The Prevalence of Serum IgG Antibody to Chlamydia trachomatis in infertile Women at the University Hospital, Syria

 

Sarah M. Alkayer*, Haitham N. Yazji, Atiea Khamis

 Department of BioChemistry and Microbiology, Tishreen university College of Pharmacy

 

ABSTRACT:

Chlamydia trachomatis is considered one of the major Causes of sexually transmissible bacterial infection throughout the world. Infection can result in serious reproductive pathologies, including pelvic inflammatory disease, ectopic pregnancy, and infertility in women. Since there have been no previous studies dealing with chlamydial trachomatis in Syria, this study was conducted to define the role of Chlamydia trachomatis in female infertility.  Method: it was a case- control study during the period from March to December 2015 Two groups of patients (n=23 infertile patients and n=21control patients) were enrolled in the study we obtained information about socio-demographic characteristics, and sexual behavior. Chlamydia trachomatis infection was detected by Enzyme Immunoassay (ELISA) for the quantitative determination of IgG antibodies specific to Chlamydia trachoamtis. Chlamydia trachoamtis antibodies were positive in 4/23 (17.1%) of the 23 infertile women while 1/21 (4.7%) in control group was positive. The difference was not statistically significant. But prevalence of Chlamydia trachoamtis antibody were high in infertile women. In view of the high incidence of Chlamydial infection in Syrian women with infertility. we recommend screening for anti. C.trachomatis antibodies using ELISA as part of routine investigations for infertility.

 

 

 

 

 

INTRODUCTION:

Chlamydia trachomatis (C. trachomatis) is a gram-negative bacteria and causes ocular, urogenital, and respiratory infections in humans[1]According to the World Health Organization(WHO) Chlamydia is the most common cause of bacterial sexually transmitted infections worldwide, approximately 131 million new C. trachomatis infections occur annually worldwide[2] Most of genital CT infections in women are asymptomatic approximately 80%of infected females show no symptoms however undetected infection can spread to upper genial track resulting pelvic inflammatory disease (PID), which is a major cause of infertility, ectopic pregnancy[3]

 

The detection of current C. trachomatis infection utilizes gene amplification technique while. Past infection with C. trachomatis can be demonstrated by IgG antibody[4]

Since the association between C. trachomatis IgG antibody in serum and infertility was noted some workers have used Chlamydia antibody testing (CAT) as a screening test for pathology in the infertility for work-up[5]while many gynecologists in Syria do not perform it ,which makes the magnitude of the infertility problem unclear and Many patients are diagnosed to have unexplained infertility without screening for possible genital tract. Against this background, the objective of the study was to estimate the prevalence of C. trachomatis IgG in Syrian women and the association between C. trachomatis and infertility

 

MATERIAL AND METHODS:

It was case control study conducted among 23 women presenting for infertility consultation at University Hospital in Latakia- Syria during the period from March to December 2015. And for the control group we selected 21 women with normal pregnancies attending the hospital. All of the control group were women had no complaint of infertility and were in the childbearing, ages (18–35 years old) during the study period.

Women who were single or who were over 35 years old were excluded from the study

 

A questionnaire to elicit information on sociodemographic and lifestyle indicators, reproductive and medical history and sexual behavior was completed. The study was approved by the Tishreen University and Al-Asad University Hospital in Latakia, and all participants signed informed consent forms prior to enrolment in the study.

 

Detection of Chlamydia trachomatis IgG:

For testing 5 ml of venous blood was collected from each participant, labelled and sent to the laboratory. The serum was separated, frozen and stored.

 

 The antibody was detected by enzyme immunoassay (ELISA) for the quantitive determination of IgG species-specific to C. trachomatis in human by DIA.PRO^® kit. The test run according to the manufacturer’s instructions. The result was interpreted to be positive if result was 5u/l > or negative if the result was<5u/l.

 

RESULT:

To our knowledge This is  the first in Latakia-Syria focusing on the detection of C. trachomatis IgG. 44 participants were enrolled into this study. There were 23 women in the infertility group and 21 women in the control group who fulfilled the inclusion criteria in this study .The demographic characteristics of both the study group and the control group were similar. The mean age of subjects was 27 ± 2 years old (range: 17-35 years old). The mean age of the control group was 28.2 ±3 years old (range: 17-35 years old). All the participants were married. Most were in monogamous marriage (study group 98%, control 100%) (table1).There was no statistical difference in the mean age between the study and the comparison group (p value >0.05).

