Chlamydial Infection Prevalence in Human Immunodeficiency Virus Patients | Teja | International Journal of Integrated Health Sciences 107 355 1 PB
Original Aricle
Chlamydial Infecion Prevalence in Human Immunodeiciency Virus Paients
Feilicia Henrica Teja,1 Rasmia Rowawi,2 Asmaja Soedarwoto,2 Diah Puspitosari,1 Rini Rasiani,1
Rahmatdinata,2 Tony Djajakusumah2
Faculty of Medicine, Universitas Padjdajaran-Dr. Hasan Sadikin General Hospital
Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjajaran-Dr. Hasan Sadikin
General Hospital
1
2
Abstract
Objecive: To determine the prevalence of chlamydial infecion in male urethra
and female cervix of HIV-posiive paients based on PCR assay in Teratai Clinic,
Dr. Hasan Sadikin General Hospital Bandung.
Methods: A cross secional observaional study with consecuive sampling
method, which was conducted in Teratai Clinic during the month of July 2012.
All paricipants underwent history taking, physical examinaion, and PCR assay
for C. trachomais. Swab samples were obtained from male urethra and female
endocervix.
Results: Eighty one HIV-posiive paients, consisted of 48 males and 33 females
were included in this study. The PCR examinaion for C. trachomais was posiive
in 14 of 81 subjects (17.3%), with 10 (20.8%) urethral chlamydial infecion in 48
males and four (12.1%) cervical chlamydial infecion in 33 females.
Received:
January 1, 2013
Revised:
March 7, 2013
Accepted:
May 21, 2013
Conclusions: The study concluded that the prevalence of chlamydial infecion in
male urethra and female cervix of HIV-posiive paients were 20.8% and 12.1%,
respecively. Idenifying chlamydial infecion based on PCR tesing should be
considered for rouine screening test in HIV-posiive paients.
Keywords: Chlamydia trachomais, HIV, prevalence, PCR
IJIHS. 2013;1(1):42–8
Introducion
Worldwide, Chlamydia trachomais is one
of the most common eiologies for sexually
transmited infecion.1 In 2009, 92 million new
cases of chlamydial infecion were reported by
World Health Organizaion, including 43 million
cases in South and South-East Asia.2 Most of
chlamydial infecions are asymptomaic (70% in
female and 20–30% in male),3 making it diicult
to diagnose clinically.1 Nowadays, polymerase
chain reacion (PCR) method has been approved
by the Food and Drug Administraion (FDA)
as the new gold standard for the diagnosis
of chlamydial infecion.4 In comparison with
culture, the PCR method has higher sensiivity in
detecing chlamydial infecion (90.4% vs 70.8%)
which makes it the best method for screening.5
Correspondence:
Feilicia Henrica Teja, Faculty of Medicine, Universitas
Padjadjaran-Dr. Hasan Sadikin General Hospital
Jl. Pasteur No. 38, Bandung, Indonesia
e-mail: feilicia.t@gmail.com
42
Acquired immunodeiciency syndrome (AIDS)
caused by human immunodeiciency virus (HIV)
has become a great public health concern.6 In
2009, the United Naions joint program on HIV/
AIDS (UNAIDS) esimated 33.3 million cases
of HIV infecion with 4.1 million cases in South
and South East Asia.7 Unil September 2012,
Indonesian Ministry of Health reported 92,251
cases of HIV infecions with most of them (50.8%)
are heterosexually transmited.8
The available epidemiological data showed
that there is “epidemiological synergy” between
sexually transmited infecions (STI) and HIV
transmission.9 HIV transmission will increase 10
fold in STI and HIV co-infected paient10 and HIVposiive paient has higher risk of being infected
with other STIs. High risk sexual behaviors and
drug abuse are the two main factors causing STI
and HIV co-infecion.11 Both ulcerated and nonulcerated STIs may increase the risk of acquiring
and transmiing HIV.12 Ulcerated STIs increase
the risk of acquiring HIV 5 to 10 folds, while nonulcerated STIs increase the risk 2 to 5 folds.13
Internaional Journal of Integrated Health Sciences. 2013;1(1):42–8
Feilicia Henrica Teja, Rasmia Rowawi, et al.
Although the impact of non-ulcerated STIs is
smaller than ulcerated STIs, non-ulcerated STIs
are more commonly found and, therefore, could
also increase the HIV epidemic.14
In 2008, it was reported in a study that the
prevalence of STI in HIV paients in Washington
was 8% with 19.4% of them were infected
by C. trachomais.15 Meanwhile, in India, the
prevalence of chlamydial infecion in HIV
paients in 2011 was 7%.16
Sexually transmited infecions among HIVposiive paients usually suggest high risk sexual
behaviors and HIV transmission to uninfected
populaion.17 High-risk sexual behavior seems
to be coninually praciced among HIV-posiive
populaion.12 To decrease associated morbidity
and prevent the secondary spread of HIV and
STIs, prevenion eforts should focus on HIVposiive paients who coninue to be engaged in
high-risk sexual pracices.
