OJOG  Vol.5 No.11 , September 2015
Screenning of Chlamydia trachomatis Infection among Women Attending Outpatient Clinic of Infertility
ABSTRACT
Objective: The goal of this study was to determine the prevalence of C. trachomatis in women diagnosed with infertility attending the Outpatient Clinic of Infertility from Botucatu Medical School, UNESP, Brazil. Patients and Methods: This molecular study enrolled a total of 112 women. Among these patients, 62 presented primary infertility while 50 presented secondary infertility. The criteria for eligibility included women who were: reproductive-aged; no prior report of seroconversion for HIV; no antibiotic or vaginal cream used in the preceding 30 days; and abstinence from sexual intercourse for 72 hours before the visit. The women were submitted to a gynecological examination and cervical samples were collected with an endocervical cytobrush for molecular analysis of C. trachomatis. Results: The prevalence of chlamydial infection was 8% with similar prevalence between primary (8.1%) and secondary (8.0%) infertility. Conclusion: Considering the asymptomatic nature of chlamydial infection and its association with tubal factor infertility, there is a pressing need to incorporate the screening of C. trachomatis infection as part of the routine investigation for infertility. The early diagnostic by screening can minimize complications and reduce Public Health costs with Assisted Reproductive Technology.

Cite this paper
Lavorato, H. , Moço, N. , Martin, L. , Santos, A. , Pontes, A. , Duarte, M. and Silva, M. (2015) Screenning of Chlamydia trachomatis Infection among Women Attending Outpatient Clinic of Infertility. Open Journal of Obstetrics and Gynecology, 5, 600-607. doi: 10.4236/ojog.2015.511085.
References
[1]   Berek, J. (2002) Novak’s Gynecology. 13th Edition, Lippincott Williams & Wilkins, Philadelphia, 973.

[2]   WHO (2012) Global Incidence and Prevalence of Selected Curable Sexually Transmitted Infections—2008. World Health Organization, Geneva.

[3]   Gradison, M. (2012) Pelvic Inflammatory Disease. American Family Physician, 85, 791-796.

[4]   Mardh, P.A. (2004) Tubal Factor Infertility, with Special Regard to Chlamydial Salpingitis. Current Opinion in Infectious Diseases, 17, 49-52.
http://dx.doi.org/10.1097/00001432-200402000-00010

[5]   Schindlbeck, C., Dziura, D. and Mylonas, I. (2014) Diagnosis of Pelvic Inflammatory Disease (PID): Intra-Operative Findings and Comparison of Vaginal and Intra-Abdominal Cultures. Archives of Gynecology and Obstetrics, 289, 1263-1269.
http://dx.doi.org/10.1007/s00404-014-3150-7

[6]   Westrom, L.V. (1994) Sexually Transmitted Diseases and Infertility. Sexually Transmitted Diseases, 21, S32-S37.

[7]   Paavonen, J. and Eggert Kruse, W. (1999) Chlamydia trachomatis: Impact on Human Reproduction. Human Reproduction Update, 5, 433-437.
http://dx.doi.org/10.1093/humupd/5.5.433

[8]   Manavi, K. (2006) A Review on Infection with Chlamydia trachomatis. Best Practice & Research Clinical Obstetrics & Gynaecology, 20, 941-951.
http://dx.doi.org/10.1016/j.bpobgyn.2006.06.003

[9]   Malhotra, M., Sood, S., Mukherjee, A., Muralidhar, S. and Bala, M. (2013) Genital Chlamydia trachomatis: An Update. Indian Journal of Medical Research, 138, 303-316.

[10]   Stephens, R.S., Kalman, S., Lammel, C., Fan, J., Marathe, R., Aravind, L., Mitchell, W., Olinger, L., Tatusov, R.L., Zhao, Q., Koonin, E.V. and Davis, R.W. (1998) Genome Sequence of an Obligate Intracellular Pathogen of Humans. Chlamydia trachomatis. Science, 282, 754-759.
http://dx.doi.org/10.1126/science.282.5389.754

[11]   Mishori, R., McClaskey, E.L. and Winklerprins, V.J. (2012) Chlamydia trachomatis Infections: Screening, Diagnosis, and Management. American Family Physician, 86, 1127-1132.

