OJOG  Vol.5 No.2 , February 2015
The Association between Chlamydia Trachomatis and Ectopic Pregnancy in Lagos, Nigeria—A Case Control Study
Abstract: Objectives: To determine the seropositivity of Chlamydia antibody in patients with ruptured ectopic pregnancy compared to normal pregnant women and the risk factors for ectopic pregnancy. Study Design: This was a prospective case-control study of 85 cases of ruptured ectopic pregnancy and 100 cases of second trimester on-going intrauterine pregnant controls presenting in Lagos State University Teaching Hospital (LASUTH) between September 2009 and March 2010. Study Site: This was at the gynaecological emergency room and antenatal clinic in the Department of Obstetrics and Gynaecology. Ethical approval was sought and granted by the ethics review committee of LASUTH. Study Participants: Patients presenting with ruptured ectopic pregnancy were recruited as cases while the controls were made up of those with uncomplicated second trimester intrauterine pregnancy. A semi-structured questionnaire containing socio-demographic and clinical characteristics was administered following informed consent. Five milliliters of venous blood was taken from each participant and tested for Lymphogranuloma Venerum (LGV) type 2 broadly reacting antigen of Chlamydia trachomatis. Data Analysis: Data gathered from the case notes and laboratories were imputed into the computer and analyzed using the statistical package Epi-Info 3.51, Atlanta, USA. Frequency tables were generated for continuous variables and chi-square analysis used to determine association between variables, with p values <0.05 considered statistically significant. Results: There were 91 cases of ectopic pregnancy among a total of 2468 deliveries giving an incidence of 3.68% or 1 in 27 deliveries. Factors which significantly contributed to increased incidence of ectopic pregnancy in this study were: level of education (p = 0.001), socio-economic status (p = 0.001), parity (p = 0.005), early age of sexual debut (p = 0.001), multiple sexual partners (p = 0.001), previous pelvic inflammatory disease (p = 0.003), previous induced abortion (p = 0.013) and previous postabortal/puerperal sepsis (p = 0.013). The seropositivity of Chlamydia IgG (62.4%) in the cases was significantly higher than that of 29% in the control (p < 0.0001). Conclusion: There was a high incidence of ectopic during the period of study and the seropositivity of Chlamydia IgG antibody was significantly higher amongst the cases. Risk factors identified were low level of education, low socio-economic status, low parity, early age of sexual debut, multiple sexual partners, previous history of pelvic inflammatory disease, previous induced abortion and previous postabortal/puerperal sepsis.
Cite this paper: Adewunmi, A. , Orekoya, O. , Rabiu, K. and Ottun, T. (2015) The Association between Chlamydia Trachomatis and Ectopic Pregnancy in Lagos, Nigeria—A Case Control Study. Open Journal of Obstetrics and Gynecology, 5, 115-122. doi: 10.4236/ojog.2015.52015.

[1]   Inglais, R.R., Rice, P.A., Qureshi, N., Takayana, N., Lin, J.S. and Golenbook, D.T. (1995) The Inflammatory Cytokine Response to Chlamydia trachomatis Infection Is Endotoxin Mediated. Infection and Immunity, 63, 3125-3130.

[2]   Cates Jr, W. and Wasserheit, J.N. (1991) Genital Chlamydia Infections: Epidemiology and Reproductive Sequelae. American Journal of Obstetrics and Gynecology, 164, 1771-1781.

[3]   Gharoro, E.P. and Igbafe, A.A. (2002) Ectopic Pregnancy Revisited in Benin City, Nigeria: Analysis of 152 Cases. Acta Obstetricia et Gynecologica Scandinavica, 81, 1139-1143.

[4]   Aboyeji, A.P., Fawole, A.A. and Olatinwo, A.W.O. (2004) Trends in Ectopic Pregnancy in Ilorin, Nigeria. Nigerian Journal of Medicine Research, 4, 6-11.

[5]   Coste, J., Bouyer, J., Ughetto, S., Gerbard, L., Fernandez, H., Ponly, J.L., et al. (2004). Ectopic Pregnancy Is Again on the Increase. Recent Trends in the Incidence of Ectopic Pregnancies in France (1992-2002). Human Reproduction, 19, 2014-2018.

[6]   Trabert, B., Holt, V.L., Yu, O., Van Den Eeeden, S.K. and Scholes, D. (2011) Population-Based Ectopic Pregnancy Trends 1993-2007. American Journal of Preventive Medicine, 40, 556-560.

[7]   Farquhar, C.M. (2005) Ectopic Pregnancy. Lancet, 366, 583-591.

[8]   Varma, R. and Gupta, J. (2009) Tubal Ectopic Pregnancy. Clinical Evidence (Online), 1406.

[9]   Leke, R.J., Goyaux, N., Matsuda, T. and Thonneau, P.F. (2004) Ectopic Pregnancy in Africa: A Population-Based Study. Journal of Obstetrics Gynaecology, 103, 692-697.

[10]   Egger, M., Low, N., Smith, G.D., et al. (1998) Screening for Chlamydia Infection and the Risk of Ectopic Pregnancy in a Country in Sweden: Ecological Analysis. BMJ, 316, 1776-1780.

[11]   Abiodun, M.O., Ijaiya, M.A., Fawole, A.A. and Jimoh, A.A. (2007) A Study of Serological Evidence of Prior Chlamydia trachomatis Infection in Patients with Ectopic Pregnancy in Ilorin, Nigeria. European Journal of Scientific Research, 16, 461-466.