Correcions of high-risk behavior and STI
management could decrease the risk of HIV
transmission as it is reported that .viral shedding
in HIV-posiive paients decreased signiicantly
ater the STIs were treated.18–20 A study on STI
intervenion with syndromic management in
several populaions in Mwanza has shown a
successful reducion of HIV incidence by 38%.21
Unil currently, there has been no study
conducted on the prevalence of chlamydial
infecion in HIV-posiive paients in Indonesia.
Therefore, this study will be the irst one that
aims to determine the prevalence of chlamydial
infecion in male urethra and female cervix of
HIV-posiive paients in Indonesia.
Methods
Study populaion
This study was conducted at Teratai Clinic in
Dr. Hasan Sadikin General Hospital, Bandung
during the month of July 2012. Sexually acive
HIV-posiive paients atending Teratai Clinic
were ofered to paricipate in this study. Eighty
one HIV-posiive paricipants (48 males and 33
females) were enrolled ater writen informed
consent was obtained. Women having her
menstrual period were excluded from the study.
The HIV serostatus of the study populaion
was determined and conirmed before this study
according to the Naional Guideline for HIV/
AIDS. Comprehensive data on characterisics
and sexual history of the paients were collected
through history taking and medical records.
History taking, clinical examinaion, and specimen
collecions were conducted in Teratai Clinic,
while the specimen processing was conducted
in Biology Molecular Laboratory, Microbiology
Department of Health Research Unit, Faculty of
Medicine, Universitas Padjadjaran.
The study was approved by the Ethical
Commitee of Faculty of Medicine, Universitas
Padjadjaran-Dr. Hasan Sadikin General Hospital
Bandung.
Specimen collecion method
Urethral swab of male paients and endocervical
swab of female paients were collected using
specimen collecion kit (Roche) and transported
to the laboratory in Chlamydia transport tubes
(Roche), on the day of collecion. At the laboratory,
urethral and endocervical swab specimens for
PCR assay were prepared immediately according
to the instrucion, frozen at -20 °C, and analyzed
within 14 days of sampling.
Specimen processing method
The Roche Amplicor PCR Assay was used (the PCR
was accomplished with thermocycler). Ater the
ampliicaion, the ampliied nucleoide sequences
were detected by an enzyme immunoassay and
the opical density at wave length 450 nm was
measured using a spectrophotometer. A posiive
result was deined as a reading above 0.5 while
the result was considered equivocal when the
reading is between 0.2 to 0.5. A negaive result
was assigned for a reading below 0.2. Staisical
analysis was performed using SPSS 17.0
Results
During the study, 81 HIV-posiive paricipants
were screened for chlamydial infecion. Among
the 81 paients tested, 14 chlamydial infecions
were ideniied with 10 in male urethra and 4 in
cervix. The prevalence of chlamydial infecion in
this study was 17.4%. Meanwhile, the prevalence
of urethral chlamydial infecion in male was
20.8% and cervical chlamydial infecion in female
was 12.1%.
A list of the 81 HIV-posiive paricipants in this
study is presented in Table 1. Male paricipants
comprised 59.3% of the total paricipants and
69.1% paricipants were in 25–35 years old
group. Half of the paricipants were high-school
graduates, 43.2% were self employed, and 55.6%
were married.
Most of paricipants who were infected
with Chlamydia was in the age group of 25–35
years old, with 17.9% of them were Chlamydia
posiive (Table 2). C. trachomais was detected
in 20.8% males and 12.1% females. Both single
and divorced groups were infected with C.
trachomais as many as 27.8%. This number is
Internaional Journal of Integrated Health Sciences. 2013;1(1):42–8
43
Chlamydial Infecion Prevalence in Human Immunodeiciency Virus Paients
much higher compared to only 8.9% of married
group that were infected by C. trachomais.
more carefully to understand the real condom
use behavior.
Table 1 Baseline Characterisics of Paricipants
Table 2 Characterisics of Paricipants with Posiive
C. trachomais
Variable
n
%
Age (yrs.)
Variable
35
20
25
Male
48
59
Female
33
41
No educaion
0
0
Elementary school
4
5
Junior High school
4
5
Senior High school
41
51
College/university
32
40
Self employed
35
43
Civil servant
1
1
Working class
20
25
Commercial sex worker
1
1
Student
1
1
Not working
23
28
Single
18
22
Married
45
56
Divorced
18
22
C. trachomais
Total
(+)
(-)
n
1
4
5
25–35
10
46
56
>35
3
17
20
Male
10
38
48
Female
4
29
33
5
13
18
6
Age (yrs.)
