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Waters MB, Hybiske K, Ikeda R, Kaltenboeck B, Manhart LE, Kreisel KM, Khosropour CM. Chlamydia trachomatis Seroassays Used in Epidemiologic Research: A Narrative Review and Practical Considerations. J Infect Dis 2024; 230:250-262. [PMID: 39052727 PMCID: PMC11272089 DOI: 10.1093/infdis/jiae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/20/2024] [Accepted: 04/16/2024] [Indexed: 04/21/2024] Open
Abstract
Chlamydia trachomatis (CT) is a sexually transmitted infection that can lead to adverse reproductive health outcomes. CT prevalence estimates are primarily derived from screening using nucleic acid amplification tests (NAATs). However, screening guidelines in the United States only include particular subpopulations, and NAATs only detect current infections. In contrast, seroassays identify past CT infections, which is important for understanding the public health impacts of CT, including pelvic inflammatory disease and tubal factor infertility. Older seroassays have been plagued by low sensitivity and specificity and have not been validated using a consistent reference measure, making it challenging to compare studies, define the epidemiology of CT, and determine the effectiveness of control programs. Newer seroassays have better performance characteristics. This narrative review summarizes the "state of the science" for CT seroassays that have been applied in epidemiologic studies and provides practical considerations for interpreting the literature and employing seroassays in future research.
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Affiliation(s)
| | - Kevin Hybiske
- Department of Medicine, University of Washington, Seattle
| | - Ren Ikeda
- Department of Medicine, University of Washington, Seattle
| | - Bernhard Kaltenboeck
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | | | - Kristen M Kreisel
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Sonigo C, Robin G, Boitrelle F, Fraison E, Sermondade N, Mathieu d'Argent E, Bouet PE, Dupont C, Creux H, Peigné M, Pirrello O, Trombert S, Lecorche E, Dion L, Rocher L, Arama E, Bernard V, Monnet M, Miquel L, Birsal E, Haïm-Boukobza S, Plotton I, Ravel C, Grzegorczyk-Martin V, Huyghe É, Dupuis HGA, Lefebvre T, Leperlier F, Bardet L, Lalami I, Robin C, Simon V, Dijols L, Riss J, Koch A, Bailly C, Rio C, Lebret M, Jegaden M, Fernandez H, Pouly JL, Torre A, Belaisch-Allart J, Antoine JM, Courbiere B. [First-line management of infertile couple. Guidelines for clinical practice of the French College of Obstetricians and Gynecologists 2022]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:305-335. [PMID: 38311310 DOI: 10.1016/j.gofs.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To update the 2010 CNGOF clinical practice guidelines for the first-line management of infertile couples. MATERIALS AND METHODS Five major themes (first-line assessment of the infertile woman, first-line assessment of the infertile man, prevention of exposure to environmental factors, initial management using ovulation induction regimens, first-line reproductive surgery) were identified, enabling 28 questions to be formulated using the Patients, Intervention, Comparison, Outcome (PICO) format. Each question was addressed by a working group that had carried out a systematic review of the literature since 2010, and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) methodology to assess the quality of the scientific data on which the recommendations were based. These recommendations were then validated during a national review by 40 national experts. RESULTS The fertility work-up is recommended to be prescribed according to the woman's age: after one year of infertility before the age of 35 and after 6months after the age of 35. A couple's initial infertility work-up includes a single 3D ultrasound scan with antral follicle count, assessment of tubal permeability by hysterography or HyFOSy, anti-Mullerian hormone assay prior to assisted reproduction, and vaginal swabbing for vaginosis. If the 3D ultrasound is normal, hysterosonography and diagnostic hysteroscopy are not recommended as first-line procedures. Chlamydia trachomatis serology does not have the necessary performance to predict tubal patency. Post-coital testing is no longer recommended. In men, spermogram, spermocytogram and spermoculture are recommended as first-line tests. If the spermogram is normal, it is not recommended to check the spermogram. If the spermogram is abnormal, an examination by an andrologist, an ultrasound scan of the testicles and hormonal test are recommended. Based on the data in the literature, we are unable to recommend a BMI threshold for women that would contraindicate medical management of infertility. A well-balanced Mediterranean-style diet, physical activity and the cessation of smoking and cannabis are recommended for infertile couples. For fertility concern, it is recommended to limit alcohol consumption to less than 5 glasses a week. If the infertility work-up reveals no abnormalities, ovulation induction is not recommended for normo-ovulatory women. If intrauterine insemination is indicated based on an abnormal infertility work-up, gonadotropin stimulation and ovulation monitoring are recommended to avoid multiple pregnancies. If the infertility work-up reveals no abnormality, laparoscopy is probably recommended before the age of 30 to increase natural pregnancy rates. In the case of hydrosalpinx, surgical management is recommended prior to ART, with either salpingotomy or salpingectomy depending on the tubal score. It is recommended to operate on polyps>10mm, myomas 0, 1, 2 and synechiae prior to ART. The data in the literature do not allow us to systematically recommend asymptomatic uterine septa and isthmoceles as first-line surgery. CONCLUSION Based on strong agreement between experts, we have been able to formulate updated recommendations in 28 areas concerning the initial management of infertile couples.