[12]   Moulder, J.W. (1991) Interaction of Chlamydiae and Host Cells in Vitro. Microbiological Reviews, 55, 143-190.

[13]   Bavoil, P.M., Hsia, R. and Ojcius, D.M. (2000) Closing in on Chlamydia and Its Intracellular Bag of Tricks. Microbiology, 146, 2723-2731.
http://dx.doi.org/10.1099/00221287-146-11-2723

[14]   van de Laar, M.J. and Morré, S.A. (2007) Chlamydia: A Major Challenge for Public Health. Eurosurveillance, 12, E1-E2.

[15]   Centers for Disease Control and Prevention. 2008 Sexually Transmitted Diseases Surveillance.
http://www.cdc.gov/std/stats08/

[16]   Centers for Disease Control and Prevention C (2009) Sexually Transmitted Disease Surveillance 2008 Supplement. Chlamydia Prevalence Monitoring Project Annual Report 2007. US Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta.

[17]   Andersen, B., Olesen, F., Moller, J.K. and Ostergaard, L. (2002) Population-Based Strategies for Outreach Screening of Urogenital Chlamydia trachomatis Infections: A Randomized, Controlled Trial. The Journal of Infectious Diseases, 185, 252-258.
http://dx.doi.org/10.1086/338268

[18]   Stamm, W.E. (1999) Chlamydia trachomatis: Progress and Problems. The Journal of Infectious Diseases, 179, S380-S383.
http://dx.doi.org/10.1086/513844

[19]   Land, J.A., Van Bergen, J.E., Morré, S.A. and Postma, M.J. (2010) Epidemiology of Chlamydia trachomatis Infection in Women and the Cost-Effectiveness of Screening. Human Reproduction Update, 16, 189-204.
http://dx.doi.org/10.1093/humupd/dmp035

[20]   Scholes, D., Stergachis, A., Heidrich, F.E., Andrilla, H., Holmes, K.K. and Stamm, W.E. (1996) Prevention of Pelvic Inflammatory Disease by Screening for Chlamydia Infection. New England Journal of Medicine, 334, 1362-1367.
http://dx.doi.org/10.1056/NEJM199605233342103

[21]   Egger, M., Low, N., Smith, G.D., Lindblom, B. and Herrmann, B. (1998) Screening for Chlamydial Infections and the Risk of Ectopic Pregnancy in a County in Sweden: Ecological Analysis. BMJ, 316, 1776-1780.
http://dx.doi.org/10.1136/bmj.316.7147.1776

[22]   Marrazzo, J.M., Celum, C.L., Hillis, S.D., Fine, D., De Lisle, S. and Handsfield, H.H. (1997) Performance and Cost-Effectiveness of Selective Screening Criteria for Chlamydia trachomatis Infection in Women. Implications for a National Chlamydia Control Strategy. Sexually Transmitted Diseases, 24, 131-141.
http://dx.doi.org/10.1097/00007435-199703000-00003

[23]   Paavonen, J., Puolakkainen, M., Paukku, M. and Sintonen, H. (1998) Cost-Benefit Analysis of First-Void Urine Chlamydia trachomatis Program. Obstetrics & Gynecology, 92, 292-298.
http://dx.doi.org/10.1016/S0029-7844(98)00167-7

[24]   Genc, M. and Mardh, A. (1996) A Cost-Effectiveness Analysis of Screening and Treatment for Chlamydia trachomatis Infection in Asymptomatic Women. Annals of Internal Medicine, 124, 1-7.
http://dx.doi.org/10.7326/0003-4819-124-1_Part_1-199601010-00001

[25]   Nettleman, M.D. and Jones, R.B. (1988) Cost-Effectiveness of Screening Women at Moderate Risk for Genital Infections Caused by Chlamydia trachomatis. JAMA, 260, 207-213.
http://dx.doi.org/10.1001/jama.1988.03410020073031

