The relationship between antisperm antibodies prevalence and genital Chlamydia trachomatis infection in women with unexplained infertility

Epidemiology of Chlamydia trachomatis in the Middle East and north Africa: a systematic review, meta-analysis, and meta-regression

BACKGROUND

The epidemiology of Chlamydia trachomatis in the Middle East and north Africa is poorly understood. We aimed to provide a comprehensive epidemiological assessment of C trachomatis infection in the Middle East and north Africa.

METHODS

We did a systematic review of C trachomatis infection as well as a meta-analysis and meta-regression of C trachomatis prevalence. We searched PubMed and Embase, as well as regional and national databases up to March 13, 2019, using broad search terms with no language or year restrictions. Any document or report including biological measures for C trachomatis prevalence or incidence was eligible for inclusion. We extracted all measures of current (genital or rectal), recent, and ever infection with C trachomatis. We estimated pooled average prevalence in different populations using random-effects meta-analysis. Factors associated with prevalence and sources of between-study heterogeneity were determined using meta-regression.

FINDINGS

We identified a total of 1531 citations, of which 255 reports contributed to 552 C trachomatis prevalence measures from 20 countries. No incidence measures were identified. Pooled prevalence of current genital infection was 3·0% (95% CI 2·3-3·8) in general populations, 2·8% (1·0-5·2) in intermediate-risk populations, 13·2% (7·2-20·7) in female sex workers, 11·3% (9·0-13·7) in infertility clinic attendees, 12·4% (7·9-17·7) in women with miscarriage, 12·4% (9·4-15·7) in symptomatic women, and 17·4% (12·5-22·8) in symptomatic men. Pooled prevalence of current rectal infection was 7·7% (4·2-12·0) in men who have sex with men. Substantial between-study heterogeneity was found. Multivariable meta-regression explained 29·0% of variation. Population type was most strongly associated with prevalence. Additional associations were found with assay type, sample size, country, and sex, but not with sampling methodology or response rate (about 90% of studies used convenience sampling and >75% had unclear response rate). There was no evidence for temporal variation in prevalence between 1982 and 2018.

INTERPRETATION

C trachomatis prevalence in the Middle East and north Africa is similar to other regions, but higher than expected given its sexually conservative norms. High prevalence in infertility clinic attendees and in women with miscarriage suggests a potential role for C trachomatis in poor reproductive health outcomes in this region.

FUNDING

National Priorities Research Program from the Qatar National Research Fund (a member of Qatar Foundation).

Association of Chlamydia trachomatis with infertility and clinical manifestations: a systematic review and meta-analysis of case-control studies

Background Chlamydia trachomatis is one of the sexually transmitted pathogens causing reproductive health-threatening diseases worldwide. However, its role in infertility, particularly in asymptomatic individuals, is not yet definitely determined. Methods For the study, electronic databases were searched using the following keywords; 'Chlamydia trachomatis', 'prevalence', 'frequency', 'fertile', 'infertile', 'case', 'control', 'symptomatic' and 'asymptomatic'. Finally, after some exclusions, 34 studies (19 fertile-infertile and 15 symptomatic-asymptomatic) from different countries were included in the study and meta-analysis was performed on the data collected. Results Odds ratios (ORs) for urogenital C. trachomatis prevalence in males in the fertile-infertile group, for infertile and fertile individuals, ranged from 1.3-3.7 and in females from 1.04-4.8, and the overall OR for both genders was 2.2 (95% CI). In the symptomatic-asymptomatic group, the overall OR in males and females was 4.9 (95% CI = 1.1-21.7) and 3.3 (95% CI = 1.7-6.3), respectively. In all of the analyses, there were high levels of heterogeneity (I(2) >50%, p-value <0.05) and, except for the females in the symptomatic-asymptomatic group, neither Egger's tests nor Begg's tests were statistically significant for publication bias. Conclusions C. trachomatis can impact on the potential for fertility and cause clinical manifestations and complications in both males and females. Thus, national programmes for adequate diagnosis, screening and treatment of infected individuals, particularly asymptomatic ones, seem to be necessary.