Diversity of Chlamydia trachomatis in young people

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Infertility and ectopic pregnancy are long-term consequences of upper genital tract infection in women, such as pelvic inflammatory disease (PID). The major cause of PID in England & Wales is Chlamydia trachomatis, which is also the commonest bacterial sexually transmitted infection. Chlamydial infection has become widespread in the community in contrast to gonorrhoea which is more prevalent in high-risk groups. This has occurred largely because the infection does not produce symptoms in 75% of women and at least 50% of men, hence individuals do not access healthcare, and because diagnostic tests were inadequate until recent years. It is of particular concern because the greatest burden of infection is among young women aged 16-19 years and men aged 20-24 years, and has been found in up to 10% of young people attending general practice and other settings, not seeking sexual healthcare. The government have recognised this as a priority to improve public health in the Sexual Health Strategy for Sexual Health and HIV, in the Health Select Committee Report and in the White Paper, ?Choosing Health?. The National Chlamydia Screening Programme has been funded, following a pilot, to provide a multifaceted, evidence based and cost-effective national prevention and screening and is currently functioning in 26 centres across England & Wales with a target to complete the national rollout by 2007.Considerable progress has been made in detecting the asymptomatic reservoir of infection but there is still may questions to be addressed about the epidemiology of this infection such as how many types are circulating in the population?, does this vary at different geographical locations? Can we distinguish between reinfection by the same or different partners? And does treatment failure occur? In order to address these questions we must first have the tools. Typing methods that allow us to follow bacteria, have for C. trachomatis been poorly discriminatory and based serological classification resulting in 15 serovars or genotypes which detects variation in the omp1 gene. The aim of this proposed project is in the first instance to develop additional molecular typing methods that will differentiate within these serovar/genotypes. We will then use these tools to look at specimens collected as part of the Reinfection Study and NCSP. In addition we will test the feasibility of establishing a sentinel study to collect positive samples, which could be used as a basis for future work to establish sentinel surveillance for antimicrobial reistance in C. trachomatis.