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J Clin Microbiol. 2019 Nov 6. pii: JCM.01375-19. doi: 10.1128/JCM.01375-19. [Epub ahead of print]

Bacterial load of Chlamydia trachomatis in the posterior oropharynx, tonsillar fossae and saliva among gay and bisexual men with untreated oropharyngeal chlamydia.

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Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
Central Clinical School, Monash University, Melbourne, VIC, Australia.
Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.
Murdoch Children's Research Institute, Parkville, VIC, Australia.
Centre for Women's Infectious Disease Research, The Royal Women's Hospital, Parkville, VIC, Australia.
Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.
Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
Department of Obstetrics and Gynaecology, University of Melbourne, Grattan Street, Parkville, VIC, Australia.


Background: The aim of this study was to determine whether Chlamydia trachomatis (CT) could be detected in saliva and if infection is specific to an anatomical site in the oropharynx.Methods: Men who have sex with men (MSM) who were diagnosed with oropharyngeal chlamydia at Melbourne Sexual Health Centre in 2017-2018 were invited to participate upon returning for treatment. Swabs at the tonsillar fossae, posterior oropharynx, and a saliva sample were collected. Throat samples were tested for CT by Aptima Combo 2 assay. The bacterial loads of CT in all samples were assessed by qPCR detecting the ompA gene. We calculated the positivity and bacterial load of CT for all samples.Results: Forty-two MSM were included. Median age was 28 (interquartile range [IQR]:24-33). 32 participants (76.2%; 95%CI:60.5% to 87.9%) had CT detected by qPCR at both the tonsillar fossae and the posterior oropharynx, followed by 9.5% (n=4; 95%CI:2.7% to 22.6%) positive at the posterior oropharynx only, and 4.8% (n=2; 95%CI:0.58% to 16.2%) positive at the tonsillar fossae only. Twenty-nine MSM had CT detected in saliva (69.0%; 95%CI:52.9% to 82.3%). The median CT load in saliva was 446 copies/ml (IQR:204-1,390), in the tonsillar fossae was 893 copies/swab (IQR:390-13,224), and in posterior oropharynx was 1,204 copies/swab (IQR:330-16,211). There was no significant difference in CT load between the tonsillar fossae and the posterior oropharynx (p=0.119).Conclusion: Among MSM with oropharyngeal chlamydia nearly three quarters had chlamydia DNA detected in saliva, although the viability and implications for transmission are unknown.


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