Chlamydial Infecion Prevalence in Human Immunodeiciency Virus Paients
Feilicia Henrica Teja,1 Rasmia Rowawi,2 Asmaja Soedarwoto,2 Diah Puspitosari,1 Rini Rasiani,1
Rahmatdinata,2 Tony Djajakusumah2
Faculty of Medicine, Universitas Padjdajaran-Dr. Hasan Sadikin General Hospital
Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjajaran-Dr. Hasan Sadikin
General Hospital
1
2
Abstract
Objecive: To determine the prevalence of chlamydial infecion in male urethra
and female cervix of HIV-posiive paients based on PCR assay in Teratai Clinic,
Dr. Hasan Sadikin General Hospital Bandung.
Methods: A cross secional observaional study with consecuive sampling
method, which was conducted in Teratai Clinic during the month of July 2012.
All paricipants underwent history taking, physical examinaion, and PCR assay
for C. trachomais. Swab samples were obtained from male urethra and female
endocervix.
Results: Eighty one HIV-posiive paients, consisted of 48 males and 33 females
were included in this study. The PCR examinaion for C. trachomais was posiive
in 14 of 81 subjects (17.3%), with 10 (20.8%) urethral chlamydial infecion in 48
males and four (12.1%) cervical chlamydial infecion in 33 females.
Received:
January 1, 2013
Revised:
March 7, 2013
Accepted:
May 21, 2013
Conclusions: The study concluded that the prevalence of chlamydial infecion in
male urethra and female cervix of HIV-posiive paients were 20.8% and 12.1%,
respecively. Idenifying chlamydial infecion based on PCR tesing should be
considered for rouine screening test in HIV-posiive paients.
Keywords: Chlamydia trachomais, HIV, prevalence, PCR
IJIHS. 2013;1(1):42–8
Introducion
Worldwide, Chlamydia trachomais is one
of the most common eiologies for sexually
transmited infecion.1 In 2009, 92 million new
cases of chlamydial infecion were reported by
World Health Organizaion, including 43 million
cases in South and South-East Asia.2 Most of
chlamydial infecions are asymptomaic (70% in
female and 20–30% in male),3 making it diicult
to diagnose clinically.1 Nowadays, polymerase
chain reacion (PCR) method has been approved
by the Food and Drug Administraion (FDA)
as the new gold standard for the diagnosis
of chlamydial infecion.4 In comparison with
culture, the PCR method has higher sensiivity in
detecing chlamydial infecion (90.4% vs 70.8%)
which makes it the best method for screening.5
Correspondence:
Feilicia Henrica Teja, Faculty of Medicine, Universitas
Padjadjaran-Dr. Hasan Sadikin General Hospital
Jl. Pasteur No. 38, Bandung, Indonesia
e-mail: feilicia.t@gmail.com
42
Acquired immunodeiciency syndrome (AIDS)
caused by human immunodeiciency virus (HIV)
has become a great public health concern.6 In
2009, the United Naions joint program on HIV/
AIDS (UNAIDS) esimated 33.3 million cases
of HIV infecion with 4.1 million cases in South
and South East Asia.7 Unil September 2012,
Indonesian Ministry of Health reported 92,251
cases of HIV infecions with most of them (50.8%)
are heterosexually transmited.8
The available epidemiological data showed
that there is “epidemiological synergy” between
sexually transmited infecions (STI) and HIV
transmission.9 HIV transmission will increase 10
fold in STI and HIV co-infected paient10 and HIVposiive paient has higher risk of being infected
with other STIs. High risk sexual behaviors and
drug abuse are the two main factors causing STI
and HIV co-infecion.11 Both ulcerated and nonulcerated STIs may increase the risk of acquiring
and transmiing HIV.12 Ulcerated STIs increase
the risk of acquiring HIV 5 to 10 folds, while nonulcerated STIs increase the risk 2 to 5 folds.13
Internaional Journal of Integrated Health Sciences. 2013;1(1):42–8
Feilicia Henrica Teja, Rasmia Rowawi, et al.
Although the impact of non-ulcerated STIs is
smaller than ulcerated STIs, non-ulcerated STIs
are more commonly found and, therefore, could
also increase the HIV epidemic.14
In 2008, it was reported in a study that the
prevalence of STI in HIV paients in Washington
was 8% with 19.4% of them were infected
by C. trachomais.15 Meanwhile, in India, the
prevalence of chlamydial infecion in HIV
paients in 2011 was 7%.16
Sexually transmited infecions among HIVposiive paients usually suggest high risk sexual
behaviors and HIV transmission to uninfected
populaion.17 High-risk sexual behavior seems
to be coninually praciced among HIV-posiive
populaion.12 To decrease associated morbidity
and prevent the secondary spread of HIV and
STIs, prevenion eforts should focus on HIVposiive paients who coninue to be engaged in
high-risk sexual pracices.
