Sero-epidemiological assessment of Chlamydia trachomatis infection and sub-fertility in Samoan women.

S Menon,P Timms,L Iosefa-Siitia,T Suaalii-Sauni,M Walsh,P C Hill,A A Righarts,M F Motu,E Hope,S A Tapelu,S H Stansfield,S V A Temese,T Niupulusu,L Isaia,W M Huston,L Auvaa

doi:10.1186/s12879-016-1508-0

Abstract

BackgroundIn our recent village-based cross-sectional study, the prevalence of nucleic acid amplification technique (NAAT) diagnosed Chlamydia trachomatis (CT) in sexually active Samoan women was very high (36 %), and test positivity was associated with sub-fertility. We conducted a serological and epidemiological analysis in these participants to identify if serological data can provide further insight into the potential contribution of CT to sub-fertility in this population.MethodsSerological prediction of CT associated sub-fertility was conducted using a series of commercial tests. The correlation between fertility or sub-fertility, behavioral factors, and serologically predicted CT associated sub-fertility was determined.ResultsA positive antibody reaction against the Chlamydia Major Outer Membrane Protein (MOMP) was significantly associated with sub-fertility, with 50 % of infertile women being positive. Serum IgG and IgA antibodies against MOMP correlated with current infection measured by urine NAAT, suggesting longer term infections are common in this population. Chlamydia pneumoniae antibodies were frequently detected in this population (84 %), and unexpectedly, were significantly associated with sub-fertility.ConclusionsThe high prevalence of chlamydial infection and of positive chlamydial sub-fertility results suggests that CT is an important and frequent contributory factor to sub-fertility in this population.

Highlights

In our recent village-based cross-sectional study, the prevalence of nucleic acid amplification technique (NAAT) diagnosed Chlamydia trachomatis (CT) in sexually active Samoan women was very high (36 %), and test positivity was associated with sub-fertility
There are numerous serological or chlamydia antibody tests (CAT) that have been developed to diagnose CT infertility, that have been validated on cohorts of women with evidence of tubal damage detected by hysterosalpingography or
We recently reported a high prevalence (36.0 % by NAAT) of CT in Samoan women using communitybased screening and survey of sexually active women aged 18–29 years having unprotected sex, and current infection was associated with women who were defined as being sub-fertile [14, 18]

Summary

Introduction

In our recent village-based cross-sectional study, the prevalence of nucleic acid amplification technique (NAAT) diagnosed Chlamydia trachomatis (CT) in sexually active Samoan women was very high (36 %), and test positivity was associated with sub-fertility. The proportion of infertility attributable to CT in the Samoan population is not known. Such infertility results from tissue damage to the fallopian tubes (tubal factor infertility, TFI) that remains after the active infection is cleared, meaning that diagnosis using nucleic acid amplification tests (NAAT) is not necessarily suitable. There are numerous serological or chlamydia antibody tests (CAT) that have been developed to diagnose CT infertility, that have been validated on cohorts of women with evidence of tubal damage detected by hysterosalpingography or

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Discussion

Conclusion