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Affiliation(s)
- Charlotte Sonigo
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Antoine-Béclère, 157, rue de la Porte-Trivaux, 92140 Clamart, France; Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - Geoffroy Robin
- Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, Lille, France
| | - Florence Boitrelle
- Service de biologie de la reproduction, préservation de fertilité, CECOS, CHI de Poissy, Poissy, France; INRAe, ENVA, BREED, UVSQ, université Paris Saclay, Jouy-en Josas, France
| | - Eloïse Fraison
- Département médecine de la reproduction, CHU Lyon, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69500 Bron, France
| | - Nathalie Sermondade
- Service de biologie de la reproduction CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Inserm US938, centre de recherche Saint-Antoine, Sorbonne université, 75012 Paris, France
| | - Emmanuelle Mathieu d'Argent
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Pierre-Emmanuel Bouet
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Charlotte Dupont
- Service de biologie de la reproduction - CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75012 Paris, France
| | - Hélène Creux
- Centre AMP, polyclinique Saint-Roch, 550, avenue du Colonel-André-Pavelet, 34070 Montpellier cedex, France
| | - Maeliss Peigné
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Jean-Verdier-Béclère, avenue du 14-Juillet, Bondy, France
| | - Olivier Pirrello
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Sabine Trombert
- Laboratoire Cerba, 6-11, rue de l'Équerre, 95310 Saint-Ouen L'Aumône, France
| | - Emmanuel Lecorche
- Laboratoire Cerba, 6-11, rue de l'Équerre, 95310 Saint-Ouen L'Aumône, France
| | - Ludivine Dion
- Département de gynécologie-obstétrique et reproduction humaine - CECOS, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - Laurence Rocher
- Service de radiologie diagnostique et interventionnelle, site Bicêtre, hôpitaux Paris Sud, 94270 Le Kremlin-Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, université Paris Sud, 4, place du Gal-Leclerc, 91401 Orsay cedex, France
| | - Emmanuel Arama
- Service de radiologie diagnostique et interventionnelle, site Bicêtre, hôpitaux Paris Sud, 94270 Le Kremlin-Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, université Paris Sud, 4, place du Gal-Leclerc, 91401 Orsay cedex, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU Pellegrin, Bordeaux, France
| | - Margaux Monnet
- Département de gynécologie médicale, maternité régionale de Nancy, hôpitaux universitaires de Nancy, Nancy, France
| | - Laura Miquel
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - Eva Birsal
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | | | - Ingrid Plotton
- Service d'hormonologie, endocrinologie moléculaire et maladies rares, CPBE, groupement hospitalier Lyon-Est, Lyon-Bron, France; Université Claude-Bernard, Lyon 1, Lyon, France; Unité Inserm 1208, Lyon, France
| | - Célia Ravel
- Département de gynécologie-obstétrique et reproduction humaine - CECOS, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - Véronika Grzegorczyk-Martin
- Centre d'assistance médicale à la procréation et de préservation de la fertilité, clinique Mathilde, 76100 Rouen, France
| | - Éric Huyghe
- Département d'urologie, hôpital de Rangueil, CHU de Toulouse, Toulouse, France; Service de médecine de la reproduction, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France; Inserm 1203, UMR DEFE, université de Toulouse, université de Montpellier, Montpellier, France
| | - Hugo G A Dupuis
- Service d'urologie et d'andrologie, CHU - hôpitaux de Rouen, CHU Charles-Nicolle, 76031 Rouen, France
| | - Tiphaine Lefebvre
- Service de médecine et biologie de la reproduction - gynécologie médicale, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Florence Leperlier
- Service de médecine et biologie de la reproduction - gynécologie médicale, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Léna Bardet
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Imane Lalami
- Service de gynécologie-obstétrique et de médecine de la reproduction, grand hôpital de l'Est Francilien - site de Meaux, 6-8, rue Saint-Fiacre, 77100 Meaux, France
| | - Camille Robin
- Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, Lille, France
| | - Virginie Simon
- Unité fonctionnelle de gynécologie endocrinienne, service de gynécologie médicale, orthogénie et sexologie, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - Laura Dijols
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Bretonneau, CHU de Tours, Tours, France
| | - Justine Riss
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Antoine Koch
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Clément Bailly
- Service de biologie de la reproduction CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Inserm US938, centre de recherche Saint-Antoine, Sorbonne université, 75012 Paris, France
| | - Constance Rio
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Marine Lebret
- Service de gynécologie-obstétrique, CHU Charles-Nicolle, 37, boulevard Gambetta, 76000 Rouen, France
| | - Margaux Jegaden
- Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Département de chirurgie gynécologique et obstétrique, hôpital Bicêtre, GHU-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Hervé Fernandez
- Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Département de chirurgie gynécologique et obstétrique, hôpital Bicêtre, GHU-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Jean-Luc Pouly
- Service de gynécologie chirurgicale, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - Antoine Torre
- Centre d'assistance médicale à la procréation clinicobiologique, centre hospitalier Sud Francilien Corbeil-Essonnes, 40, avenue Serge-Dassault, 91106 Corbeil-Essonnes, France
| | - Joëlle Belaisch-Allart
- Service de médecine de la reproduction, pôle Femme-Enfant, Centre hospitalier des 4 villes, rue Charles-Lauer, 92210 Saint-Cloud, France
| | - Jean-Marie Antoine
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Blandine Courbiere
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; IMBE, CNRS, IRD, Aix-Marseille université, Avignon université, Marseille, France.
