Chlamydia antibody testing and diagnosing tubal pathology in subfertile women: an individual patient data meta-analysis

Broeze, Kimiko A.; Opmeer, Brent C.; Coppus, S.F.P.J.; Geloven, Nan van; Alves, M. F. C.; Anestad, G; Bhattacharya, Sohinee; Allan, John; Guerra‐Infante, Fernando M.; Hartog, J.E. den; Land, J. A.; Idahl, Annika; Linden, Paul J.Q. van der; Mouton, Johan W.; Ng, Ernest Hung Yu; Steeg, Jan Willem van der; Steures, Pieternel; Svenstrup, Helle Friis; Tiitinen, Aila; Toye, Baldwin; Veen, Fulco van der; Mol, Ben Willem J.

doi:10.1093/humupd/dmq060

Cited by 37 publications

(34 citation statements)

References 42 publications

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“…However, it is frequently not used and it is not listed in gynaecological guidelines in several countries. This lack of widespread implementation seems likely to be due to low specificity of the gold standard MIF and due to different perspectives on how the result can be best implemented into clinical protocol (Broeze et al, 2011). This has resulted in attempts to identify new antigens and develop new serological tests that could be used to specifically and sensitively identify chlamydial tubal infertility (Rodgers et al, 2010(Rodgers et al, , 2011Sanchez-Campillo et al, 1999;ForsbachBirk et al, 2010;Wills et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

“…surgical investigation) or alternatively, they could be used as an indicator of likely tubal infertility to recommend direct progression to IVF treatment. A meta-analysis of the performance of various serological Chlamydia antibody tests for the prediction of tubal infertility reported that microimmunofluorescence (MIF) has the highest accuracy (compared to ELISA and immunofluorescence) but only a moderate ability to discriminate between women with and without tubal pathology (Broeze et al, 2011). This meta-analysis demonstrated that MIF has the lowest specificity, meaning up to 34 % of positives are not tubal pathology; thus, MIF is generally only used to identify women who require further tubal pathology investigation.…”

Section: Introductionmentioning

confidence: 99%

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Development and evaluation of a multi-antigen peptide ELISA for the diagnosis of Chlamydia trachomatis-related infertility in women

Menon

Stansfield

Logan

et al. 2016

Journal of Medical Microbiology

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Chlamydia trachomatis results in tubal factor infertility in some women. Diagnosis of this tubal infertility is difficult and typically involves laparoscopy or hysterosalpingography to detect the tubal blockages. Numerous serological tests have been developed; however, they are presently not used for diagnosis without subsequent surgical investigation during the infertility investigation. This study aimed to develop a highly specific serological assay for chlamydial tubal factor infertility in women that could be used to recommend direct progression to in vitro fertilization (IVF) treatment for women who are positive. Women were recruited from a variety of settings including women seeking fertility treatment, sexual health and general practitioner (GP) consultations or antenatal care (n=259). The serological assay was developed using sera from a large group of women by using infertile microimmunofluorescence (MIF)-positive women with tubal damage as the positives compared to infertile or acute infection and/or fertile controls (negatives). The new multi-peptide ELISA was highly specific for the detection of tubal factor infertility (P=0.011) compared to another ELISA (P=0.022) and MIF (P=0.099). The sensitivity of the assay should be improved before clinical utility. Potentially, a two-step testing protocol could be used during the initial infertility investigation, where MIF followed by a highly specific ELISA could be used to recommend direct progression to IVF for women who are positive.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Development and evaluation of a multi-antigen peptide ELISA for the diagnosis of Chlamydia trachomatis-related infertility in women

Menon

Stansfield

Logan

et al. 2016

Journal of Medical Microbiology

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“…The performance of the serological tests that are commonly used in conjunction with gynecological investigation to attribute infertility to Chlamydia is one of the limitations of the assessment of the burden of chlamydial infertility. However, a meta-analysis conducted in 2011 compared micro-immunofluorescence (MIF) tests and several enzyme-linked immunosorbent assays (ELISAs) and found that MIF tests had the highest accuracy (area under the curve) for a positive reaction in women with tubal pathology (P Ͻ 0.001; P ϭ 0.01 for bilateral occlusion) (17). Regardless of test performance, numerous studies have identified a correlation of Chlamydia serology positivity (Chlamydia antibody testing) with diagnosed TFI (18)(19)(20)(21)(22)(23)(24).…”

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confidence: 99%

Human and Pathogen Factors Associated with Chlamydia trachomatis-Related Infertility in Women

et al. 2015

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SUMMARY Chlamydia trachomatis is the most common bacterial sexually transmitted pathogen worldwide. Infection can result in serious reproductive pathologies, including pelvic inflammatory disease, ectopic pregnancy, and infertility, in women. However, the processes that result in these reproductive pathologies have not been well defined. Here we review the evidence for the human disease burden of these chlamydial reproductive pathologies. We then review human-based evidence that links Chlamydia with reproductive pathologies in women. We present data supporting the idea that host, immunological, epidemiological, and pathogen factors may all contribute to the development of infertility. Specifically, we review the existing evidence that host and pathogen genotypes, host hormone status, age of sexual debut, sexual behavior, coinfections, and repeat infections are all likely to be contributory factors in development of infertility. Pathogen factors such as infectious burden, treatment failure, and tissue tropisms or ascension capacity are also potential contributory factors. We present four possible processes of pathology development and how these processes are supported by the published data. We highlight the limitations of the evidence and propose future studies that could improve our understanding of how chlamydial infertility in women occurs and possible future interventions to reduce this disease burden.

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“…Furthermore, the impact of chlamydial infection in the etiology of tubal pathology secondary to salpingitis [70][71][72] on female fertility is well documented. Although neither HSG or LPS may identify tubal pathology secondary to chlamydial infections in the absence of overt occlusion or peritubal adhesions, subfertile women with a positive Chlamydia trachomatis antibody have lower chances for pregnancy than seronegative women [73].…”

Section: Tuboperitoneal Disordersmentioning

confidence: 99%

Potential Etiologies of Unexplained Infertility in Females

Galliano

Pellicer

2015

Unexplained Infertility

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Chlamydia antibody testing and diagnosing tubal pathology in subfertile women: an individual patient data meta-analysis

Abstract: In Chlamydia antibody testing, MIF is superior in the assessment of tubal pathology. In the initial screen for tubal pathology MIF should therefore be the test of first choice.

Cited by 37 publications

References 42 publications

Development and evaluation of a multi-antigen peptide ELISA for the diagnosis of Chlamydia trachomatis-related infertility in women

Development and evaluation of a multi-antigen peptide ELISA for the diagnosis of Chlamydia trachomatis-related infertility in women

Human and Pathogen Factors Associated with Chlamydia trachomatis-Related Infertility in Women

Potential Etiologies of Unexplained Infertility in Females

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