Chronic Chlamydia trachomatis infections in infants.
Abstract
Objective. —To study the natural history ofChlamydia trachomatisinfections in infants. Design. —Bacteriologic and serologic study of an inception cohort. Setting. —University of Washington Medical Center, Seattle. Participants. —Twenty-two infants withC trachomatisinfections either not treated early in life or recurring after antimicrobial treatment. Main Outcome Measures. —Persistence of infection in various anatomic sites, antibody responses to specific serovars (serologic variants) ofC trachomatis, and serovars of isolates from mothers and infants. Results. —The cumulative proportion of infants still infected at the age of 1 year was 35%. Infection persisted in the conjunctiva, nasopharynx, and oropharynx in one child for as long as 866 days (28.5 months), when she was cured by treatment. In none of the infants did serologic tests suggest acquisition of infection other than at birth. Isolates ofC trachomatisfrom mothers and their respective infants were always of the same serovar. Conclusions. —Many infants infected withC trachomatisat birth remain infected for months or years in the absence of specific antimicrobial therapy. Such infections may be confused with those acquired by sexual abuse. (JAMA. 1992;267:400-402)
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Genital infection with T. vaginalis or rectal or genital infection with C. trachomatis among young children might be the result of perinatally acquired infection and has, in certain cases of chlamydial infection, persisted for as long as 2-3 years.
“For example, genital infection with T. vaginalis (1442) or rectal or genital infection with C. trachomatis among young children might be the result of perinatally acquired infection and has, in certain cases of chlamydial infection, persisted for as long as 2–3 years (1443–1445), although perinatal chlamydial infection is now uncommon because of prenatal screening and treatment of pregnant women.”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [1443]
Cited by
Sorted by citations
Sexually Transmitted Infections Treatment Guidelines, 2021
Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr7004a1 · Cited by 2,759 · see citing works
The evaluation of children in the primary care setting when sexual abuse is suspected.
Jenny, C., Crawford-Jakubiak, J. E., COMMITTEE ON CHILD ABUSE AND NEGLECT, Jenny, C., Crawford-Jakubiak, J. E., Christian, C. W., Crawford-Jakubiak, J. E., Flaherty, E. G., Leventhal, J. M., Lukefahr, J. L., et al. (2013) · PEDIATRICS · doi:10.1542/peds.2013-1741 · Cited by 222 · see citing works
Chlamydia trachomatis Infections in Neonates and Young Children
Darville, T. L. (2005) · Seminars in Pediatric Infectious Diseases · doi:10.1053/j.spid.2005.06.004 · Cited by 194 · see citing works
Rank, R. G., & Yeruva, L. (2014) · Infection and Immunity · doi:10.1128/iai.01244-13 · Cited by 183 · see citing works
“Bell and colleagues in Seattle published a similar study in which they obtained cultures from the conjunctiva, nasopharynx, oropharynx, rectum, and vagina for well over 2 years (42).”
ResultChlamydial infection of the gastrointestinal tract: a reservoir for persistent infection
Yeruva, L., Spencer, N. E., Bowlin, A. K., Wang, Y., & Rank, R. G. (2013) · Pathogens and Disease · doi:10.1111/2049-632x.12052 · Cited by 127 · see citing works
“While it is not uncommon to find women who are rectal positive for chlamydiae, the only evidence for long-term infection was a prospective study by Bell and colleagues in which they obtained cultures from various anatomic sites of infants born to Chlamydia-infected mothers (Bell et al., 1992).”
BackgroundThe intracellular life of chlamydiae
Hammerschlag, M. R. (2002) · Seminars in Pediatric Infectious Diseases · doi:10.1053/spid.2002.127201 · Cited by 112 · see citing works
Sexually transmitted diseases in sexually abused children: medical and legal implications
Hammerschlag, M. R. (1998) · Sexually Transmitted Infections · doi:10.1136/sti.74.3.167 · Cited by 107 · see citing works
The Bronchial Lavage of Pediatric Patients with Asthma Contains Infectious Chlamydia
Webley, W. C., Salva, P. S., Andrzejewski, C., et al. (2005) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200407-917oc · Cited by 83 · see citing works
Medical and Legal Implications of Testing for Sexually Transmitted Infections in Children
Hammerschlag, M. R., & Guillén, C. D. (2010) · Clinical Microbiology Reviews · doi:10.1128/cmr.00024-09 · Cited by 68 · see citing works
“These infections are asymptomatic and may persist as long as 3 years (7).”
