethra, and optimal transport and storage conditions of specimens to preserve viable organisms.

Antigen and nucleic acid detection technologies were developed during the 1980s and have been extensively applied to diagnosis due to their lower cost, a lower level of expertise, preservation of infectivity during transport, and a shorter time to obtain the results. Unfortunately, most of these tests are less sensitive thanin vitro cell culture, and may miss a large number ofChlamydia infected individuals.

Nucleic acid amplification technologies have therefore been developed, and application of these tests has shown that culture is not as sensitive as previously believed and that the prevalence ofC. trachomatis infection is higher in most populations. These assays can use non-invasive specimens such as first void urine and semen, and do not require special storage conditions.

Advantages of nucleic acid amplification tests are their ability to detect even a small amount of organisms. This enables a high detection rate forC. trachomatis in symptomatic persons, diagnosis of chlamydial infections in asymptomatic individuals with a small number of elementary bodies, and diagnosis of persistent infections.

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  1. Laboratoire de Bactériologie-Hygiène, CHU d'Amiens, Place Victor Pauchet, 80054, Amiens Cedex 1

    Farida Hamdad-Daoudi, Jeanne Orfila & François Eb

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  1. Farida Hamdad-Daoudi
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Correspondence to Farida Hamdad-Daoudi.

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Hamdad-Daoudi, F., Orfila, J. & Eb, F. Infection uro-génitale masculine àChlamydia trachomatis: Vers une meilleure approche diagnostique. Androl. 14, 206–215 (2004). https://doi.org/10.1007/BF03034796

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Basic and Clinical Andrology

ISSN: 2051-4190