Chlamydia trachomatis antibody titers and hysterosalpingography in predicting tubal disease in infertility patients

Female urogenital chlamydia: Epidemiology, chlamydia on pregnancy, current diagnosis, and treatment

Female urogenital chlamydia is a disease caused by Chlamydia trachomatis infection in the female urogenital tract. It is a common bacterial sexually transmitted disease. The bacteria is transmitted through sexual contact with an infected partner or from mother to newborn during vaginal delivery. The prevalence varies among studies and the number is possibly higher due to the lack of massive screening. Many patients were asymptomatic and still be able to transmit the disease. The undiagnosed and untreated disease could cause pelvic inflammatory disease, which leads to infertility, ectopic pregnancy, and chronic pelvic pain. The prevalence among pregnant women is similar to non-pregnant women, therefore chlamydia screening in pregnant women is highly recommended. The nucleic acid amplification test is the most reliable method for the diagnosis due to high sensitivity. The current treatment is given by prescribing antibiotics.

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Female urogenital chlamydia is caused by Chlamydia trachomatis.

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Urogenital chlamydia affects young and sexually active women.

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Female urogenital chlamydia is diagnosed through indirect methods (serology-based tests) and direct methods (culture).

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Treatment of chlamydia consists of antibiotics with doxycycline being the first-line choice.

Bowel obstruction due to Chlamydia trachomatis: a case report and review of literature

Background

Chlamydial infection is a difficult-to-diagnose type of sexually transmitted disease that occurs mainly in young people. We report a case of bowel obstruction caused by intrapelvic adhesions formed by chlamydial infection.

Case presentation

This patient was a 23-year-old woman who had been suffering from acute abdominal pain. She had been previously treated several times for intrapelvic abscesses and had a history of chlamydial infection. Endometriosis was thought to be the cause of her pelvic abscess based on endoscopic findings. Computed tomography demonstrated a small bowel obstruction caused by a pelvic abscess. However, the diagnosis could not be confirmed. She underwent laparoscopic surgery and was diagnosed with bowel obstruction due to adhesion of chlamydial infection based on the intraoperative findings and Chlamydia trachomatis antibody test. She was discharged 5 days after surgery.

Conclusions

It is necessary to consider the possibility of chlamydial infection as a cause for lower abdominal pain and unexplained bowel obstruction in female patients.

Proportion of Tubal Factor Infertility due to Chlamydia: Finite Mixture Modeling of Serum Antibody Titers

In this study, we examined whether the proportion of tubal factor infertility (TFI) that is attributable to Chlamydia trachomatis, the population excess fraction (PEF), can be estimated from serological data using finite mixture modeling. Whole-cell inclusion immunofluorescence serum antibody titers were recorded among infertile women seen at St. Michael's Hospital in Bristol, United Kingdom, during the period 1985-1995. Women were classified as TFI cases or controls based on laparoscopic examination. Finite mixture models were used to identify the number of component titer distributions and the proportion of serum samples in each, from which estimates of PEF were derived. Four titer distributions were identified. The component at the highest titer was found only in samples from women with TFI, but there was also an excess of the second-highest titer component in TFI cases. Minimum and maximum estimates of the PEF were 28.0% (95% credible interval: 6.9, 50.0) and 46.8% (95% credible interval: 23.2, 64.1). Equivalent estimates based on the standard PEF formula from case-control studies were 0% and over 65%. Finite mixture modeling can be applied to serological data to obtain estimates of the proportion of reproductive damage attributable to C. trachomatis Further studies using modern assays in contemporary, representative populations should be undertaken.

Sexually transmitted diseases and infertility

Female infertility, including tubal factor infertility, is a major public health concern worldwide. Most cases of tubal factor infertility are attributable to untreated sexually transmitted diseases that ascend along the reproductive tract and are capable of causing tubal inflammation, damage, and scarring. Evidence has consistently demonstrated the effects of Chlamydia trachomatis and Neisseria gonorrhoeae as pathogenic bacteria involved in reproductive tract morbidities including tubal factor infertility and pelvic inflammatory disease. There is limited evidence in the medical literature that other sexually transmitted organisms, including Mycoplasma genitalium, Trichomonas vaginalis, and other microorganisms within the vaginal microbiome, may be important factors involved in the pathology of infertility. Further investigation into the vaginal microbiome and other potential pathogens is necessary to identify preventable causes of tubal factor infertility. Improved clinical screening and prevention of ascending infection may provide a solution to the persistent burden of infertility.

The value of Chlamydia trachomatis-specific IgG antibody testing and hysterosalpingography for predicting tubal pathology and occurrence of pregnancy

We assessed two diagnostic methods, Chlamydia trachomatis-specific IgG and hysterosalpingography (HSG), as a screening test for the likelihood of tubal damage or occurrence of pregnancy before laparoscopy in 178 subfertile women who were randomly assigned to HSG followed by laparoscopy or immediate laparoscopy. The diagnostic accuracy and prognostic value of both C. trachomatis-specific IgG antibody testing and HSG are comparable but show poor performance.