BackgroundMechanisms of Chlamydia-Induced Disease
Ward, M. E. (2014) · ASM Press eBooks · doi:10.1128/9781555818203.ch7 · Cited by 55 · see citing works
Neonatal Chlamydial Infections
Zar, H. J. (2005) · Pediatric Drugs · doi:10.2165/00148581-200507020-00003 · Cited by 54 · see citing works
Occurrence ofChlamydia trachomatisandChlamydia pneumoniaein paediatric respiratory infections
Webley, W. C., Tilahun, Y., Lay, K., et al. (2008) · European Respiratory Journal · doi:10.1183/09031936.00019508 · Cited by 49 · see citing works
Sexual Assault and Abuse of Children
Hammerschlag, M. R. (2011) · Clinical Infectious Diseases · doi:10.1093/cid/cir700 · Cited by 40 · see citing works
“Perinatally acquired rectal or vaginal Chlamydia trachomatis infection may persist for 2–3 years after birth [1].”
BackgroundStamm, W. E., & Batteiger, B. E. (2010) · Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases · doi:10.1016/b978-0-443-06839-3.00180-6 · Cited by 39 · see citing works
Thomas, A. (2002) · Sexually Transmitted Infections · doi:10.1136/sti.78.5.324 · Cited by 38 · see citing works
Howell, J. O., & Flowers, D. (2016) · Obstetrical & Gynecological Survey · doi:10.1097/ogx.0000000000000290 · Cited by 29 · see citing works
Thomas, A. (2003) · Archives of Disease in Childhood · doi:10.1136/adc.88.4.303 · Cited by 30 · see citing works
Forensic examination of suspected child victims of sexual abuse in the UK: a personal view
Pillai, M. (2005) · Journal of Clinical Forensic Medicine · doi:10.1016/j.jcfm.2004.10.012 · Cited by 28 · see citing works
Hammerschlag, M. R., Ajl, S., & Laraque, D. (1999) · PEDIATRICS · doi:10.1542/peds.104.5.1137 · Cited by 24 · see citing works
Reading, R., Rogstad, K. E., Hughes, G., et al. (2014) · Archives of Disease in Childhood · doi:10.1136/archdischild-2013-304996 · Cited by 21 · see citing works
Problems with Non-Gonococcal Urethritis
Shahmanesh, M. (1994) · International Journal of STD & AIDS · doi:10.1177/095646249400500603 · Cited by 20 · see citing works
Comparison of doxycycline with azithromycin in treatment of pharyngeal chlamydia infection
Manavi, K., Hettiarachchi, N., & Hodson, J. A. (2015) · International Journal of STD & AIDS · doi:10.1177/0956462415614723 · Cited by 19 · see citing works
“A study on neonates reported persistence of infection in 35% at the age of one year with one child remaining infected for 866 days after birth.(8) In a study on adults, 37.”
BackgroundSexually transmitted diseases in children: introduction.
