Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

Current Chlamydia Trachomatis Infection, A Major Cause of Infertility

Authors
1 Department of Health Research, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Mumbai, India
2 Seth G S Medical College and KEM Hospital, J M Street, Parel, Mumbai, India; Seven Hills Hospital, Mumbai, India
Abstract
Background: In India, the impact of current Chlamydia trachomatis (C. trachomatis) in reproductive health remains a neglected area of investigation. The present study evaluates if current Chlamydia infection is associated with any clinical complication that needs the attention of clinical investigators. Methods: In this cross-sectional study, we enrolled 896 women attending the Gynecology Out Patient for the detection of C. trachomatis infection. Polymerase chain reaction was used to diagnose current C. trachomatis infection and ELISA for past infections. Bacterial vaginosis, Candida and Trichomonas were screened. The results of symptomatic and asymptomatic groups were compared. The data was analyzed using Epi Info version 6 and "Z" test. A probability value of p≤0.05 was considered as significant. Results: Statistical analysis revealed significant association between current C. trachomatis infection with infertility when comparing infected fertile (18.6% vs. 9.4%, odds ratio: 2.19, p < 0.0005) and uninfected infertile women (45.6% vs. 27.3%, odds ratio: 2.24, p < 0.0001). Average infection rate was 12.1%, highest in women with infertility (18.6%) or with ectopic pregnancy (25%). Significant proportions of infected women with infertility (p < 0.01) or with recent pregnancy (p < 0.001) were asymptomatic. Follow up of infected women who became negative after treatment [28 women from infertility group and 9 women with recurrent spontaneous abortion (RSA)] revealed live birth in 8 (21.6%) women within one year, 4 with infertility and 4 with RSA. Conclusion: Study findings suggests, association between current C. trachomatis infection and infertility. Absence of signs and symptoms associated with this infection highlights its diagnosis in women with a history of infertility and RSA for their better management, as revealed by live births with one year of follow up.
Keywords

  1. Grosskurth H, Mosha F, Todd J, Mwijarubi E, Klokke A, Senkoro K, et al. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet. 1995;346(8974):530-6.
  2. Bébéar C, de Barbeyrac B. Genital Chlamydia trachomatis infections. Clin Microbiol Infect. 2009;15(1):4-10.
  3. Darville T, Hiltke TJ. Pathogenesis of genital tract disease due to Chlamydia trachomatis. J Infect Dis. 2010;201 Suppl 2:S114-25.
  4. Haggerty CL, Gottlieb SL, Taylor BD, Low N, Xu F, Ness RB. Risk of sequelae after Chlamydia trachomatis genital infection in women. J Infect Dis. 2010;201 Suppl 2:S134-55.
  5. Stamm WE. Chlamydia trachomatis infections of the adult. In: Holmes KK, Sparling PF, Mardh PA, editors. Sexually transmitted diseases. New York: McGraw-Hill; 1999. p. 407-22.
  6. Schachter J, Stoner E, Moncada J. Screening for chlamydial infections in women attending family planning clinics. West J Med. 1983;138(3):375-9.
  7. Cates W Jr, Wasserheit JN. Genital chlamydial infections: epidemiology and reproductive sequelae. Am J Obstet Gynecol. 1991;164(6 Pt 2):1771-81.
  8. Malik A, Jain S, Hakim S, Shukla I, Rizvi M. Chlamydia trachomatis infection & female infertility. Indian J Med Res. 2006;123(6):770-5.
  9. Mittal A, Kapur S, Gupta S. Screening for genital chlamydial infection in symptomatic women. Indian J Med Res. 1993;98:119-23.
  10. Singh V, Rastogi S, Garg S, Kapur S, Kumar A, Salhan S, et al. Polymerase chain reaction for detection of endocervical Chlamydia trachomatis infection in women attending a gynecology outpatient department in India. Acta Cytol. 2002;46 (3):540-4.
  11. Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991;29(2):297-301.
  12. Lahiri DK, Nurnberger JI Jr. A rapid non-enzymatic method for the preparation of HMW DNA from blood for RFLP studies. Nucleic Acids Res. 1991;19(19):5444.
  13. Stephens RS, Mullenbach G, Sanchez-Pescador R, Agabian N. Sequence analysis of the major outer membrane protein gene from Chlamydia trachomatis serovar L2. J Bacteriol. 1986;168(3): 1277-82.
  14. Mania-Pramanik J, Potdar S, Kerkar S. Diagnosis of Chlamydia trachomatis infection. J Clin Lab Anal. 2006;20(1):8-14.
  15. Siemer J, Theile O, Larbi Y, Fasching PA, Danso KA, Kreienberg R, et al. Chlamydia trachomatis infection as a risk factor for infertility among women in Ghana, West Africa. Am J Trop Med Hyg. 2008;78(2):323-7.
  16. Chandhok N, Datey S, Gaur LN, Saxena NC. Prevalence of chlamydia trachomatis in women attending different clinics at tertiary hospitals. J Obstet Gynecol India. 2003;53(5):463-7.
  17. Mania-Pramanik J, Meherji P, Gokral J, Donde U. Chlamydia trachomatis infection in an urban setting. Sex Transm Infect. 2001;77(2):141.
  18. Divekar AA, Gogate AS, Shivkar LK, Gogate S, Badhwar VR. Disease prevalence in women attending the STD clinic in Mumbai (formerly Bombay), India. Int J STD AIDS. 2000;11(1):45-8.
  19. Witkin SS, Ledger WJ. Antibodies to Chlamydia trachomatis in sera of women with recurrent spontaneous abortions. Am J Obstet Gynecol. 1992;167(1):135-9.
  20. Schachter J. Infection and disease epidemiology. In: Stephens RS, editor. Chlamydia intracellular biology, pathogenesis, and immunity. Washington DC: American Society for Microbiology; 1999. p. 139-69.
  21. Thompson SE, Washington AE. Epidemiology of sexually transmitted Chlamydia trachomatis infections. Epidemiol Rev. 1983;5:96-123.
  22. Sellors JW, Mahony JB, Chernesky MA, Rath DJ. Tubal factor infertility: an association with prior chlamydial infection and asymptomatic salpingitis. Fertil Steril. 1988;49(3):451-7.
  23. Osser S, Persson K, Liedholm P. Tubal infertility and silent chlamydial salpingitis. Hum Reprod. 1989;4(3):280-4.
  24. Moscicki B, Shafer MA, Millstein SG, Irwin CE Jr, Schachter J. The use and limitations of endocervical Gram stains and mucopurulent cervicitis as predictors for Chlamydia trachomatis in female adolescents. Am J Obstet Gynecol. 1987;157(1):65-71.
  25. Eltabbakh GH, Eltabbakh GD, Broekhuizen FF, Griner BT. Value of wet mount and cervical cultures at the time of cervical cytology in asymptomatic women. Obstet Gynecol. 1995;85(4):499-503.
  26. Brabin L, Gogate A, Gogate S, Karande A, Khanna R, Dollimore N, et al. Reproductive tract infections, gynaecological morbidity and HIV seroprevalence among women in Mumbai, India. Bull World Health Organ. 1998;76(3):277-87.