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Gadenne C, Miquel L, Faust C, Berbis J, Perrin J, Courbiere B. Impact of a positive Chlamydia trachomatis serology on cumulative IVF live birth rate. Reprod Biomed Online 2024; 48:103586. [PMID: 38113763 DOI: 10.1016/j.rbmo.2023.103586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 12/21/2023]
Abstract
RESEARCH QUESTION Does positive Chlamydia trachomatis serology have an impact on the cumulative live birth rate from IVF? DESIGN A retrospective matched cohort study compared women with positive Chlamydia trachomatis serology (group A) who underwent IVF treatment between January 2016 and December 2021 with a control group of women with negative Chlamydia trachomatis serology (group B). The main outcome measures were the cumulative live birth rate per IVF cycle and the live birth rate per embryo transfer. Secondary outcomes were the cumulative rates of clinical pregnancy, ectopic pregnancy and pregnancy loss calculated per IVF cycle and per embryo transfer. RESULTS A total of 151 women in group A were matched 1:2 to 302 women in group B, representing 220 and 440 IVF cycles, respectively. Women with a history of Chlamydia trachomatis infection had a significantly higher rate of tubal obstruction (P < 0.001), excluded or operated hydrosalpinx (P = 0.002) and/or history of chronic endometritis (P < 0.001). There were no statistically significant differences between the two groups in the mean number of mature oocytes retrieved, fertilization rate or implantation rate. The IVF cumulative live birth rate per cycle was similar in the two groups (36.7% in group A versus 34.9% in group B, P = 0.692). The cumulative rates of clinical pregnancy, pregnancy loss, biochemical pregnancy and ectopic pregnancy were comparable between the two groups. CONCLUSION Positive Chlamydia trachomatis serology has no impact on IVF pregnancy outcomes.
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Affiliation(s)
- Clara Gadenne
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France.
| | - Laura Miquel
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France
| | - Cindy Faust
- Public Health Department, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Univ, Marseille, France
| | - Julie Berbis
- Public Health Department, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Univ, Marseille, France
| | - Jeanne Perrin
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France; IMBE, CNRS, IRD, Avignon Univ, Marseille, France
| | - Blandine Courbiere
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France; IMBE, CNRS, IRD, Avignon Univ, Marseille, France
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Tjahyadi D, Ropii B, Tjandraprawira KD, Parwati I, Djuwantono T, Permadi W, Li T. Female urogenital chlamydia: Epidemiology, chlamydia on pregnancy, current diagnosis, and treatment. Ann Med Surg (Lond) 2022; 75:103448. [PMID: 35386801 PMCID: PMC8977933 DOI: 10.1016/j.amsu.2022.103448] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/26/2022] Open
Abstract
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. Female urogenital chlamydia is caused by Chlamydia trachomatis. Urogenital chlamydia affects young and sexually active women. Female urogenital chlamydia is diagnosed through indirect methods (serology-based tests) and direct methods (culture). Treatment of chlamydia consists of antibiotics with doxycycline being the first-line choice.
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In Silico and In Vitro Evaluation of the Antimicrobial Potential of Bacillus cereus Isolated from Apis dorsata Gut against Neisseria gonorrhoeae. Antibiotics (Basel) 2021; 10:antibiotics10111401. [PMID: 34827339 PMCID: PMC8614935 DOI: 10.3390/antibiotics10111401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 12/22/2022] Open
Abstract
Antimicrobial resistance is a major public health and development concern on a global scale. The increasing resistance of the pathogenic bacteria Neisseria gonorrhoeae to antibiotics necessitates efforts to identify potential alternative antibiotics from nature, including insects, which are already recognized as a source of natural antibiotics by the scientific community. This study aimed to determine the potential of components of gut-associated bacteria isolated from Apis dorsata, an Asian giant honeybee, as an antibacterial against N. gonorrhoeae by in vitro and in silico methods as an initial process in the stage of new drug discovery. The identified gut-associated bacteria of A. dorsata included Acinetobacter indicus and Bacillus cereus with 100% identity to referenced bacteria from GenBank. Cell-free culture supernatants (CFCS) of B. cereus had a very strong antibacterial activity against N. gonorrhoeae in an in vitro antibacterial testing. Meanwhile, molecular docking revealed that antimicrobial lipopeptides from B. cereus (surfactin, fengycin, and iturin A) had a comparable value of binding-free energy (BFE) with the target protein receptor for N. gonorrhoeae, namely penicillin-binding protein (PBP) 1 and PBP2 when compared with the ceftriaxone, cefixime, and doxycycline. The molecular dynamics simulation (MDS) study revealed that the surfactin remains stable at the active site of PBP2 despite the alteration of the H-bond and hydrophobic interactions. According to this finding, surfactin has the greatest antibacterial potential against PBP2 of N. gonorrhoeae.
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Horner PJ, Flanagan H, Horne AW. Is There a Hidden Burden of Disease as a Result of Epigenetic Epithelial-to-Mesenchymal Transition Following Chlamydia trachomatis Genital Tract Infection? J Infect Dis 2021; 224:S128-S136. [PMID: 34396405 DOI: 10.1093/infdis/jiab088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Chlamydia trachomatis (CT), the most common bacterial sexually transmitted infection worldwide, has been widely researched for its involvement in many disease pathologies in the reproductive tract, including pelvic inflammatory disease, ectopic pregnancy, and tubal factor infertility. Recent findings, through the efforts to understand the pathogenesis of CT, suggest that CT can induce the process of epithelial-to-mesenchymal transition (EMT) through epigenetic changes in the epithelium of the female reproductive tract. This literature review aims to analyze the evidence for CT's ability to promote EMT and to pinpoint the areas that merit further investigation.