Estreich, S., & FORSTER, G. E. (1992) · Sexually Transmitted Infections · doi:10.1136/sti.68.1.2 · Cited by 19 · see citing works
Laboratory Diagnosis of Sexually Transmitted Infections in Cases of Suspected Child Sexual Abuse
Qin, X. G., & Melvin, A. J. (2019) · Journal of Clinical Microbiology · doi:10.1128/jcm.01433-19 · Cited by 17 · see citing works
Gynecologic Examination of the Prepubertal Girl
Jacobs, A. M., & Alderman, E. M. (2014) · Pediatrics in Review · doi:10.1542/pir.35-3-97 · Cited by 16 · see citing works
Conover, C. S., Rend, C. A., Miller, G. B., & Schmid, G. P. (1998) · Infectious Diseases in Obstetrics and Gynecology · doi:10.1002/(sici)1098-0997(1998)6:3 · Cited by 24 · see citing works
Establishing a Medical Research Agenda for Child Sexual Abuse
Kerns, D. L. (1998) · Child Abuse & Neglect · doi:10.1016/s0145-2134(98)00011-8 · Cited by 16 · see citing works
Forensic medical evaluations of child maltreatment: A proposed research agenda
Dubowitz, H., Christian, C. W., Hymel, K. P., & Kellogg, N. D. (2014) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2014.07.012 · Cited by 12 · see citing works
Pitfalls in the diagnosis of child sexual abuse
Chariot, P., Rey‐Salmon, C., & Werson, P. (1999) · Journal of Clinical Forensic Medicine · doi:10.1016/s1353-1131(99)90174-8 · Cited by 8 · see citing works
Batteiger, B. E., & Tan, M. (2015) · Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases · doi:10.1016/b978-1-4557-4801-3.00182-x · Cited by 12 · see citing works
Gynecologic Examination of the Prepubertal Girl
Jacobs, A. M., & Alderman, E. M. (2014) · Pediatrics in Review · doi:10.1542/pir.35.3.97 · Cited by 8 · see citing works
Leenen, J., van Liere, G. A. F. S., Hoebe, C. J. P. A., et al. (2019) · Epidemiology and Infection · doi:10.1017/s0950268819001018 · Cited by 6 · see citing works
Sexually Transmitted Diseases in Children and Adolescents
Oranje, A. P., Bilo, R. A. C., & Hartwig, N. G. (2011) · Wiley eBooks · doi:10.1002/9781444345384.ch153 · Cited by 6 · see citing works
Problems for Physicians Dealing with Sexual Abuse Evaluations
Jaudes, P. K., & Zimo, D. A. (1992) · Clinical Pediatrics · doi:10.1177/000992289203101208 · Cited by 6 · see citing works
Les enfants et adolescents victimes d'abus sexuels. Diagnostic et prise en charge
Nathanson, M., Muller, M., Belasco, C. A., et al. (1998) · Archives de Pédiatrie · doi:10.1016/s0929-693x(97)83473-2 · Cited by 5 · see citing works
Primary and Secondary Amenorrhea and Precocious Puberty
Løbo, R. A. (2007) · Elsevier eBooks · doi:10.1016/b978-0-323-02951-3.50041-8 · Cited by 5 · see citing works
Transmissão de verrugas anogenitais em crianças e associação com abuso sexual
Drezett, J., de Vasconcellos, R. M., Pedroso, D., et al. (2012) · Journal of Human Growth and Development · doi:10.7322/jhgd.20047 · Cited by 4 · see citing works
Pediatric and Adolescent Gynecology
Davis, A. J., & Katz, V. L. (2007) · Elsevier eBooks · doi:10.1016/b978-0-323-02951-3.50016-9 · Cited by 4 · see citing works
Darville, T., & Rours, G. I. J. G. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-40181-4.00167-5 · Cited by 3 · see citing works
Benton, S. A. (2014) · Springer eBooks · doi:10.1007/978-1-61779-403-2_16 · Cited by 3 · see citing works
Oral Surgical Aspects of Child Abuse and Neglect
Sugar, N. F., & Feldman, K. W. (2005) · Oral and Maxillofacial Surgery Clinics of North America · doi:10.1016/j.coms.2005.06.002 · Cited by 3 · see citing works
“Chlamydial infection of the oropharynx is asymptomatic, and in the absence of treatment, it can persist for several years [32].”