[26]   Alfarraj, D.A., Somily, A.M., Alssum, R.M., Abotalib, Z.M., El-Sayed, A.A. and Al-Mandeel, H.H. (2015) The Prevalence of Chlamydia trachomatis Infection among Saudi Women Attending the Infertility Clinic in Central Saudi Arabia. Saudi Medical Journal, 36, 61-66.
http://dx.doi.org/10.15537/smj.2015.1.9967

[27]   Rashidi, B.H., Chamani-Tabriz, L., Haghollahi, F., Jeddi-Tehrani, M., Naghizadeh, M.M., Shariat, M., Akhondi, M.M., Bagheri, R., Asgari, S. and Wylie, K. (2013) Effects of Chlamydia trachomatis Infection on Fertility; A Case-Control Study. Journal of Reproduction & Infertility, 14, 67-72.

[28]   Kamel, R.M. (2013) Screening for Chlamydia trachomatis Infection among Infertile Women in Saudi Arabia. International Journal of Women’s Health, 5, 277-284.
http://dx.doi.org/10.2147/IJWH.S46678

[29]   Darville, T. and Hiltke, T.J. (2010) Pathogenesis of Genital Tract Disease Due to Chlamydia trachomatis. The Journal of Infectious Diseases, 201, S114-S125.
http://dx.doi.org/10.1086/652397

[30]   Ray, K. (2006) Chlamydia trachomatis and Infertility. Indian Journal of Medical Research, 123, 730-734.

[31]   Dhawan, B., Rawre, J., Ghosh, A., Malhotra, N., Ahmed, M.M., Sreenivas, V. and Chaudhry, R. (2014) Diagnostic Efficacy of a Real Time PCR Assay for Chlamydia trachomatis Infection in Infertile Women in North India. Indian Journal of Medical Research, 140, 252-261.

[32]   Pantoja, M., Campos, E.A., Pitta Dda, R., Gabiatti, J.E., Bahamondes, M.V. and Fernandes, A.M. (2012) Prevalence of Chlamydia trachomatis Infection among Women Candidates for in Vitro Fertilization at a Public Institution of the State of Sao Paulo, Brazil. Revista Brasileira de Ginecologia e Obstetrícia, 34, 425-431.
http://dx.doi.org/10.1590/S0100-72032012000900007

[33]   Ness, R.B., Soper, D.E., Richter, H.E., Randall, H., Peipert, J.F., Nelson, D.B., Schubeck, D., McNeeley, S.G., Trout, W., Bass, D.C., Hutchison, K., Kip, K. and Brunham, R.C. (2008) Chlamydia Antibodies, Chlamydia Heat Shock Protein and Adverse Sequelae after Pelvic Inflammatory Disease: The PID Evaluation and Clinical Health (PEACH) Study. Sexually Transmitted Diseases, 35, 129-135.
http://dx.doi.org/10.1097/OLQ.0b013e3181557c25

[34]   Marashi, S.M.A., Moulana, Z., Fooladi, A.A.I. and Karim, M.M. (2014) Comparison of Genital C. Trachomatis Infection Incidence between Women with Infertility and Healthy Women in Iran Using PCR and Immunofluorescence Methods. Jundishapur Journal of Microbiology, 7, 1-4.
http://dx.doi.org/10.5812/jjm.9450

[35]   Nwankwo, E.O. and Sadiq, M.N. (2014) Prevalence of Chlamydia trachomatis Infection among Patients Attending Infertility and Sexually Transmitted Diseases Clinic (STD) in Kano, North Western Nigeria. African Health Sciences, 14, 672-678.
http://dx.doi.org/10.4314/ahs.v14i3.24

[36]   Pimenta, J., Catchpole, M., Gray, M., Hopwood, J. and Randall, S. (2000) Screening for Genital Chlamydial Infection. BMJ, 321, 629-631.
http://dx.doi.org/10.1136/bmj.321.7261.629

[37]   Al-Ramahi, M., Mahafzah, A., Saleh, S. and Fram, K. (2008) Prevalence of Chlamydia trachomatis Infection in Infertile Women at a University Hospital in Jordan. Eastern Mediterranean Health, 14, 1148-1154.