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Affiliation(s)
- Patrick J Horner
- Population Health Sciences, University of Bristol, Bristol, United Kingdom.,National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
| | - Heather Flanagan
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew W Horne
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
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Horner PJ, Anyalechi GE, Geisler WM. What Can Serology Tell Us About the Burden of Infertility in Women Caused by Chlamydia? J Infect Dis 2021; 224:S80-S85. [PMID: 34396401 DOI: 10.1093/infdis/jiab047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Chlamydia trachomatis (CT) causes pelvic inflammatory disease, which may result in tubal factor infertility (TFI) in women. Serologic assays may be used to determine the proportion of women with and without TFI who have had previous CT infection and to generate estimates of infertility attributable to chlamydia. Unfortunately, most existing CT serologic assays are challenged by low sensitivity and, sometimes, specificity for prior CT infection; however, they are currently the only available tests available to detect prior CT infection. Modeling methods such as finite mixture modeling may be a useful adjunct to quantitative serologic data to obtain better estimates of CT-related infertility. In this article, we review CT serological assays, including the use of antigens preferentially expressed during upper genital tract infection, and suggest future research directions. These methodologic improvements, coupled with creation of new biomarkers for previous CT infection, should improve our understanding of chlamydia's contribution to female infertility.
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Affiliation(s)
- Patrick J Horner
- Population Health Sciences, University of Bristol, Bristol, United Kingdom.,National Institute for Health Research, Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
| | - Gloria E Anyalechi
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William M Geisler
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Pregnancies and Time to Pregnancy in Women With and Without a Previous Chlamydia trachomatis Infection. Sex Transm Dis 2021; 47:739-747. [PMID: 32701764 PMCID: PMC7553199 DOI: 10.1097/olq.0000000000001247] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND A Chlamydia trachomatis infection (chlamydia) can result in tubal factor infertility in women. To assess if this association results in fewer pregnant women, we aimed to assess pregnancy incidences and time to pregnancy among women with a previous chlamydia infection compared with women without one and who were participating in the Netherlands Chlamydia Cohort Study (NECCST). METHODS The NECCST is a cohort of women of reproductive age tested for chlamydia in a chlamydia screening trial between 2008 and 2011 and reinvited for NECCST in 2015 to 2016. Chlamydia status (positive/negative) was defined using chlamydia screening trial-nucleic acid amplification test results, chlamydia immunoglobulin G presence in serum, or self-reported chlamydia infections. Data on pregnancies were collected via questionnaires in 2015-2016 and 2017-2018. Overall pregnancies (i.e., planned and unplanned) and time to pregnancy (among women with a pregnancy intention) were compared between chlamydia-positive and chlamydia-negative women using Cox regressions. RESULTS Of 5704 women enrolled, 1717 (30.1%; 95% confidence interval [CI], 28.9-31.3) women was chlamydia positive. Overall pregnancy proportions were similar in chlamydia-positive and chlamydia-negative women (49.0% [95% CI, 46.5-51.4] versus 50.5% [95% CI, 48.9-52.0]). Pregnancies per 1000 person-years were 53.2 (95% CI, 51.5-55.0) for chlamydia negatives and 83.0 (95% CI, 78.5-87.9) for chlamydia positives. Among women with a pregnancy intention, 12% of chlamydia-positive women had a time to pregnancy of >12 months compared with 8% of chlamydia negatives (P < 0.01). CONCLUSIONS Overall pregnancy rates were not lower in chlamydia-positive women compared with chlamydia-negative women, but among women with a pregnancy intention, time to pregnancy was longer and pregnancy rates were lower in chlamydia-positive women. TRIAL REGISTRATION NUMBER Dutch Trial Register NTR-5597.
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Debonnet C, Robin G, Prasivoravong J, Vuotto F, Catteau-Jonard S, Faure K, Dessein R, Robin C. [Update of Chlamydia trachomatis infection]. ACTA ACUST UNITED AC 2021; 49:608-616. [PMID: 33434747 DOI: 10.1016/j.gofs.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Indexed: 12/25/2022]
Abstract
Chlamydia trachomatis (CT) is the most common sexually transmitted bacterial infection worldwide. It is asymptomatic in most cases and mainly affects young women, with potential long term sequelae (pelvic inflammatory disease, tubal infertility, obstetric complications). The impact on male fertility is controversial. Screening methods as well as antibiotics use have recently been reassessed due to resistance phenomena and the negative effect on the urogenital microbiota. Positive CT serology may be indicative of tuboperitoneal pathology, which may not be noticed on hysterosalpingography. New research on single-nucleotide polymorphisms (SNPs) aims to establish a patient profile at higher risk of infectious tubal damage due to CT. CT seropositivity is also associated with decreased spontaneous pregnancy rates and is a predictive factor for obstetrical complications.
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Affiliation(s)
- C Debonnet
- Service de médecine de la reproduction, université de Lille, CHU Lille, 59000 Lille, France.
| | - G Robin
- Service de médecine de la reproduction, université de Lille, CHU Lille, 59000 Lille, France; Service d'andrologie, université de Lille, CHU Lille, 59000 Lille, France
| | - J Prasivoravong
- Service d'andrologie, université de Lille, CHU Lille, 59000 Lille, France
| | - F Vuotto
- Service de maladies infectieuses, université de Lille, CHU Lille, 59000 Lille, France
| | - S Catteau-Jonard
- Service de médecine de la reproduction, université de Lille, CHU Lille, 59000 Lille, France
| | - K Faure
- Service de maladies infectieuses, université de Lille, CHU Lille, 59000 Lille, France
| | - R Dessein
- Institut de microbiologie et service de bactériologie, université de Lille, CHU Lille, 59000 Lille, France
| | - C Robin
- Service de médecine de la reproduction, université de Lille, CHU Lille, 59000 Lille, France
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10
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Predictive Values of Serum Chlamydia trachomatis TroA and HtrA IgG Antibodies as Markers of Persistent Infection in the Detection of Pelvic Adhesions and Tubal Occlusion. Microorganisms 2019; 7:microorganisms7100391. [PMID: 31557782 PMCID: PMC6843830 DOI: 10.3390/microorganisms7100391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/18/2019] [Accepted: 09/23/2019] [Indexed: 11/18/2022] Open
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.
