Identification of individual genotypes of Chlamydia trachomatis from experimentally mixed serovars and mixed infections among trachoma patients

Genetic polymorphisms in the major outer membrane protein gene (omp-1) of Chlamydia trachomatis B and Ba serovars have been demonstrated in Tunisian isolates. A total of 15 of 27 unique sequence signatures or omp-1 genotypes were identified. However, differentiation of unique signatures from sequences that reflect those of strains involved in a mixed infection is necessary to define the molecular epidemiology of chlamydial ocular infections. We devised a strategy for identifying mixed infections by characterizing their effects on omp-1 genotyping. Various ratios of elementary bodies from organisms of serovars A, B, Ba, and C that cause trachoma were amplified by PCR and were subjected to automated and manual sequencing. Serovar-specific primers were also designed so that each serovar could be individually amplified and its omp-1 genotype unequivocally determined. One of 27 Tunisian samples showed a mixed infection with sequences comparable to those of serovars B and D. The omp-1 genotypes of organisms involved in mixed infections can be accurately identified by automated sequencing and will be useful for molecular epidemiologic studies of populations worldwide who live where trachoma is endemic.