Chlamydia trachomatis : identifying women with tubal factor subfertility

Abstract

Background Persistent Chlamydia (C.) trachomatis infections are assumed to increase the risk of tubal pathology. We studied whether serological markers, assumed to be associated with persistent C. trachomatis infections, could identify subfertile women at risk of tubal pathology. Methods Sera of 313 subfertile women, who all underwent a laparoscopy with tubal testing to assess the grade of tubal pathology, were tested for the presence of immunoglobulin (Ig) G and IgA antibodies to C. trachomatis, IgG antibodies to chlamydia heat shock protein 60 (cHSP60) and high-sensitivity C-reactive protein (hs-CRP). Results C. trachomatis IgA, cHSP60 IgG and hs-CRP, all serological markers of persistent infections, were significantly more prevalent in women with tubal pathology as compared to those without tubal pathology. The predictive value of the currently used screening test for tubal pathology (IgG to C. trachomatis) could be significantly improved by adding the hs-CRP test. Conclusions In subfertile women with tubal pathology, serological markers of persistent C. trachomatis infections are significantly more common as compared to women without tubal pathology. C. trachomatis IgG-positive subfertile women with slightly elevated (< 10 mg/L) hs-CRP levels are at highest risk of persistent C. trachomatis infections and tubal pathology. Thesis J den hartog V18.pdf Chapter 2 Markers of persistent infections 4 3