BackgroundPediatric and Adolescent Gynecology
Davis, A. J., & Katz, V. L. (2012) · Elsevier eBooks · doi:10.1016/b978-0-323-06986-1.00012-3 · Cited by 3 · see citing works
Chlamydia trachomatis conjunctivitis in the pre-pubertal child
Moore, R., Mallett, P., Hull, S., et al. (2022) · Archives of Disease in Childhood Education & Practice · doi:10.1136/archdischild-2022-323845 · Cited by 2 · see citing works
Darville, T., & Rours, G. I. J. G. (2012) · Elsevier eBooks · doi:10.1016/b978-1-4377-2702-9.00169-0 · Cited by 2 · see citing works
Hafner, L. M., & Timms, P. (2013) · Sexually Transmitted Diseases · doi:10.1016/b978-0-12-391059-2.00015-2 · Cited by 2 · see citing works
Trachoma and Inclusion Conjunctivitis
Hu, V. H., Caswell, R., Last, A. R., et al. (2020) · Elsevier eBooks · doi:10.1016/b978-0-323-55512-8.00039-9 · Cited by 2 · see citing works
Pediatric and adolescent gynecology
Lara‐Torre, E., & Valea, F. A. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-65399-2.00021-8 · Cited by 2 · see citing works
Chlamydia Trachomatis Urogenital Infections
Armitage, C. W., Carey, A. J., Hickey, D. K., & Beagley, K. W. (2018) · doi:10.1002/9781119380924.ch8 · Cited by 2 · see citing works
Sexually Transmitted Diseases in Children and Adolescents
Oranje, A. P., Bilo, R. A. C., & Hartwig, N. G. (2019) · Wiley eBooks · doi:10.1002/9781119142812.ch163 · Cited by 2 · see citing works
Darville, T. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-79525-8.00029-9 · Cited by 1 · see citing works
Fong, H., & Christian, C. W. (2012) · Clinical Pediatric Emergency Medicine · doi:10.1016/j.cpem.2012.06.004 · Cited by 1 · see citing works
Primary and secondary amenorrhea and precocious puberty
Lobo, R. A. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-65399-2.00045-0 · Cited by 1 · see citing works
Wacogne, I. D. (2003) · Archives of Disease in Childhood · doi:10.1136/adc.88.4.311 · Cited by 1 · see citing works
“28 The prevalence of genital chlamydial infection is highest among sexually active adolescents.”
BackgroundChlamydia trachomatis respiratory infection in Korean young infants
Hong, K. B., Shin, Y. S., Roh, E. J., et al. (2008) · Korean Journal of Pediatrics · doi:10.3345/kjp.2008.51.7.729 · Cited by 1 · see citing works
Jones, R. B. (2014) · ASM Press eBooks · doi:10.1128/9781555818210.ch11 · Cited by 1 · see citing works
The school health service through parents' eyes.
Blackwell, P. H., Sikka, S., Davies, G. N., et al. (1990) · Archives of Disease in Childhood · doi:10.1136/adc.65.3.336
Atypowe zapalenie płuc u dzieci wywołane przez Chlamydia species
Woźniakowska‐Gęsicka, T., Kiciński, P., Wiśniewska‐Ligier, M., et al. (2007) · Pediatria Polska · doi:10.1016/s0031-3939(07)70397-9
STIs in children and adolescents
Rogstad, K. E. (2010) · Medicine · doi:10.1016/j.mpmed.2010.01.015
Dermatological Emergencies: Skin Manifestations of Abuse
Nazarian, R., Checa, J., & Markowitz, O. (2012) · Springer eBooks · doi:10.1007/978-1-4614-5031-3_13
What's happening in respiratory infection?
Hewer, S. C. L. (2001) · Paediatric Respiratory Reviews · doi:10.1053/prrv.2001.0163
Chlamydia trachomatis in a girl suspected of sexual abuse in the city of Córdoba, Argentina
Kiguen, A. X., Ochonga, G. E., Venezuela, R. F., et al. (2014) · Case Reports in Clinical Medicine · doi:10.4236/crcm.2014.32024
“Babies may acquire the infection at birth if their mother’s cervix is infected resulting in neonatal ophthalmia, pneumonitis, or both, in addition to nasopharyngeal and genital tract colonization, which may persist for 2 - 3 years after birth [4,5].”
