Association between serum chlamydial antibody levels and tubal infertility in tertiary health facility in South-East Nigeria: a case-control study

Objectives: This study evaluates the association between genital Chlamydial infection and tubal factor infertility in a tertiary health facility in South-East Nigeria.Design: This was a case-control analytical study.Setting: Gynaecology Clinic and Maternity Unit of the Department of Obstetrics and Gynaecology of the Federal Medical Centre (FMC), Owerri, Imo State, Nigeria.Participants: Ninety-six (96) women with confirmed tubal factor infertility served as the cases, and 96 women with normal intra-uterine pregnancy matched in age served as the control.Data Collection/Intervention: A structured questionnaire was used to extract information on the sociodemographic data and the sexual history of the participants. About 2mls of blood was collected, the blood was allowed to clot, and the sera were used for the test.Statistical analysis/Main outcome measure: Pearson Chi-square, Fisher’s exact test, likelihood ratio and multivariate logistic regression were used to determine risk associations and identify factors independently related to tubal factor infertility. P-value < 0.05 was considered significant.Results: The sociodemographic characteristics of both cases and control did not differ (P = 0.975). The Chlamydial antibody seropositivity was significantly higher in the cases than the control 78(81.2%) versus 13(13.5%) respectively {(P < 0.001; OR (95% CI) = 27.7(12.7-60.2)}. Only lower abdominal pain {(P = 0.011); OR (95% CI) = 4.3(1.4-13.3)}; was independently associated with tubal factor infertility.Conclusion: Tubal factor infertility is strongly associated with chlamydial IgG antibodies, and a history of lower abdominal pain significantly predicted tubal factor infertility.

Burden of Chlamydia trachomatis infection amongst infertile women compared with pregnant controls in North-central Nigeria

Background: Female infertility due to tubal damage resulting from pelvic infections including Chlamydia trachomatis is common among women in our environment. The study aimed at determining the prevalence of Chlamydia trachomatis antibody amongst infertile women and to assess the relationship between exposure to Chlamydia trachomatis infection and tubal infertility in Garki Hospital, Abuja, Nigeria.Methods: This was a case control study among 76 infertile patients with tubal occlusion diagnosed with hysterosalpingography and confirmed by laparoscopy compared with 81 pregnant women recruited from the antenatal clinic. Both cases and control were investigated with a study protocol which solicited information on socio-demographic variables, sexual and reproductive risk factors and history of previous pelvic infection. Each subject and control had 5 ml of blood collected for serological assay for Chlamydial antibody titre using the immunocomb Chlamydia trachomatis 1gG kit. The data was analyzed using the SPSS version 20 (IBM, Armonk, NY, USA). A p-value of < 0.05 was considered statistically significant.Results: The prevalence of serum Chlamydial antibody was 57 (75.0%) and 19 (23.5%) among the cases and the pregnant controls respectively (P-value < 0.001). The results showed statistically significant associations between tubal infertility and early age at sexual debut, three or more sexual partners, nulliparity and positive Chlamydia trachomatis antibody titre (P-values < 0.001).Conclusions: The prevalence of Chlamydia trachomatis antibody titre was higher among women with infertility compared to the pregnant controls. The findings suggest that tubal infertility is associated with exposure to Chlamydial trachomatis infection.

