Chlamydia trachomatis: strain distribution and host response in relation to gynaecological complications.

沙眼衣原体是英国最常见的性传播感染，据估计，NHS每年要花费1亿多英镑。年轻人中的病例数量继续增加。苏格兰2007年1月至6月的实验室诊断显示，三分之二是女性，第一季度和第二季度总体增长了6%。控制措施依赖于提高公众认识、诊断、抗生素治疗和伙伴通知的组合，但显然无法防止感染的传播。沙眼衣原体感染通常是无症状的，没有得到治疗，但可能会对随后的女性生殖健康产生严重影响。原发感染可以在没有干预的情况下消失，这可能是由于保护性免疫。在一些人中，沙眼衣原体感染可能是间歇性的，尽管尚不清楚这是由于抗生素控制失败、细菌持续存在还是由于生殖道保护性免疫不足而再次感染。英国国家衣原体筛查计划报告称，感染沙眼衣原体的妇女中有10%-30%会患上盆腔炎。随着沙眼衣原体感染的每次复发，发生盆腔炎和其他生殖后遗症的风险增加，而感染与输卵管不孕、生殖失败和异位妊娠的风险增加有关。关于某些沙眼衣原体的毒力是否比其他菌株更强，以及持续感染是否导致生殖疾病，存在争议。到目前为止，研究一直是由不同的小组单独进行的。这种脱节导致缺乏对感染的自然病史和宿主反应如何转化为妇科问题风险的清楚了解。我们建议整合一个具有国际竞争力的英国临床医生和基础科学家小组来调查沙眼衣原体感染对女性生殖健康的影响。

Chlamydia trachomatis is the commonest sexually transmitted infection in the UK and is estimated to cost the NHS over #100 million per year. The number of cases continues to increase in young adults. Laboratory diagnoses in Scotland for Jan-Jun 2007 show that two thirds were female with an overall 6% increase between the first and second quarters. Control measures rely on a combination of increased public awareness, diagnosis, antibiotic treatment and partner notification but are clearly failing to prevent spread of infection. C. trachomatis infection is often asymptomatic and goes untreated but can have serious implications for subsequent female reproductive health. Primary infection can resolve without intervention, presumably due to protective immunity. In some individuals C. trachomatis infection can be episodic although it is unclear whether this is due to failure of antibiotic control, bacterial persistence or to reinfection due to inadequate protective immunity in the reproductive tract. The National Chlamydia Screening Programme in England reports that 10-30% of women infected by C. trachomatis develop pelvic inflammatory disease [PID]. The risk of developing PID and other reproductive sequelae increases with each recurrence of C. trachomatis infection and infection is associated with increased risk of tubal infertility, reproductive failure and ectopic pregnancy. There is controversy as to whether some strains of C. trachomatis are more virulent than others and whether persistent infection is responsible for reproductive disease. Hitherto studies have been conducted in isolation by different groups. This disconnection has contributed to lack of clear understanding how natural history of infection and the host response translate into risk of gynaecological problems. We propose to integrate an internationally competitive, UK group of clinicians and basic scientists to investigate outcomes of C. trachomatis infection on female reproductive health.