Журнал инфекционных заболеваний и терапии

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Issues with the Diagnosis of Chlamydia trachomatis in Cervical Infections in Mexico: From the Causes to the Interventions

Cecilia Hernández-Cortez, José Tomás Hernández-Méndez, Claudia Aurora Saldaña-Juárez and Ma Guadalupe Aguilera-Arreola

In contrast to other countries, Mexico lacks precise estimations on the prevalence and risk factors associated with the Chlamydia trachomatis bacterium as well as the impact caused by this infection in different groups of women. There are multiple difficulties, but one of the main reasons is, without a doubt, that cervicovaginal cervicitis caused by this bacterium is not mandatorily reported to epidemiology departments. On the other hand, lymphogranuloma venereal (LGV) is mandatorily reported (including the number of female/male cases, federal entities/districts and age) and the diagnosis is performed using the syndromic management recommended by the World Health Organization (WHO), which is a medical practice with low sensitivity and specificity. A second cause could be the relative difficulty in establishing a diagnosis, considering the laboratory methodology is technically demanding and expensive. A literature review was performed of Mexican research studies on this bacterium, which were presented in congresses or publications, allowing for the identification of a very important number of studies on female patients who visit different governmental and private facilities. These studies report the laboratory methods used to perform diagnostics; furthermore some of these evaluate the sensitivity and specificity. The frequency of this bacterium is varying, which most likely results from the diverse methodologies applied in the cited works.

The latest estimations/projections published by the WHO in 2008 indicate that the number of treatable sexually transmitted infection (STI) cases in adults is approximately 498 million cases, and only 105.7 million cases correspond to Chlamydia. Americas accounted for 25.2 million of these cases. Nevertheless, the WHO acknowledges that “There is, however, a great deal of uncertainty surrounding the global and regional STI estimates. If these uncertainties are to be reduced a determined effort is needed to obtain relevant data, in particular: prevalence data disaggregated by age and sex and estimates of the duration of infection disaggregated by pathogen, the health care seeking behaviour of the population, and access to health care”. While C. trachomatis is the most common bacterial cause of Sexually transmitted infections (STIs) in the United States, Mexico provides little to the estimations reported by the WHO.