Tubal damage in infertile women: prediction using chlamydia serology

Akande, Valentine; Hunt, Linda; Cahill, David J; Caul, E.O.; Ford, W. C. L.; Jenkins, Julian

doi:10.1093/humrep/deg347

Cited by 99 publications

(79 citation statements)

References 44 publications

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“…Price et al used a statistical modelling approach to estimate that 45% (credible interval 28%, 62%) of tubal infertility cases are caused by chlamydia [138]. This estimate is similar to some obtained directly from case-control studies but has the advantage that the method takes into account uncertainty about the sensitivity and specificity of chlamydia antibody tests [139] and the likelihood that chlamydia antibody levels are higher in women with tubal factor infertility that was caused by chlamydia that in women with tubal factor infertility caused by another organism or condition in women with coincidental exposure to chlamydia [161]. The attributable fraction could change over time if either prevalence or the strength of association change.…”

Section: Ectopic Pregnancy and Tubal Infertilitysupporting

confidence: 66%

Opportunistic testing for urogenital infection with Chlamydia trachomatis in south-western Switzerland, 2012: a feasibility study

et al. 2015

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The feasibility of opportunistic screening of urogenital infections with Chlamydia trachomatis was assessed in a cross-sectional study in 2012, in two cantons of south-western Switzerland: Vaud and Valais. Sexually active persons younger than?30 years, not tested for C. trachomatis in the last three months, were invited for free C. trachomatis testing by PCR in urine or self-applied vaginal swabs. Of 2,461 consenting participants, 1,899 (77%) were women and all but six (0.3%) submitted a sample. Forty-seven per cent of female and 25% of male participants were?younger than?20 years. Overall, 134 (5.5%) of 2,455 tested participants had a positive result and were followed up. Seven per cent of all candidates for screening were not invited, 10% of invited candidates were not eligible, 15% of the eligible candidates declined participation, 5% of tested participants testing positive were not treated, 29% of those treated were not retested after six months and 9% of those retested were positive for C. trachomatis. Opportunistic C. trachomatis testing proved technically feasible and acceptable, at least if free of charge. Men and peripheral rural regions were more difficult to reach. Efforts to increase testing and decrease dropout at all stages of the screening procedure are necessary.

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Section: Ectopic Pregnancy and Tubal Infertilitysupporting

confidence: 66%

Opportunistic testing for urogenital infection with Chlamydia trachomatis in south-western Switzerland, 2012: a feasibility study

et al. 2015

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“…However, none of the chlamydial serological results were significantly associated with tubal infertility in the validation infertility clinic group (group 4). This result was inconsistent with most published studies, where chlamydial serology is typically significantly associated with tubal infertility (Akande et al, 2003;Mehanna et al, 1995;Claman et al, 1997;Land et al, 2003). However, it is possible that this is because the study included women with unknown tubal status in the comparison group, who would often be excluded in studies like this one.…”

Section: Discussionmentioning

confidence: 65%

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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“…It has been shown that CAT is more accurate in predicting distal tubal pathology, instead of unspecified tuboperitoneal abnormalities or proximal tubal occlusion [11]. Moreover, in studying the implications of different cutoff titres for a positive test, it has been noted that increasing the cutoff titre will improve the specificity, at the expense of sensitivity [7,12,15]. In patients with laparoscopically detected tubal pathology but negative antibody titres, diminished antibody titres related to time has been considered by some authors but not by others [26,27].…”

Section: Discussionmentioning

confidence: 99%

“…However, both methods are costly and invasive, and therefore unsuitable for screening on a large scale. Since tubal pathology and infertility have been associated with asymptomatic Chlamydia trachomatis infections in the past, chlamydia antibody testing (CAT) in serum has been introduced as a screening method for tubal factor subfertility [7][8][9][10]. Hence the development of a simple and reliable assay for the detection of C. trachomatis antibodies is essential.…”

Section: Introductionmentioning

confidence: 99%

Comparison of four serological assays for the diagnosis of Chlamydia trachomatis in subfertile women

Muvunyi

Claeys

Sutter

et al. 2011

J Infect Dev Ctries

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Introduction: Chlamydia antibody testing (CAT) in serum has been introduced as a screening method in the infertility workup. We evaluated the test characteristics of two ELISA tests compared to micro-immunofluorescence tests (MIFs). MIFs are considered the gold standard in the C. trachomatis IgG antibodies detection. We also compared the accuracy of all CAT tests in predicting tubal subfertility, using laparoscopy as a reference. Methodology: Four commercial serological methods were used to analyse 101 serum samples for the presence of C. trachomatis IgG antibodies from patients at the Infertility Clinic of Ghent University Hospital. The diagnostic utility for prediction of tubal infertility of serological methods was evaluated based on patients' medical records. Results: A comparison of the serological assays showed little difference in the major performance characteristics: the sensitivities of all MIFs and ELISAs were 100% for all assays (except the ELISA Vircell, with a sensitivity of 90%), and the specificities ranged from 92% for MIF Ani Labsystems to 98% for the MIF Focus and ELISA Vircell. As compared to laparoscopy data, CAT positivity in subfertile women with tubal damage (n=40) did not significantly differ from that of subfertile women without tubal damage (n=61): Positive predictive values (PPV) of CAT ranged from 53% to 60% and negative predictive values (NPV) ranged from 62% to 64%. Conclusion: evaluated ELISAs are comparable to MIFs in the detection of C. trachomatis IgG antibodies and should be preferred for large serological studies, especially in resource poor settings.

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Tubal damage in infertile women: prediction using chlamydia serology

Cited by 99 publications

References 44 publications

Opportunistic testing for urogenital infection with Chlamydia trachomatis in south-western Switzerland, 2012: a feasibility study

Opportunistic testing for urogenital infection with Chlamydia trachomatis in south-western Switzerland, 2012: a feasibility study

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

Comparison of four serological assays for the diagnosis of Chlamydia trachomatis in subfertile women

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