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11
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van Ess EF, Ouburg S, Spaargaren J, Land JA, Morré SA. Performance of the multitarget Mikrogen Chlamydia trachomatis IgG ELISA in the prediction of tubal factor infertility (TFI) in subfertile women: comparison with the Medac MOMP IgG ELISA plus. Pathog Dis 2018; 75:3883981. [PMID: 28854690 DOI: 10.1093/femspd/ftx067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/20/2017] [Indexed: 12/31/2022] Open
Abstract
There is a need for more accurate Chlamydia trachomatis (CT) IgG antibody tests for tubal factor infertility (TFI) diagnostics. We evaluated the predictive value for TFI of Medac ELISA plus (MOMP) and multitarget Mikrogen ELISA (MOMP-CPAF-TARP). Based on Medac ELISA plus results, 183 subfertile women underwent either hysterosalpingography or laparoscopy to diagnose TFI. TFI was defined as extensive adhesions and/or distal occlusion of at least one tube. Women not fulfilling the definition of TFI served as controls. Serum was subsequently tested with Mikrogen ELISA and results were compared. 48 patients had TFI, 135 were controls. Mikrogen ELISA tested 125 patients positive/borderline of which 32% had TFI. Medac ELISA plus tested 77 patients positive/borderline of which 29.9% had TFI. Mikrogen tested 40 out of 48 TFI patients positive/borderline, Medac 23 out of 48. Kappa value was 0.34. PPV of Mikrogen ELISA and Medac ELISA plus were respectively 32% (95% CI 26%-39%) and 30% (95% CI 24%-37%), and NPV 86% (95% CI 81%-91%) and 76% (95% CI 70%-82%). Both tests were comparable in the prediction of TFI. However, Mikrogen ELISA had a higher NPV and might be more reliable in identifying patients without TFI. Kappa-value showed limited concordance between both tests.
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Affiliation(s)
- Eleanne F van Ess
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1007 MB Amsterdam, The Netherlands
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1007 MB Amsterdam, The Netherlands
| | - Joke Spaargaren
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1007 MB Amsterdam, The Netherlands
| | - Jolande A Land
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Servaas A Morré
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.,Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine and Life Sciences, University of Maastricht, 6200 MB Maastricht, The Netherlands
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12
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The prognostic capacity of transvaginal hydrolaparoscopy to predict non-IVF conception. Reprod Biomed Online 2018; 36:552-559. [DOI: 10.1016/j.rbmo.2018.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 01/14/2018] [Accepted: 01/16/2018] [Indexed: 11/21/2022]
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13
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Rantsi T, Joki-Korpela P, Öhman H, Bloigu A, Kalliala I, Puolakkainen M, Paavonen J, Surcel HM, Tiitinen A. Chlamydia trachomatis-induced cell-mediated and humoral immune response in women with unexplained infertility. Am J Reprod Immunol 2018; 80:e12865. [PMID: 29693287 DOI: 10.1111/aji.12865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/03/2018] [Indexed: 11/26/2022] Open
Abstract
PROBLEM What is the role of past Chlamydia trachomatis infection in unexplained infertility? METHOD OF STUDY This is a prospective study of the impact of past C. trachomatis infection on pregnancy rates in 96 women with unexplained infertility. Both humoral and cell-mediated immune responses (CMI) against C. trachomatis were studied. Serum C. trachomatis IgG antibodies were analyzed using major outer membrane protein (MOMP) peptide-based ELISA. CMI was studied by lymphocyte proliferation (LP) assay in vitro. Data on given fertility treatment, time to pregnancy, and pregnancy outcome were collected. RESULTS Altogether, 11.5% of the 96 women had C. trachomatis IgG antibodies. LP response to C. trachomatis was positive in 62.9% women. The overall pregnancy rate or live birth rate did not differ by the presence of antichlamydial antibodies or CMI against C. trachomatis. Time to spontaneous pregnancy was longer among C. trachomatis sero-positive women than among sero-negative women (2.9 years vs 2.0 years, P = .03). CONCLUSION Past chlamydial infection does not play a major role in unexplained infertility. Women with unexplained infertility and positive immune response to C. trachomatis do not have reduced pregnancy rates, but time to spontaneous pregnancy is longer among C. trachomatis IgG sero-positive women than among sero-negative women.
