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Abstract
This case-control study assesses the association between past Chlamydia trachomatis infection with first-trimester miscarriage by using an enzyme-linked immunosorbent assay to detect antibodies to the protein Pgp3.
Highlights
IntroductionFirst-trimester miscarriages are commonly associated with chromosomal abnormality of the embryo (approximately 50% of cases). 15% of first-trimester and 66% of second-trimester miscarriages are attributed to reproductive tract infections. It has been suggested that Chlamydia trachomatis is a causative organism, but its association with miscarriage is inconsistently reported. This difference of opinion likely reflects the poor performance of major outer membrane protein (MOMP) peptide-based serology assays and the inability of nucleic acid amplification tests (which detect current infection) to detect previous exposure. It is possible to accurately measure lifetime exposure to C trachomatis using an enzyme-linked immunosorbent assay (ELISA) that detects antibodies to the chlamydial plasmid-encoded protein Pgp3.5 This ELISA is more sensitive (73.8%) and specific (97.6%) than commercial ELISAs, including the Medac MOMP-peptide ELISA, or previous serological antibody tests. Pgp is unique to C trachomatis, eliminating cross-reactivity with antibodies to C pneumoniae infection (a common respiratory pathogen), a major weakness of previous serological tests
A total of 65 women (25.9%; 95% CI, 20.6%-31.4%) in the miscarriage group and 33 women (28.0%; 95% CI, 19.9%-36.1%) in the control group had positive test results for Pgp3 antibodies, suggesting previous infection with C trachomatis (P = .71)
More women in the miscarriage group (n = 34 [13.5%; 95% CI, 11.3%-15.7%]) than the control group (n = 2 [1.7%; 95% CI, 0.5%-2.9%]) self-reported past C trachomatis infection (P < .001)
Summary
First-trimester miscarriages are commonly associated with chromosomal abnormality of the embryo (approximately 50% of cases). 15% of first-trimester and 66% of second-trimester miscarriages are attributed to reproductive tract infections. It has been suggested that Chlamydia trachomatis is a causative organism, but its association with miscarriage is inconsistently reported. This difference of opinion likely reflects the poor performance of major outer membrane protein (MOMP) peptide-based serology assays and the inability of nucleic acid amplification tests (which detect current infection) to detect previous exposure. It is possible to accurately measure lifetime exposure to C trachomatis using an enzyme-linked immunosorbent assay (ELISA) that detects antibodies to the chlamydial plasmid-encoded protein Pgp3.5 This ELISA is more sensitive (73.8%) and specific (97.6%) than commercial ELISAs, including the Medac MOMP-peptide ELISA, or previous serological antibody tests. Pgp is unique to C trachomatis, eliminating cross-reactivity with antibodies to C pneumoniae infection (a common respiratory pathogen), a major weakness of previous serological tests. It has been suggested that Chlamydia trachomatis is a causative organism, but its association with miscarriage is inconsistently reported.. It has been suggested that Chlamydia trachomatis is a causative organism, but its association with miscarriage is inconsistently reported.2-4 This difference of opinion likely reflects the poor performance of major outer membrane protein (MOMP) peptide-based serology assays and the inability of nucleic acid amplification tests (which detect current infection) to detect previous exposure.. It is possible to accurately measure lifetime exposure to C trachomatis using an enzyme-linked immunosorbent assay (ELISA) that detects antibodies to the chlamydial plasmid-encoded protein Pgp3.5 This ELISA is more sensitive (73.8%) and specific (97.6%) than commercial ELISAs, including the Medac MOMP-peptide ELISA, or previous serological antibody tests.. The aim of this study was to provide an estimation of the association of previous C trachomatis infection with the risk of spontaneous first-trimester miscarriage
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