 

Table 1: Socio-demographic characteristics

Variables		Study group	Control group	P value
Mean age		27±2	28±3	NS
Material status	Married	100%	100%	NS
	Single	0%	0%	NS
Education level	Elementary	24.72%	18.1%	NS
	High school	40.45 %	37.6%
	University	34.83%	42.5%

In the infertility group four women (4/23 - 17.1%) tested positive for C. trachomatis while one women (1/21-3.3%) in the control group tested positive(Figure1), Despite this tendency towards a higher rate of positive cases in the infertility group, the difference was not statistically significant p-value >0.05

 

Fig.1: Chlamydia trachomatis IgG prevalence

 

The type of infertility and the positive cases is shown in (Table 2) There were significant difference concerning the tubal cause of infertility and Chlamydia trachomatis infection.

 

Table 2: Cause of infertility in the infertility group, with the results testing for Chlamydia trachomatis

Variables	All tested		Positive cases		P value
	Number	%	Number	%
Unexplained	9	39	0	0	0.02
Tubal factor	9	39	4	44.4
Non-ovulation	5	22	0	0

 

we was found that testing positive for C. trachomatis in the primary infertility group (1/9, 11.1%) was lower than the testing positive in the secondary infertility group (3/14, 21.1%), but the difference was not statistically significant (table3).

 

Table 3: primary and secondary infertility, with the results testing for Chlamydia trachomatis

Variables	All tested		Positive cases		P value
	Number	%	Number	%
primary infertility	9	39	1	11.1	>0.05
Secondary infertility	14	61%	3	21.1

 

DISCUSSION:

Seroepidemiological studies have indicated that chlamydial infections account for a large proportion of infertile by demonstrating a strong link between the presences of serum antibodies to C. trachomatis and infertily.

In our study we use the ELISA technique for the detection of serum C. trachomatis IgG antibodies. We found positive titers of Chlamydia trachomatis IgG antibody was 17.1% in fertile group and 4.1 in the control group even the differences was not statistically significant but is quite high. A WHO study reported the current chlamydial infection in infertile women to be 18-20%[6]

 

The incidence of C.  trachomatis infection was similar in women with primary and secondary infertility. And high percentage of C. trachomatis IgG(38%) were in women

With tubal infertility This finding supports a high correlation between Chlamydia antibody positivity and tubal blockage and its is consistent with other reports[7, 8].

 

In conclusion, although it was not statistically significant, there was a tendency towards increased prevalence of C. trachomatis infection in infertile patients compared to a control group of women. Therefore, screening of women for C. trachomatis infection is recommended as part of investigations for infertility since infertile patients may undergo further invasive diagnostic and to achieve right treatment studies with larger sample size should further elucidate the extent of infertility caused by C. trachomatis in Syria

 

REFERENCES:

1.   Becker, Y., Chlamydia, in Medical Microbiology, S. Baron, Editor. 1996: Galveston (TX).

2.   organization, W.h., Sexually transmitted infections (STIs). 2015.

3.   Prevention, C.f.D.C.a., Sexually transmitted disease surveillance. 2015.

4.   Domeika, M., et al., Guidelines for the laboratory diagnosis of Chlamydia trachomatis infections in East European countries. J Eur Acad Dermatol Venereol, 2009. 23(12): p. 1353-63.

5.   Campbell, L.A., et al., Detection of Chlamydia trachomatis deoxyribonucleic acid in women with tubal infertility. Fertil Steril, 1993. 59(1): p. 45-50.

6.   Tubal infertility: serologic relationship to past chlamydial and gonococcal infection. World Health Organization Task Force on the Prevention and Management of Infertility. Sex Transm Dis, 1995. 22(2): p. 71-7.

7.   Punnonen, R., et al., Chlamydial serology in infertile women by immunofluorescence. Fertil Steril, 1979. 31(6): p. 656-9.

8.   Darville, T. and T.J. Hiltke, Pathogenesis of genital tract disease due to Chlamydia trachomatis. J Infect Dis, 2010. 201 Suppl 2: p. S114-25.

 

 

 

Accepted on 04.05.2017           © RJPT All right reserved