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Novel Chlamydia trachomatis Strains in Heterosexual Sex Partners, Indianapolis, Indiana, USA - Volume 20, Number 11—November 2014 - Emerging Infectious Disease journal - CDC

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Novel Chlamydia trachomatis Strains in Heterosexual Sex Partners, Indianapolis, Indiana, USA - Volume 20, Number 11—November 2014 - Emerging Infectious Disease journal - CDC






Volume 20, Number 11—November 2014

Research

Novel Chlamydia trachomatis Strains in Heterosexual Sex Partners, Indianapolis, Indiana, USA

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Byron E. Batteiger1, Raymond Wan, James A. Williams, Linda He, Arissa Ma, J. Dennis Fortenberry, and Deborah Dean1Comments to Author 
Author affiliations: Indiana University School of Medicine, Indianapolis, Indiana, USA (B.E. Batteiger, J.A. Williams, J.D. Fortenberry); Children’s Hospital Oakland Research Institute, Oakland, California, USA (R. Wan, L. He, A. Ma, D. Dean); University of California, Berkeley, California, USA (D. Dean); University of California, San Francisco, California, USA (D. Dean)

Abstract

Chlamydia trachomatis causes a high number of sexually transmitted infections worldwide, but reproducible and precise strain typing to link partners is lacking. We evaluated multilocus sequence typing (MLST) for this purpose by detecting sequence types (STs) concordant for the ompA genotype, a single-locus typing standard. We tested samples collected during April 2000–October 2003 from members of established heterosexual partnerships (dyads) in the Indianapolis, Indiana, USA, area who self-reported being coital partners within the previous 30 days. C. trachomatis DNA from 28 dyads was tested by MLST; sequences were aligned and analyzed for ST and phylogenetic relationships. MLST detected 9 C. trachomatis STs, 4 unique to Indianapolis; STs were identical within each dyad. Thirteen unique strains were identified; 9 (32%) dyads harbored novel recombinant strains that phylogenetically clustered with strains comprising the recombinants. The high rate of novel C. trachomatis recombinants identified supports the use of MLST for transmission and strain diversity studies among at-risk populations.
Chlamydia trachomatis, a bacterium that can infect both men and women, is most commonly sexually transmitted. In 2008, approximately 105.7 million new C. trachomatis sexually transmitted infections (STIs) occurred worldwide (1); an estimated 2.86 million incident cases occurred in the United States (2). The last surveillance study of STIs in the United States, in 2011, reported 1,412,791 chlamydial infections, the largest case number for any disease ever reported to the Centers for Disease Control and Prevention (3).
C. trachomatis infections in men and women are mostly asymptomatic; thus, continued sexual activity among persons unaware of their infection status facilitates further transmission. Gaps in knowledge of chlamydial STIs include how measures of immunity, bacterial load, condom use, and other factors relate to transmission risk. Longitudinal studies of these factors are needed to inform treatment and prevention strategies (4). The tools required include careful ascertainment of sexual history and behavioral determinants and reproducible and discriminating biomarkers to strengthen the case for transmission between sex partners linked by partner tracing.
The standard biomarker for these studies is ompA genotyping, but this method lacks precision because the gene is under immune selection and represents only 0.1% of the genome. Because large-scale whole-genome sequencing of clinical samples is not yet feasible, multilocus sequence typing (MLST) for C. trachomatis has been developed to provide greater insight into strain types; 3 such MLST methods have been reported in the literature (5–10). The scheme we developed, on the basis of analysis of 19 reference strains and 68 geographically diverse clinical isolates, identified 44 MLST sequence types (STs), compared with only 20 ompA genotypes (11). In our scheme, we were also able to discriminate single-nucleotide polymorphisms (SNPs) that correlate with disease phenotypes attributable to C. trachomatis: lymphogranuloma venereum (LGV), trachoma, and non-LGV urogenital diseases (11). Our scheme has since been expanded to encompass 192 geographically and clinically diverse samples.
For this study, we applied our MLST scheme to a subset of a well-defined heterosexual partnership (dyad) cohort in Indianapolis, Indiana, USA, comprising 28 dyads for which concordance of the ompA genotype existed between partners. The purpose of the study was to determine whether MLST, which provides a more detailed level of strain typing than ompA genotyping, would also show strain concordance between partners, as would be expected if transmission had occurred within the dyads. In addition, we sought to identify additional C. trachomatis strain types, beyond those identified by ompAgenotyping, that might be unique to Indianapolis, because this geographic region has not previously been included in any MLST database.

Dr Batteiger is an academic infectious diseases physician in the Division of Infectious Diseases, Department of Medicine, and Department of Microbiology and Immunology at Indiana University School of Medicine. His research interests are the epidemiology and molecular epidemiology of C. trachomatis and other sexually transmitted infections in the context of longitudinal studies of high-risk adolescents and infection concordance in partnerships.

Acknowledgments



We thank James Rothschild for excellent technical support.
This work was supported in part by Public Health Service grants from the National Institutes of Health (R01 AI098843 to D.D. and U19 AI31494 to J.D.F. and B.E.B.) and a grant from the Centers for Disease Control and Prevention (UR3/CCU5516481 to B.E.B.).

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Table

Technical Appendix

Suggested citation for this article: Batteiger BE, Wan R, Williams JA, He L, Ma A, Fortenberry JD, et al. Novel Chlamydia trachomatis strains in heterosexual sex partners, Indianapolis, Indiana, USA. Emerg Infect Dis [Internet]. 2014 Nov [date cited]. http://dx.doi.org/10.3201/eid2011.140604
DOI: 10.3201/eid2011.140604
1These authors contributed equally to this article.
Novel Chlamydia trachomatis Strains in Heterosexual Sex Partners, Indianapolis, Indiana, USA - Volume 20, Number 11—November 2014 - Emerging Infectious Disease journal - CDC
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