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Affiliation(s)
- Tiina Rantsi
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Päivi Joki-Korpela
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Hanna Öhman
- National Institute for Health and Welfare, Oulu, Finland.,Biobank Borealis of Northern Finland, Oulu University Hospital, Oulu, Finland
| | - Aini Bloigu
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Ilkka Kalliala
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Institute of Reproductive and Developmental Biology, London, UK
| | - Mirja Puolakkainen
- Virology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Heljä-Marja Surcel
- Biobank Borealis of Northern Finland, Oulu University Hospital, Oulu, Finland.,Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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14
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Hoenderboom BM, van Oeffelen AAM, van Benthem BHB, van Bergen JEAM, Dukers-Muijrers NHTM, Götz HM, Hoebe CJPA, Hogewoning AA, van der Klis FRM, van Baarle D, Land JA, van der Sande MAB, van Veen MG, de Vries F, Morré SA, van den Broek IVF. The Netherlands Chlamydia cohort study (NECCST) protocol to assess the risk of late complications following Chlamydia trachomatis infection in women. BMC Infect Dis 2017; 17:264. [PMID: 28399813 PMCID: PMC5387293 DOI: 10.1186/s12879-017-2376-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/31/2017] [Indexed: 11/19/2022] Open
Abstract
Background Chlamydia trachomatis (CT), the most common bacterial sexually transmitted infection (STI) among young women, can result in serious sequelae. Although the course of infection is often asymptomatic, CT may cause pelvic inflammatory disease (PID), leading to severe complications, such as prolonged time to pregnancy, ectopic pregnancy, and tubal factor subfertility. The risk of and risk factors for complications following CT-infection have not been assessed in a long-term prospective cohort study, the preferred design to define infections and complications adequately. Methods In the Netherlands Chlamydia Cohort Study (NECCST), a cohort of women of reproductive age with and without a history of CT-infection is followed over a minimum of ten years to investigate (CT-related) reproductive tract complications. This study is a follow-up of the Chlamydia Screening Implementation (CSI) study, executed between 2008 and 2011 in the Netherlands. For NECCST, female CSI participants who consented to be approached for follow-up studies (n = 14,685) are invited, and prospectively followed until 2022. Four data collection moments are foreseen every two consecutive years. Questionnaire data and blood samples for CT-Immunoglobulin G (IgG) measurement are obtained as well as host DNA to determine specific genetic biomarkers related to susceptibility and severity of infection. CT-history will be based on CSI test outcomes, self-reported infections and CT-IgG presence. Information on (time to) pregnancies and the potential long-term complications (i.e. PID, ectopic pregnancy and (tubal factor) subfertility), will be acquired by questionnaires. Reported subfertility will be verified in medical registers. Occurrence of these late complications and prolonged time to pregnancy, as a proxy for reduced fertility due to a previous CT-infection, or other risk factors, will be investigated using longitudinal statistical procedures. Discussion In the proposed study, the occurrence of late complications following CT-infection and its risk factors will be assessed. Ultimately, provided reliable risk factors and/or markers can be identified for such late complications. This will contribute to the development of a prognostic tool to estimate the risk of CT-related complications at an early time point, enabling targeted prevention and care towards women at risk for late complications. Trial registration Dutch Trial Register NTR-5597. Retrospectively registered 14 February 2016.
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Affiliation(s)
- B M Hoenderboom
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. .,Laboratory of Immunogenetics, Department Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands.
| | - A A M van Oeffelen
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - B H B van Benthem
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - J E A M van Bergen
- Department of General Practice, Division Clinical Methods and Public Health, Academic Medical Center, Amsterdam, the Netherlands.,STI AIDS Netherlands (SOA AIDS Nederland), Amsterdam, The Netherlands
| | - N H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD South Limburg), Geleen, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - H M Götz
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Department Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond (GGD Rotterdam), Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C J P A Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD South Limburg), Geleen, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - A A Hogewoning
- STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
| | - F R M van der Klis
- Laboratory for Infectious Diseases and Perinatal Screening, Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - D van Baarle
- Department Immune Mechanisms, Center for Infectious Disease control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - J A Land
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, The Netherlands
| | - M A B van der Sande
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M G van Veen
- STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
| | - F de Vries
- Department of Clinical Pharmacology and Toxicology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - S A Morré
- Laboratory of Immunogenetics, Department Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands.,Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - I V F van den Broek
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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15
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Tsevat DG, Wiesenfeld HC, Parks C, Peipert JF. Sexually transmitted diseases and infertility. Am J Obstet Gynecol 2017; 216:1-9. [PMID: 28007229 PMCID: PMC5193130 DOI: 10.1016/j.ajog.2016.08.008] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/29/2016] [Accepted: 08/08/2016] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
- Danielle G Tsevat
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, MO
| | - Harold C Wiesenfeld
- Division of Gynecologic Specialties, Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Caitlin Parks
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, MO
| | - Jeffrey F Peipert
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN.
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16
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Development and evaluation of a multi-antigen peptide ELISA for the diagnosis of Chlamydia trachomatis-related infertility in women. J Med Microbiol 2016; 65:915-922. [DOI: 10.1099/jmm.0.000311] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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17
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Menon S, Stansfield SH, Walsh M, Hope E, Isaia L, Righarts AA, Niupulusu T, Temese SVA, Iosefa-Siitia L, Auvaa L, Tapelu SA, Motu MF, Suaalii-Sauni T, Timms P, Hill PC, Huston WM. Sero-epidemiological assessment of Chlamydia trachomatis infection and sub-fertility in Samoan women. BMC Infect Dis 2016; 16:175. [PMID: 27102989 PMCID: PMC4839085 DOI: 10.1186/s12879-016-1508-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 04/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background 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. 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. Methods Serological 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. Results A 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. Conclusions The 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.
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Affiliation(s)
- S Menon
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - S H Stansfield
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - M Walsh
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - E Hope
- National University of Samoa, Apia, Samoa
| | - L Isaia
- National Health Service Laboratory Division, Apia, Samoa
| | - A A Righarts
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - T Niupulusu
- Samoa Family Health Association, Apia, Samoa
| | - S V A Temese
- Centre for Samoan Studies, National University of Samoa, Apia, Samoa
| | | | - L Auvaa
- National University of Samoa, Apia, Samoa
| | | | - M F Motu
- Samoa National Council of Churches, Apia, Samoa
| | | | - P Timms
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, Australia
| | - P C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - W M Huston
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia. .,School of Life Sciences, Faculty of Science, University of Technology Sydney, Broadway, Sydney, NSW, Australia. .,School of Life Sciences, University of Technology Sydney, PO BOX 123, Broadway, Sydney, NSW, 2007, Australia.
