Bacterial Vaginosis and Spontaneous Clearance of Chlamydia trachomatis in the Longitudinal Study of Vaginal Flora

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Abstract
Up to 26% of urogenital Chlamydia trachomatis infections spontaneously resolve between detection and treatment. Mechanisms governing natural resolution are unknown. We examined whether bacterial vaginosis (BV) was associated with greater chlamydia persistence versus spontaneous clearance in a large, longitudinal study. Between 1999-2003, the Longitudinal Study of Vaginal Flora followed reproductive-age women quarterly for one year. Baseline chlamydia screening and treatment were initiated after ligase chain reaction testing became available mid-study, and unscreened endocervical samples were tested after study completion. Chlamydia clearance and persistence were defined between consecutive visits without chlamydia-active antibiotics (N = 320 persistence/N = 310 clearance). Associations between Nugent score (0-3, no BV; 4-10, intermediate/BV), Amsel-BV, and chlamydia persistence versus clearance were modeled with alternating and conditional logistic regression. 48% of chlamydia cases spontaneously cleared by the next visit (310/630). Nugent-Intermediate/BV was associated with higher odds of chlamydia persistence (aOR = 1.89, 95% CI:1.30-2.74), and the findings were similar for Amsel-BV (aOR 1.39, 95% CI:0.99-1.96). The association between Nugent-Intermediate/BV and chlamydia persistence was stronger in a within-participant analysis of 67 participants with both clearance/persistence intervals (aOR = 4.77, 95% CI:1.39-16.35). BV symptoms did not affect any results. BV is associated with greater chlamydia persistence. Optimizing the vaginal microbiome may promote chlamydia clearance.
Funding Information
  • National Institute of Allergy and Infectious Diseases
  • National Institutes of Health (R01-AI116799, R01-AI167629)
  • National Institute of Child Health and Human Development (Z01-HD002535)

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