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A new study has identified markers that may predict whether a chlamydia infection is likely to ascend into the uterus and endometrium. The work could lead to new diagnostics that can predict a woman’s risk of severe infection.

Chlamydia trachomatis (CT) is a sexually transmitted bacterium that can lead to pelvic inflammatory disease, infertility and other reproductive problems in women when it ascends to the upper genital tract.

“Chlamydia infection cannot be definitively diagnosed as ascending beyond the cervix into the endometrium without performing an endometrial biopsy,” says Dr. Toni Darville, professor of pediatrics, microbiology and immunology at the University of North Carolina at Chapel Hill’s School of Medicine and director of the UNC-Chlamydia Vaccine Initiative, which initiated the research project.

“We wanted to see if we could identify biomarkers that would allow us to predict which women were at risk of severe disease without having to perform an invasive procedure,” says Xinxia Peng, professor of infectious disease and member of the Bioinformatics Research Center at North Carolina State University. Peng is the corresponding author of the study.

Peng and colleagues from NC State and UNC School of Medicine performed 16S ribosomal RNA (rRNA) gene based high-throughput amplicon sequencing analysis of mucosal samples from the cervicovaginal microbiome (CVM) of 246 women who were part of a cohort at high risk for CT. 16S rRNA genes are used to tag and identify bacteria so that amounts can be quantified.

The women were divided into three groups: CT negative, CT positive and CT ascended. The researchers then compared CVM composition between the three groups to see if there were any features that indicated a higher risk for ascended CT.

The sequencing analysis revealed that the amounts of certain microbial species, such as Hemophilus haemolyticus, Sutterella stercoricanis or Actinobaculum massiliense, were predictive of ascended chlamydial infection and they were also correlated with the levels of seven cytokines, or proteins secreted by the immune system, previously reported to be associated with CT ascension.

“The most striking point is that it’s the amount of chlamydia that correlates most strongly with ascension,” Peng says. “Which is both surprising and not – of course a high level of CT would drive spread, but prior to this work it was difficult to quantify CT levels accurately.”

“The part we don’t know yet is how these microbes may be interacting with the immune system to control pathogen burden and ascension,” says Catherine O’Connell, professor of pediatrics at UNC School of Medicine and co-project leader.

“We knew that some bacterial species make a woman more susceptible to CT infection, while ‘good’ bacteria such as lactobacillus seem to make it harder to become infected,” O’Connell says. “This work shows that other bacteria present may be keeping host immunity alert and responsive, making it harder for infecting chlamydia to grow abundantly. It shows that there is potential for developing biomarkers to identify women at high risk for ascended CT.”

Reference:

Sangmi Jeong ht, Tammy Tollison , Hayden Brochu, Cervicovaginal microbial features predict Chlamydia trachomatis spread to the upper genital tract of infected women, Infection and Immunity, https://doi.org/10.1128/iai.00057-25

Recent scientific study looked into the use of local anesthetic medications administered directly into the abdominal cavity to manage pain after abdominal surgery. While this method is commonly used, its effectiveness and safety have been unclear. The researchers conducted a systematic review and meta-analysis of various studies to evaluate how well these medications work for postoperative pain control. The study found that intraperitoneal local anesthetics (IPLA) were associated with a small reduction in postoperative pain intensity up to 48 hours after surgery. Patients who received IPLA also tended to use less opioid pain medication at 24 hours post-surgery, experienced less nausea and vomiting, and had a quicker recovery of gastrointestinal transit. However, there was no significant impact on the length of hospital stay or the overall quality of recovery. It is important to note that the level of evidence supporting the use of IPLA was considered to be low to very low. This means that while there were some positive effects observed, there was insufficient data on potential side effects and long-term outcomes. The researchers recommended further studies to better understand the risks and benefits of using IPLA as a routine pain management strategy after abdominal surgery. Overall, the study suggested that using local anesthetics directly into the abdominal cavity could provide some relief for postoperative pain, but due to the limited evidence available, it is not yet recommended as a standard practice. More research is needed to fully assess the safety and long-term effects of this approach before it can be widely adopted in clinical settings.

Key Points –

– -Effectiveness of Intraperitoneal Local Anesthetics (IPLA):- The systematic review and meta-analysis found that IPLA is associated with a statistically significant reduction in postoperative abdominal pain intensity when compared to control groups at multiple time points (6, 12, 24, and 48 hours post-surgery), suggesting it may provide a small short-term analgesic effect. However, the clinical significance remains unclear due to the low certainty of the evidence.

– -Reduction in Opioid Consumption:- IPLA was linked to a significant decrease in opioid use at 24 hours after surgery, with an average reduction of approximately 10.4 mg of oral morphine equivalent. However, no substantial reduction in opioid use was observed at the 48-hour mark, indicating that the benefit may be short-lived.

– -Impact on Nausea and Vomiting:- The administration of IPLA led to a notable reduction in the incidence of postoperative nausea and vomiting, with a 21% lower risk (relative risk of 0.79). This effect was consistent across various types of surgeries, suggesting a beneficial outcome of IPLA in managing these common postoperative complications.

– -Gastrointestinal Recovery:- There was a reported decrease in time to gastrointestinal transit recovery associated with IPLA, with an average reduced time of approximately 3.8 hours. However, the certainty of this evidence is low, given the limited number of studies contributing to this finding.

– -No Effect on Hospital Stay and Quality of Recovery:- The analysis showed no significant differences in hospital length of stay and quality of recovery between groups receiving IPLA and control groups. This suggests that while IPLA may alleviate pain and nausea, it does not appear to influence overall recovery metrics or hospitalization duration.

– -Low Certainty of Evidence and Need for Further Research:- Despite some promising outcomes related to pain management and nausea reduction, the evidence supporting the use of IPLA is considered low to very low quality. The study calls for more rigorous randomized controlled trials to better evaluate adverse effects and long-term outcomes related to IPLA to definitively determine its role in standard postoperative care after intra-abdominal surgeries.

Reference –

M. Boulianne et al. (2025). Intraperitoneal Local Anesthetics For Postoperative Pain Management Following Intra-Abdominal Surgery: A Systematic Review And Meta-Analysis. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03105-y.