Role of IgG Chlamydia antibody in tubal factor infertility

Background: Chlamydial infection is considered to be one of the important causes of tubal factor infertility. This study will help to explore the relationship between positive Chlamydial infection and tubal damage in infertile women assessed by diagnostic laparoscopy. The results will help to determine whether a policy of routine screening for Chlamydia antibody is justifiable in infertile women to suspect tubal factor so that they can be taken up for laparoscopy earlier.Methods: A prospective study was performed on 158 consecutive patients who underwent laparoscopy as part of infertility evaluation. About 5 mL of venous blood was drawn preoperatively to detect Chlamydia IgG antibody in all the patients by ELISA. The laparoscopic findings were documented and the relationship to Chlamydial antibody evaluated.Results: Of the 158 patients who underwent laparoscopy, 95 patients had evidence of tubal disease as evidenced by unilateral or bilateral tubal block, peritubal adhesions, hydrosalpinx, beading of the tube and unhealthy shaggy appearance. Of the 95 patients with documented tubal disease at laparoscopy, 14 (14.7%) had antibodies to Chlamydia. Of the 63 patients with normal tubes, 12 (19%) had Chlamydial positivity. The difference is not statistically significant. However of the 26 patients who were positive for Chlamydia antibodies 14 patients (53.8%) had abnormal tubes. Out of the 158 patients who underwent laparoscopy 26 patients were positive for Chlamydia. Hence the prevalence in our study is 16.4% (26/158). The sensitivity is 14.7% and the specificity is 81%.Conclusions: This study showed no difference in Chlamydial positivity between infertile women with abnormal tubes and those with normal looking tubes in our population. The absence of Chlamydial antibodies cannot be taken as a marker for normal tubes. Hence screening for chlamydial antibody can neither be used as a screening test for tubal factor infertility nor to decide on the need for laparoscopy in the present population.

Antichlamydial Antibodies, Human Fertility, and Pregnancy Wastage

Genital infections withChlamydia trachomatis (C. trachomatis)continue to be a worldwide epidemic. Immune response to chlamydia is important to both clearance of the disease and disease pathogenesis. Interindividual responses and current chlamydial control programs will have enormous effects on this disease and its control strategies. Humoral immune response toC. trachomatisoccurs in humans and persistent antibody levels appear to be most directly correlated with more severe and longstanding disease and with reinfection. There is a close correlation between the presence of antichlamydial antibodies in females and tubal factor infertility; the closest associations have been found for antibodies against chlamydial heat shock proteins. The latter antibodies have also been shown to be useful among infertile patients with prior ectopic pregnancy, and their presence has been correlated with poor IVF outcomes, including early pregnancy loss. We review the existing literature on chlamydial antibody testing in infertile patients and present an algorithm for such testing in the infertile couple.

A Chlamydia trachomatis-Specific Th2 Clone Does Not Provide Protection against a Genital Infection and Displays Reduced Trafficking to the Infected Genital Mucosa

ABSTRACT A T helper type 1 (Th1) response is essential for resolving genital infections with the mouse pneumonitis biovar of Chlamydia trachomatis (MoPn). However, T-cell-dependent anti-chlamydial antibody is produced and may also contribute to protective immunity. We produced a MoPn-specific CD4 Th2 clone (Th2-MoPn) to study the role of a Th2 response during infection. We found that Th2-MoPn was unable to eradicate chlamydiae from the genital tract (GT) when it was transferred into MoPn-infected nude mice. Mice that received Th2-MoPn produced greater titers of MoPn-specific serum immunoglobulin G (IgG) antibody than mice that received a MoPn-specific Th1 clone (Th1-MoPn) (log10 titers, 1.89 ± 0.84 and 0.58 ± 0.76 [mean ± standard deviation], respectively [P < 0.01]). Also, the IgG isotypes were different for the two groups; whereas IgG1 was associated with Th2-MoPn, IgG2a was associated with Th1-MoPn. Also, infected nude mice that received Th2-MoPn produced higher levels of IgA in vaginal secretions. Although clone Th2-MoPn was detected in the GT, it was less efficient at migrating (112 ± 35.6 labeled Th2 clone cells/105 GT cells) than Th1-MoPn (505 ± 51.6 Th1 clone cells/105 GT cells) (P < 0.001, as determined by a t test). This may have been due to reduced expression of α4β7 and P-selectin ligand 1 on Th2-MoPn. However, Th2-MoPn cells were retained in the GT during chronic infection and comprised 10 to 15% of the total GT cells 80 days after transfer. The data show that the MoPn-specific Th2 cells are important for serum and vaginal antibody production and may accumulate in the GT during chronic infection.