Abstract
Chlamydia trachomatis IgG antibody testing (CAT) has been used as a screening test for tubal factor infertility (TFI), but as the CAT is only a marker of a past exposure to C. trachomatis and not of late sequelae, the positive predictive value (PPV) of the test is low. The persistence of C. trachomatis in the upper genital tract has been suggested as one of the key mechanisms in the development of TFI. Serum antibodies against C. trachomatis TroA and HtrA, proteins expressed specifically during persistent infection, have been suggested as novel biomarkers for TFI diagnostics. We studied serum IgG antibody responses against C. trachomatis TroA, HtrA and MOMP in 79 subfertile women, of whom 28 had laparoscopically proven TFI. We confirmed that the accuracy of CAT in diagnosing TFI is low, whereas TroA IgG and HtrA IgG are more accurate tests in detecting tubal occlusion and pelvic adhesions. However, the sensitivity and negative predictive value (NPV) of TroA IgG and HtrA IgG are still too low to justify their use as a screening test in clinical practice. Individual immunogenetic profiles combined with TroA and HtrA antibody responses might identify women with the highest risk for developing late complications after C. trachomatis infection.
Highlights
Chlamydia trachomatis infection is the most prevalent bacterial sexually transmitted infection with over 130 million new cases reported annually [1]
Of the 79 women, 28 (35.4%) had C. trachomatis TroA IgG antibodies, 27 (34.2%) had High temperature requirement protein (HtrA) IgG antibodies, and 32 (40.5%) had IgG antibodies against C. trachomatis major outer membrane protein (MOMP)
Women with tubal factor infertility (TFI) had more often TroA IgG (60.7% vs. 21.6%, p < 0.001) and HtrA IgG antibodies (57.1% vs. 21.6%, p = 0.001) than women without TFI (Table 1)
Summary
Chlamydia trachomatis infection is the most prevalent bacterial sexually transmitted infection with over 130 million new cases reported annually [1]. The majority of infected women have uncomplicated lower genital tract infections, but some women develop a persistent or ascending infection [2]. In the latter, infection can lead to severe reproductive morbidity, including tubal factor infertility (TFI) [3]. Tissue damage resulting from chlamydial infection has been attributed to inflammatory processes in the upper genital tract, leading to pelvic adhesions and scarring of the tubal epithelium [4]. Hysterosalpingography (HSG) and hysterosalpingosonography (HSSG) are alternative less-invasive methods for tubal evaluation, but less accurate in identifying TFI, as peritubal adhesions cannot be detected [6]
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