The Prevalence of Chronic Chlamydial Infections and of Infections of the Lower Female Genital Tract in Unselected Infertile Patients - A Prospective Study

Abstract

OBJECTIVE: Data on upper genital tract infections in females in subfertile couples are well known. However, there are only few data available on lower genital tract infections in this patient group. In addition to the frequently discussed question which infections should be screened, we wanted to evaluate what we can expect if we screen unselected infertile patients. MATERIAL AND METHODS: In a prospective study 163 consecutive unselected infertile women (32.2 ± 4.8 years; mean ± standard deviation) were screened for chronic chlamydial (chlamydial serology - IgG, IgA) and other genital infections (human papilloma virus [HPV] in cervical smear, bacteriological investigation of the vaginal smear) during their first visit to our department. RESULTS: The chlamydial serology detected IgG in 21.6 % and IgA in 7.6 %. The prevalence of positive bacteriology in the vaginal smear was 43.7 % (mainly Gardnerella vaginalis and Ureaplasma urealyticum). The prevalence of HPV DNA in the cervical smear was 18.2 %. CONCLUSIONS: The published association between chronic chlamydial infection and tubal factor, between the different infections of the female genital tract and infertility/reproductive outcome and the prevalence in this study justify a screening in infertile patients which includes chlamydial serology and bacteriological investigation of the vaginal smear. Because a recent study showed a decreased pregnancy rate in HPV-positive women, routine testing of HPV DNA in the cervical smear should also be discussed as a part of routine screening. Additional studies must further evaluate the cost-benefit ratio of HPV screening in infertility.