Correcions of high-risk behavior and STI
management could decrease the risk of HIV
transmission as it is reported that .viral shedding
in HIV-posiive paients decreased signiicantly
ater the STIs were treated.18–20 A study on STI
intervenion with syndromic management in
several populaions in Mwanza has shown a
successful reducion of HIV incidence by 38%.21
Unil currently, there has been no study
conducted on the prevalence of chlamydial
infecion in HIV-posiive paients in Indonesia.
Therefore, this study will be the irst one that
aims to determine the prevalence of chlamydial
infecion in male urethra and female cervix of
HIV-posiive paients in Indonesia.
Methods
Study populaion
This study was conducted at Teratai Clinic in
Dr. Hasan Sadikin General Hospital, Bandung
during the month of July 2012. Sexually acive
HIV-posiive paients atending Teratai Clinic
were ofered to paricipate in this study. Eighty
one HIV-posiive paricipants (48 males and 33
females) were enrolled ater writen informed
consent was obtained. Women having her
menstrual period were excluded from the study.
The HIV serostatus of the study populaion
was determined and conirmed before this study
according to the Naional Guideline for HIV/
AIDS. Comprehensive data on characterisics
and sexual history of the paients were collected
through history taking and medical records.
History taking, clinical examinaion, and specimen
collecions were conducted in Teratai Clinic,
while the specimen processing was conducted
in Biology Molecular Laboratory, Microbiology
Department of Health Research Unit, Faculty of
Medicine, Universitas Padjadjaran.
The study was approved by the Ethical
Commitee of Faculty of Medicine, Universitas
Padjadjaran-Dr. Hasan Sadikin General Hospital
Bandung.
Specimen collecion method
Urethral swab of male paients and endocervical
swab of female paients were collected using
specimen collecion kit (Roche) and transported
to the laboratory in Chlamydia transport tubes
(Roche), on the day of collecion. At the laboratory,
urethral and endocervical swab specimens for
PCR assay were prepared immediately according
to the instrucion, frozen at -20 °C, and analyzed
within 14 days of sampling.
Specimen processing method
The Roche Amplicor PCR Assay was used (the PCR
was accomplished with thermocycler). Ater the
ampliicaion, the ampliied nucleoide sequences
were detected by an enzyme immunoassay and
the opical density at wave length 450 nm was
measured using a spectrophotometer. A posiive
result was deined as a reading above 0.5 while
the result was considered equivocal when the
reading is between 0.2 to 0.5. A negaive result
was assigned for a reading below 0.2. Staisical
analysis was performed using SPSS 17.0
Results
During the study, 81 HIV-posiive paricipants
were screened for chlamydial infecion. Among
the 81 paients tested, 14 chlamydial infecions
were ideniied with 10 in male urethra and 4 in
cervix. The prevalence of chlamydial infecion in
this study was 17.4%. Meanwhile, the prevalence
of urethral chlamydial infecion in male was
20.8% and cervical chlamydial infecion in female
was 12.1%.
A list of the 81 HIV-posiive paricipants in this
study is presented in Table 1. Male paricipants
comprised 59.3% of the total paricipants and
69.1% paricipants were in 25–35 years old
group. Half of the paricipants were high-school
graduates, 43.2% were self employed, and 55.6%
were married.
Most of paricipants who were infected
with Chlamydia was in the age group of 25–35
years old, with 17.9% of them were Chlamydia
posiive (Table 2). C. trachomais was detected
in 20.8% males and 12.1% females. Both single
and divorced groups were infected with C.
trachomais as many as 27.8%. This number is
Internaional Journal of Integrated Health Sciences. 2013;1(1):42–8
43
Chlamydial Infecion Prevalence in Human Immunodeiciency Virus Paients
much higher compared to only 8.9% of married
group that were infected by C. trachomais.
more carefully to understand the real condom
use behavior.
Table 1 Baseline Characterisics of Paricipants
Table 2 Characterisics of Paricipants with Posiive
C. trachomais
Variable
n
%
Age (yrs.)
Variable
35
20
25
Male
48
59
Female
33
41
No educaion
0
0
Elementary school
4
5
Junior High school
4
5
Senior High school
41
51
College/university
32
40
Self employed
35
43
Civil servant
1
1
Working class
20
25
Commercial sex worker
1
1
Student
1
1
Not working
23
28
Single
18
22
Married
45
56
Divorced
18
22
C. trachomais
Total
(+)
(-)
n
1
4
5
25–35
10
46
56
>35
3
17
20
Male
10
38
48
Female
4
29
33
5
13
18
6
Age (yrs.)