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18
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Steiner AZ, Diamond MP, Legro RS, Schlaff WD, Barnhart KT, Casson PR, Christman GM, Alvero R, Hansen KR, Geisler WM, Thomas T, Santoro N, Zhang H, Eisenberg E. Chlamydia trachomatis immunoglobulin G3 seropositivity is a predictor of reproductive outcomes in infertile women with patent fallopian tubes. Fertil Steril 2015; 104:1522-6. [PMID: 26413816 PMCID: PMC4663111 DOI: 10.1016/j.fertnstert.2015.08.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 08/14/2015] [Accepted: 08/14/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine if Chlamydia trachomatis (C. trachomatis) seropositivity, as detected by the C. trachomatis elementary body (EB)-based enzyme-linked immunosorbent assay [EB ELISA] predicts pregnancy and pregnancy outcome among infertile women with documented tubal patency. DESIGN Cohort study. SETTING Outpatient clinics. PATIENT(S) In all, 1,250 infertile women with documented tubal patency enrolled in 1 of 2 randomized controlled trials: Pregnancy in Polycystic Ovary Syndrome II; and the Assessment of Multiple Intrauterine Gestations From Ovarian Stimulation. INTERVENTION(S) Sera were analyzed for anti-C. trachomatis immunoglobulin G (IgG)1 and IgG3 antibodies, using a research C. trachomatis EB ELISA. The optical density (OD)405 readings of ≥ 0.35 and ≥ 0.1 were considered positive for IgG1 and IgG3, respectively. MAIN OUTCOME MEASURE(S) Primary outcomes included pregnancy, live birth, and ectopic pregnancy. Log-linear regression was used to determine the relative risk after adjusting for age, race, treatment medication, smoking status, and current alcohol use. RESULT(S) A total of 243 (19%) women were seropositive for anti-C. trachomatis IgG3. They tended to be nonwhite and smokers. Anti-C. trachomatis IgG3 seropositive women were significantly less likely to conceive (risk ratio [RR] 0.65, 95% confidence interval [CI] 0.52-0.83) or to have a live birth (RR 0.59, 95% CI 0.43-0.80); these associations were weakened after adjusting for number of hysterosalpingography-documented patent tubes (RR 0.73, 95% CI 0.56-0.97) and (RR 0.73, 95% CI 0.50-1.04), respectively. Anti-C. trachomatis IgG3 seropositive women who conceived had a ×2.7 risk (95% CI 1.40-5.34) of ectopic pregnancy. CONCLUSION(S) Even in the presence of tubal patency, anti-C. trachomatis IgG3 seropositivity is associated with a lower likelihood of pregnancy. Anti-C. trachomatis IgG3 seropositive women have as high as 3 times the risk of ectopic pregnancy. CLINICAL TRIAL REGISTRATION NUMBER PPCOSII: NCT00719186 and AMIGOS: NCT01044862.
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Affiliation(s)
- Anne Z Steiner
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan; Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State University, Hershey, Pennsylvania
| | - William D Schlaff
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado
| | - Kurt T Barnhart
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter R Casson
- Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont
| | - Gregory M Christman
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Ruben Alvero
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado
| | - Karl R Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, Oklahoma
| | - William M Geisler
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Tracey Thomas
- Department of Biostatistics, Yale University, New Haven, Connecticut
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado
| | - Heping Zhang
- Department of Biostatistics, Yale University, New Haven, Connecticut
| | - Esther Eisenberg
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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19
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Cheslack-Postava K, Brown AS, Chudal R, Suominen A, Huttunen J, Surcel HM, Sourander A. Maternal exposure to sexually transmitted infections and schizophrenia among offspring. Schizophr Res 2015; 166:255-60. [PMID: 26022653 PMCID: PMC4512848 DOI: 10.1016/j.schres.2015.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 05/01/2015] [Accepted: 05/04/2015] [Indexed: 01/13/2023]
Abstract
Animal models and epidemiologic studies suggest that prenatal maternal infection, and sexually transmitted infection (STI) in particular, is associated with an increased risk of schizophrenia in the offspring. However, findings from prior research studies on common infections, including herpes simplex virus type 2 (HSV-2) and Chlamydia trachomatis (C. trachomatis) have been inconsistent. To investigate these associations, we conducted a case-control study nested in the population-based Finnish Prenatal Study of Schizophrenia. Using linked national registries, 963 cases with schizophrenia (ICD-10 F20) or schizoaffective disorder (ICD-10 F25), and 963 matched controls were identified from among all persons born between 1983 and 1998 in Finland. HSV-2 IgG antibody levels were quantified in archived maternal serum samples drawn during pregnancy. Mothers of 16.4% of cases versus 12.6% of controls were HSV-2 seropositive. Mean levels of maternal HSV-2 IgG were marginally higher among cases than controls (index values of 0.98 versus 0.86; p=0.06). The unadjusted odds ratio (OR) of maternal HSV-2 IgG seropositivity was 1.33 (95% confidence interval (CI)=1.03-1.72, p=0.03). Following adjustment for covariates, the relationship was attenuated (OR=1.22, CI=0.93-1.60; p=0.14). In an exploratory analysis of another STI, C. trachomatis antibodies were measured in a subsample of 207 case-control pairs drawn from the cohort. The proportions of subjects that were seropositive and the mean levels of C. trachomatis antibodies were similar for cases and controls. This study does not support a strong association of HSV-2 or C. trachomatis IgG antibodies in maternal serum during early to mid-gestation with the development of schizophrenia in the offspring.
