Abstract
Background: Chlamydia trachomatis infection is an important preventable cause of infertility. In women, up to 70% of genital infection with Chlamydia trachomatis are asymptomatic. In the management of infertility patients, a lot of clinicians or centres do not routinely screen for Chlamydia trachomatis infection. Hence all patients being investigated for infertility may potentially be at risk of tubal blockage in addition to non-tubal factor aetiology. Those with primary tubal blockage also are at risk of worsening of the blockage. Objective: To determine if there is a relationship between IgG and IgM Chlamydia antibody testing (CAT) and tubal factor infertility. Design: It was a cross sectional descriptive study. Method: The sera of 400 consecutive consenting infertile patients presenting to the gynaecological clinic of the Ahmadu Bello University Teaching Hospital, Zaria, Northern Nigeria were tested for Chlamydia antibodies using ELISA IgG and IgM kits produced by Diagnostic Automation, Inc., 23961 Craftsman Road, Suite D/E/F, Calabasas, CA 91302, USA. Results: Up to 264 (66%) of the patients had tubal factor, 64 (16%) had uterine, 56 (14%) had ovarian, 50 (12.5%) had male while 40 (10%) had others. The causative factors were not mutually exclusive. The sero-prevalence of IgG and IgMChlamydia trachomatis amongst patients with tubal infertility were 35.6% and 35.6% respectively. There was a stronger significant relation (P = 0.008) between IgM sero-positivity which suggests recent infection and tubal infertility. The relation between IgG sero-positivity which suggest chronic infection and tubal infertility was also significant (P = 0.036) but relatively lower. Conclusion: The sero-prevalence of Chlamydia trachomatis infection, IgG and IgM was significantly higher among the sub-population with tubal infertility. Chlamydia antibody testing (CAT) has predictive value for tubal infertility.
Highlights
Tubal disease following pelvic inflammatory disease (PID) is the commonest cause of infertility in Africa and this is caused by sexually transmitted infections, with Neisseria gonorrheae and Chlamydia trachomatis being the most common pathogens [1]
Up to 70% of genital infection with Chlamydia trachomatis are asymptomatic and among those with symptomatic pelvic inflammatory disease (PID) due to Chlamydia trachomatis, 20% may become infertile while 10% may have ectopic pregnancy [2]
The IgG Chlamydia trachomatis sero-prevalence amongst those with tubal infertility was similar to the prevalence of 38.3% found by Tukur and Shittu et al in a similar study in Zaria in 2002 [6] but was much lower than the IgG seroprevalence of 64.2% found amongst patients with tubal infertility in Benin [8]
Summary
Tubal disease following PID is the commonest cause of infertility in Africa and this is caused by sexually transmitted infections, with Neisseria gonorrheae and Chlamydia trachomatis being the most common pathogens [1]. Genital Chlamydia trachomatis is the commonest sexually transmitted infection (STI) today in Nigeria majority of the infections are asymptomatic, sequelae such as PID, ectopic pregnancy and infertility are common [3] [4]. Objective: To determine if there is a relationship between IgG and IgM Chlamydia antibody testing (CAT) and tubal factor infertility. The sero-prevalence of IgG and IgM Chlamydia trachomatis amongst patients with tubal infertility were 35.6% and 35.6% respectively. Conclusion: The sero-prevalence of Chlamydia trachomatis infection, IgG and IgM was significantly higher among the sub-population with tubal infertility. Chlamydia antibody testing (CAT) has predictive value for tubal infertility
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