[12]   Okunola, M.A., Owonikoko, K.M., Adeyemi, A.S. and Adeyemi-Doro, F.A.B. (2009) Chlamydia Serology and Ectopic Pregnancy in Ibadan. Nigerian Medical Practitioner, 55, 13-15.

[13]   Brunham, R.C., Pealing, R., MacLean, I., Kossein, M.L. and Paraskevas, M. (1992) Chlamydia trachomatis Associated Ectopic Pregnancy: Serologic and Histological Correlates. Journal of Infectious Diseases, 165, 1076-1081.

[14]   Hillis, S.D., Owens, L.M., Marchbanks, P.A., Amsterdam, L.E. and Mac Kenzie, W.R. (1997) Recurrent Chlamydia Infections Increase the Risk of Hospitalization for Ectopic Pregnancy and Pelvic Inflammatory Disease. American Journal of Obstetrics and Gynecology, 176, 103-107.

[15]   Anorlu, R.I., Oluwole, A., Abudu, O.O. and Adebajo, S. (2005) Risk Factors for Ectopic Pregnancy in Lagos, Nigeria. Acta Obstetricia et Gynecological Scandinavia, 84, 184-188.

[16]   Bouyer, J., Coste, J., Shojael, T., Pouly, J-L., Fernandez, H., Gerband, L. and Job-Spira, N. (2003) Risk Factors for Ectopic Pregnancy: A Comprehensive Analysis Based on a Large Case-Control, Population-Based Study in France. American Journal of Epidemiology, 157, 185-194.

[17]   Andersen, B., OStergaard, L., Putro, E., Skriver, M.V. and Schonheyder, H.C. (2005) Ectopic Pregnancies and Reproductive Capacity after Chlamydia trachomatis Positive and Negative Results: A Histological Follow-Up Study. Sexually Transmitted Diseases, 32, 377-381.

[18]   Low, N., Egger, M., Sterne, J.A., Harboral, R.M., Ibrahim, F., Lindborn, B. and Hermann, B. (2006) Incidence of Severe Reproductive Tract Complications Associated with Diagnosed Genital Chlamydial Infection: The Uppsala Women’s Cohort Study. Sexually Transmitted Infections, 82, 2212-2218.

[19]   Benjamin, M.A., Yaakub, R., Paul, M., Yusof, M.D. and Osman, J, (2013) Role of Chlamydial Infection in Ectopic Pregnancy. Brunei International Medical Journal, 9, 97-101.

[20]   Agholor, K., Omo-Aghoja, L. and Okonofua, F. (2013) Association of Anti-Chlamydia Antibodies with Ectopic Pregnancy in Benin City, Nigeria: A Case-Control Study. African Health Sciences, 13, 430-440.

[21]   Adewunmi, A.A., Rabiu, K.A., Tayo, A.O. and Aletan, O.E. (2010) Ectopic Pregnancy in Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria. Nigerian Medical Practitioner, 58, 13-16.

[22]   Igberase, G.O., Ebeigbe, P.N., Igbekoyi, O.F. and Ajuform, B.I. (2005) Ectopic Pregnancy: An 11-Year Review in a Tertiary Centre in Niger Delta. Tropical Doctor, 35, 175-177.

[23]   Chow, J.M., Yonekura, M.L., Richwald, G.A., Greenland, S., Sweet, R.L. and Sinacter, J. (1990) The Association between Chlamydia trachomatis and Ectopic Pregnancy: A Matched Pair Case-Control Study. Journal of American Medical Association, 263, 3164-3167.

[24]   Machaso, A.C.S., Guimarces, E.M.B., Sakurai, E., Florarante, F.C.R., Amara, W.N. and Alves, M.F.O. (2007) High Titers of Chlamydia trachomatis Antibodies in Brazilian Women with Tubal Occlusion or Previous Ectopic Pregnancy. Infectious Diseases in Obstetrics and Gynecology, 24, 16-21.

[25]   Ville, Y., Lernez, M., Glowaczower, E., Robertson, J.N. and Ward, M.E. (1991) The Role of Chlamydia trachomatis and Neisseria gonorrhoeae in the Aetiology of Ectopic Pregnancy in Gabon. BJOG: An International Journal of Obstetrics & Gynaecology, 98, 1260-1266.

[26]   Bakken, I.J., Skjeldenstad, F.E. and Nordb, S.A. (2007) Chlamydia trachomatis Infections Increase the Risk for Ectopic Pregnancy: A Population-Based Nested Case-Control Study. Sexually Transmitted Diseases, 34, 166-169.

[27]   Svenstrup, H.F., Fedder, J., Kristoffersen, S.E., Trolle, B., Birkelund, S. and Christiansen, G. (2008) Mycoplasma genitalium, Chlamydia trachomatis, and Tubal Factor Infertility—A Prospective Study. Fertility and Sterility, 90, 513-520.

[28]   Black, C.M. (1997) Current Methods for Laboratory Diagnosis of Chlamydia trachomatis Infections. Clinical Microbiology Review, 10, 160-184.

[29]   Omo-Aghoja, L.O., Okonofuaa, F.E., Onemu, S.O., Larsen, U. and Bergsrom, S. (2007) Association of Chlamydia trachomatis Serology with Tubal Infertility in Nigerian Women. Journal of Obstetrics and Gynaecology Research, 33, 688-695.