Genotypic characterization and epidemiology of genital Chlamydia trachomatis among women: A hospital-based study in Hangzhou, China.

OBJECTIVE

This study aimed to investigate the epidemiological characteristics and genotype distribution of genital Chlamydia trachomatis (CT) among women in Hangzhou, China, to provide evidence for improving clinical management and prevention strategies.

METHODS

Vaginal swabs specimens from 23,421 female outpatients were screened for CT using quantitative real-time PCR (qPCR). Positive specimens underwent ompA-based genotyping by PCR and Sanger sequencing. Statistical analyses were conducted using chi-square testing and logistic regression to evaluate genotype distribution and associations with clinical features. All analyses were performed using SPSS version 27.0, with a significance threshold of P < 0.05.

RESULTS

Among 23,421 tested specimens, 1111 were positive for CT, yielding an overall positivity proportion of 4.74%. The infection proportion varied significantly across age groups (P < 0.001), with the highest prevalence observed in adolescents under 20 years old (20.77%). The highest proportion of positive cases (54.6%) was found in women aged 20-29 years. No statistically significant seasonal variation in detection proportion was found. Genotyping of 184 samples successfully identified eight circulating serovars, with J (23.91%) and F (21.74%) being the most predominant. Specific clinical manifestations were associated with distinct CT genotypes; serovar D demonstrated significant association with urinary tract infections, pregnancy, and miscarriage; serovar E and F were also significantly linked to miscarriage, whereas both genotypes F and J showed significant correlations with HPV infection. These findings demonstrate a clear genotype-phenotype correlation in this clinical cohort.

CONCLUSION

The distinct genotype-phenotype correlations and epidemiological features identified in this study offer critical insights for guiding targeted CT surveillance, clinical management, and future vaccine development, thereby guiding effective intervention strategies to alleviate the infection burden.