BackgroundInfantile Chlamydia trachomatis pneumonia in siblings
Numazaki, K., & Kubo, S. (2004) · Clinical Microbiology Newsletter · doi:10.1016/j.clinmicnews.2004.09.005
STIs in Pediatrics, Perinatology and Reproduction
Gill, A. R., & Shetty, A. K. (2011) · Springer eBooks · doi:10.1007/978-3-642-14663-3_58
Bacterial Sexually Transmitted Infections in Children
Girardet, R. G. (2010) · Elsevier eBooks · doi:10.1016/b978-1-4160-6393-3.00022-1
Hemorragias genitales prepuberales
Flandrin, J., & Duranteau, L. (2019) · EMC - Ginecología-Obstetricia · doi:10.1016/s1283-081x(19)42496-x
Darville, T. (2010) · Elsevier eBooks · doi:10.1016/b978-1-4160-6400-8.00019-5
CHLAMYDIA TRACHOMATIS INFECTIONS IN THE NEONATE
Hammerschlag, M. R. (2009) · Elsevier eBooks · doi:10.1016/b978-1-4160-4044-6.50079-0
Chacko, M. R., Staat, M. A., & Woods, C. R. (2009) · Elsevier eBooks · doi:10.1016/b978-1-4160-4044-6.50053-4
Burstein, G. R., & Rompalo, A. M. (2000) · Elsevier eBooks · doi:10.1016/b978-012288145-9/50025-5
Primary and Secondary Amenorrhea and Precocious Puberty
Lobo, R. A. (2012) · Elsevier eBooks · doi:10.1016/b978-0-323-06986-1.00038-x
Chronic Chlamyida Infections in Males: Impacts on Testicular Function and Spermatogenesis
Bryan, E. R. (2018) · Queensland University of Technology · doi:10.5204/thesis.eprints.119158
Darville, T. L. (2008) · Elsevier eBooks · doi:10.1016/b978-0-7020-3468-8.50173-5
Pappas, P. G. (1993) · Immunology and Allergy Clinics of North America · doi:10.1016/s0889-8561(22)00432-5
Darville, T., Rours, G. I. J. G., & Rours, J. G. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-75608-2.00167-1
Chlamydia: The Secret Enemy from the Past to Present, and Future
Misra, S. K., & Pundir, A. (2023) · Infectious diseases · doi:10.5772/intechopen.110902
(2000) · Time to knit · doi:10.1016/s0246-1064(18)72912-5
Hammerschlag, M. R., & Kohlhoff, S. A. (2025) · Elsevier eBooks · doi:10.1016/b978-0-323-82763-8.00212-0
Raphael, M., Needham, H. E., & Woods, C. R. (2025) · Elsevier eBooks · doi:10.1016/b978-0-323-82763-8.00044-3
Corry, R., Beard, S., Thompson, F. E., et al. (2025) · BMJ Paediatrics Open · doi:10.1136/bmjpo-2025-003653
“Taking all these factors together, and given the rarity of these infections, it is unlikely that a significant number of cases were missed.”
- Authors
- Bell, T. A.
- Corresponding author
- Bell, Thomas A.
- Venue
- JAMA: The Journal of the American Medical Association
- Publisher
- American Medical Association (AMA)
- Published
- 1992-01-15
- Volume
- 267
- Issue
- 3
- Pages
- 400
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W4300198086
- Cited by
- 77
- References
- 0
- Citations by year
- 2025: 3 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 1 · 2019: 4 · 2018: 2 · 2017: 1 · 2016: 1 · 2015: 2 · 2014: 8 · 2013: 3 · 2012: 6
- FWCI
- 1.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- Funders
- National Eye Institute (EY00219)
- National Institute of Allergy and Infectious Diseases (AI-12192, AI-16 222)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
- Keywords
- Chlamydia trachomatis, infants, congenital infection, persistent infection, serotypes, antibody response, conjunctival infection, nasopharyngeal infection, oropharyngeal infection, mother-to-child transmission, natural history (disease)
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