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Affiliation(s)
- Keely Cheslack-Postava
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| | - Alan S. Brown
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
,Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168 Street, New York, NY 10032, United States
| | - Roshan Chudal
- Department of Child Psychiatry, Faculty of Medicine, University of Turku, Turku Finland
| | - Auli Suominen
- Department of Child Psychiatry, Faculty of Medicine, University of Turku, Turku Finland
| | - Jukka Huttunen
- Department of Child Psychiatry, Faculty of Medicine, University of Turku, Turku Finland
| | | | - Andre Sourander
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
,Department of Child Psychiatry, Faculty of Medicine, University of Turku, Turku Finland
,Department of Child Psychiatry, Turku University Hospital, Turku Finland
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Cardona D, Leite R, Carvalho A, Campos C, Coelho C, da Costa MJP, Sousa S, Sousa M. Epidemiologic study of infertility: Report of the hospital centre of St. John, Porto. Rev Int Androl 2014. [DOI: 10.1016/j.androl.2014.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chlamydia trachomatis Antibody Testing in Vaginal Mucosal Material versus Blood Samples of Women Attending a Fertility Clinic and an STI Clinic. Obstet Gynecol Int 2014; 2014:601932. [PMID: 24757446 PMCID: PMC3976833 DOI: 10.1155/2014/601932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/23/2014] [Accepted: 02/06/2014] [Indexed: 11/21/2022] Open
Abstract
Background. Chlamydia infections often follow an asymptomatic course but may damage the reproductive tract. Chlamydia antibodies in serum are used as markers for past infections and can relate to tubal pathology and infertility. This “proof of principle” study aimed to assess whether Chlamydia antibodies are detectable in easier to obtain, noninvasive, vaginal mucosa samples and relate to current or past infection. Methods. We compared outcomes of Chlamydia IgG and IgA antibody tests in serum and vaginal mucosal swabs in (a) 77 women attending a fertility clinic, of whom 25 tested positive for serum-IgG and (b) 107 women visiting an STI centre, including 30 Chlamydia PCR-positive subjects. Results. In the STI clinic, active Chlamydia infections were linked to serum-IgG and serum-IgA (P < 0.001) and mucosa-IgA (P < 0.001), but not mucosa-IgG. In the fertility clinic, mucosa-IgG had stronger correlations with serum-IgG (P = 0.02) than mucosa-IgA (P = 0.06). Women with tubal pathology or Chlamydia history more commonly had serum-IgG and mucosa-IgA (both P < 0.001), whereas this link was weaker for mucosa-IgG (P = 0.03). Conclusion. Chlamydia IgG and IgA are detectable in vaginal mucosal material. Serum-IgG had stronger associations with current or past infections. Mucosa-IgA also showed associations with (past) infection and complications. IgA presence in vaginal mucosa warrants further epidemiological studies.
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Strowitzki T. Infertilität bei Frauen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:1628-32. [DOI: 10.1007/s00103-013-1851-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stansfield SH, Patel P, Debattista J, Armitage CW, Cunningham K, Timms P, Allan J, Mittal A, Huston WM. Proof of concept: A bioinformatic and serological screening method for identifying new peptide antigens for Chlamydia trachomatis related sequelae in women. RESULTS IN IMMUNOLOGY 2013; 3:33-9. [PMID: 24600556 DOI: 10.1016/j.rinim.2013.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/01/2013] [Accepted: 05/02/2013] [Indexed: 12/30/2022]
Abstract
This study aimed to identify new peptide antigens from Chlamydia (C.) trachomatis in a proof of concept approach which could be used to develop an epitope-based serological diagnostic for C. trachomatis related infertility in women. A bioinformatics analysis was conducted examining several immunodominant proteins from C. trachomatis to identify predicted immunoglobulin epitopes unique to C. trachomatis. A peptide array of these epitopes was screened against participant sera. The participants (all female) were categorized into the following cohorts based on their infection and gynecological history; acute (single treated infection with C. trachomatis), multiple (more than one C. trachomatis infection, all treated), sequelae (PID or tubal infertility with a history of C. trachomatis infection), and infertile (no history of C. trachomatis infection and no detected tubal damage). The bioinformatics strategy identified several promising epitopes. Participants who reacted positively in the peptide 11 ELISA were found to have an increased likelihood of being in the sequelae cohort compared to the infertile cohort with an odds ratio of 16.3 (95% c.i. 1.65-160), with 95% specificity and 46% sensitivity (0.19-0.74). The peptide 11 ELISA has the potential to be further developed as a screening tool for use during the early IVF work up and provides proof of concept that there may be further peptide antigens which could be identified using bioinformatics and screening approaches.
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Affiliation(s)
- Scott H Stansfield
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld. 4059, Australia
| | - Pooja Patel
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld. 4059, Australia
| | - Joseph Debattista
- Metro North and Sunshine Health Service Districts, Sexual Health and HIV Service, Queensland Health, 270 Roma Street, Brisbane, Qld. 4000, Australia
| | - Charles W Armitage
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld. 4059, Australia
| | - Kelly Cunningham
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld. 4059, Australia
| | - Peter Timms
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld. 4059, Australia
| | - John Allan
- The Wesley Research Institute and The Wesley Reproductive Medicine and Gynaecological Surgery Unit, The Wesley Medical Centre, 40 Chasley Street, Auchenflower, Qld. 4066, Australia
| | - Aruna Mittal
- Institute of Pathology-ICMR, Safdarjung Hospital Campus, Post Box no. 4909, New Delhi 110029, India
| | - Wilhelmina M Huston
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld. 4059, Australia
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