Transvaginal three-dimensional ultrasonography combined with serum CA 125 level for the diagnosis of pelvic adhesions before laparoscopic surgery

STUDY OBJECTIVE

To investigate the role of transvaginal three-dimensional ultrasonography combined with serum CA 125 level in diagnosing pelvic adhesions before scheduled laparoscopic surgery.

DESIGN

Prospective study (Canadian Task Force classification II-1).

SETTING

Tertiary care academic hospital.

PATIENTS

Fifty-nine women with an adnexal mass diagnosed by two-dimensional transvaginal ultrasonography.

INTERVENTION

Preoperative transvaginal three-dimensional ultrasonography and serum CA 125 level, followed by laparoscopy or laparotomy.

MEASUREMENTS AND MAIN RESULTS

Pelvic adhesions were correctly identified by transvaginal three-dimensional ultrasonography in 26 of 32 women in whom the lesions were confirmed at laparoscopy or laparotomy. Mean serum CA125 level in women with adhesions was 70 +/- 73.7 U/ml, which was significantly higher than that in women without adhesions (24 +/- 16.16 U/ml, p = 0.004). The sensitivity of combined transvaginal three-dimensional ultrasonography and serum CA 125 level was 90%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 89%. The two methods showed strong agreement with surgical results (kappa = 0.889). Eight scheduled laparoscopies (13.6%) were converted to laparotomy due to severe adhesions. One patient (1.7%) experienced colon injury during laparoscopic adhesiolysis.

CONCLUSION

Transvaginal three-dimensional ultrasonography combined with serum CA 125 level is sensitive in detecting pelvic adhesions before laparoscopic surgery. Patients with suspected severe pelvic adhesions should have preoperative bowel preparation to reduce the risk of intraoperative injury.

Laparoscopy in the "normal" infertile patient: a question revisited

STUDY OBJECTIVE

To determine the prevalence of reproductive pathology in a group of infertile women thought to be at low risk for altered pelvic anatomy.

DESIGN

Retrospective chart review and follow-up (Canadian Task Force classification II-2).

SETTING

Academic-affiliated, private reproductive endocrinology practice.

PATIENTS

One hundred infertile women.

INTERVENTION

Diagnostic and/or therapeutic laparoscopy.

MEASUREMENTS AND MAIN RESULTS

Of 100 patients with a negative reproductive work-up up to the point of laparoscopy, 68 had pathology of reproductive significance: intrinsic tubal disease 24, peritubal adhesive disease 34, and endometriosis 43, some in combination. Laparoscopy was especially helpful in establishing treatment protocols for older women, who were referred for assisted reproductive techniques earlier than otherwise might have been the case. Women conceived after hormone therapy and after operative intervention. Although the hysterosalpingogram was read as normal in all women, tubal disease was diagnosed laparoscopically, independent of endometriosis, in 27 patients, with 2 having complete obstruction. Endometriosis stage I-II was found in 22 patients, stage III in 13, and stage IV in 6.

CONCLUSION

Even in women thought to be at low risk for significant pelvic pathology affecting reproduction, the yield was high. Although some pregnancies were achieved after operative intervention, frequently laparoscopy was helpful in making a decision to go to assisted reproductive technology, particularly when infertility had been of long duration and in older women. Frequently the degree of pathology was such that a full operating suite was necessary to provide adequate instrumentation and anesthesia for operative intervention, which would not have been the case with office laparoscopy.

The accuracy of serum chlamydial antibodies in the diagnosis of tubal pathology: a meta-analysis

OBJECTIVE

To assess the discriminative capacity of Chlamydia antibody titers in the diagnosis of tubed pathology in subfertile patients.

DESIGN

Meta-analysis of studies comparing Chlamydia antibody titers and laparoscopy for tubal patency and peritubal adhesions.

PATIENTS

A total of 2,729 patients with subfertility in 23 studies.

INTERVENTION(S)

Chlamydia antibody titer and laparoscopy as part of subfertility work-up.

MAIN OUTCOME MEASURE

Sensitivity and specificity of Chlamydia antibody titers in the diagnosis of tubal pathology using laparoscopy with chromopertubation as the reference standard.

RESULT(S)

The discriminative capacity of Chlamydia antibody titers depended on the type of assay that was used. Summary receiver operating characteristic (ROC) curves of studies using ELISA or (micro)immunofluorescence revealed a better discrimination than the summary ROC-curve of studies using immunoperoxidase assay.

CONCLUSION(S)

The discriminative capacity of Chlamydia antibody titers by means of ELISA, microimmunofluorescence, or immunofluorescence in the diagnosis of any tubal pathology is comparable to that of hysterosalpingography (HSG) in the diagnosis of tubal occlusion. Chlamydia antibody testing involves little burden but provides no details on the anatomy of uterus and tubes. Whether or not Chlamydia antibody testing can replace HSG depends on the perspective taken in the diagnostic work-up of subfertility.