[38]   Afrakhteh, M., Beyhaghi, H., Moradi, A., Hosseini, S.J., Mahdavi, A., Giti, S., et al. (2008) Sexually Transmitted Infections in Tehran. Journal of Family & Reproductive Health, 2, 123-128.

[39]   Fernandes, L.B., Arruda, J.T., Approbato, M.S. and Garcia-Zapata, M.T. (2014) Chlamydia trachomatis and Neisseria gonorrhoea Infection: Factors Associated with Infertility in Women Treated at a Human Reproduction Public Service. Revista Brasileira de Ginecologia e Obstetrícia, 36, 353-358.
http://dx.doi.org/10.1590/SO100-720320140005009

[40]   Taylor-Robinson, D. and Thomas, B.J. (1991) Laboratory Techniques for the Diagnosis of Chlamydial Infections. Sexually Transmitted Infections, 67, 256-266.
http://dx.doi.org/10.1136/sti.67.3.256

[41]   Ljubin-Sternak, S. and Mestrovic, T. (2014) Chlamydia trachomatis and Genital Mycoplasmas: Pathogens with an Impact on Human Reproductive Health. Journal of Pathogens, 2014, Article ID: 183167.
http://dx.doi.org/10.1155/2014/183167

[42]   Griffais, R. and Thibon, M. (1989) Detection of Chlamydia trachomatis by the Polimerase Chain Reaction. Research in Microbiology, 140, 139-141.
http://dx.doi.org/10.1016/0923-2508(89)90047-8

[43]   Al Subhi, T., Al Jashnmi, R.N., Al Khaduri, M. and Gowri, V. (2013) Prevalence of Tubal Obstruction in the Hysterosalpingogram of Women with Primary and Secondary Infertility. Journal of Reproduction & Infertility, 14, 214-216.

[44]   Wilkowska-Trojniel, M., Zdrodowska-Stefanow, B., Ostaszewska-Puchalska, I., Zbucka, M., Wolczyński, S., Grygoruk, C., Kuczyński, W. and Zdrodowski, M. (2009) Chlamydia trachomatis Urogenital Infection in Women with Infertility. Advances in Medical Sciences, 54, 82-85.
http://dx.doi.org/10.2478/v10039-009-0007-6

[45]   Marques, C.A.S., Menezes, M.L.B., Coelho, I.M.G., Marques, C.R.C., Celestino, L.C., Melo, M.C. and Lima, P.R. (2007) Infeccao genital por Chlamydia trachomatis em casais atendidos em ambulatório de esterilidade conjugal. Jornal brasileiro de doencas sexualmente transmissíveis, 19, 5-10.

[46]   Malik, A., Jain, S., Hakim, S., Shukla, I. and Rizvi, M. (2006) Chlamydia trachomatis Infection & Female Infertility. Indian Journal of Medical Research, 123, 770-775.

[47]   Lappa, S. and Moscicki, A.B. (1997) The Pediatrician and the Sexually Active Adolescent: A Primer for Sexually Transmitted Diseases. Pediatric Clinics of North America, 44, 1405-1445.
http://dx.doi.org/10.1016/S0031-3955(05)70567-8

[48]   Araújo, R.S., Guimaraes, E.M., Alves, M.F., Sakurai, E., Domingos, L.T., Fioravante, F.C. and Machado, A.C. (2006) Prevalence and Risk Factors for Chlamydia Trachomatis Infection in Adolescent Females and Young Women in Central Brazil. European Journal of Clinical Microbiology & Infectious Diseases, 25, 397-400.
http://dx.doi.org/10.1007/s10096-006-0142-y

[49]   Saxena, S.B. and Jenkins, R.R. (1997) Sexually Transmitted Diseases in Adolescents: Screening and Treatment. Comprehensive Therapy, 23, 108-115.

[50]   Centers for Disease Control and Prevention (2001) Surveillance 2001: Special Focus Profiles: STDs in Adolescents and Young Adults. US Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, 51-58.

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

[52]   Watson, E.J., Templeton, A., Russell, I., Paavonen, J., Mardh, P.A., Stary, A. and Pederson, B.S. (2002) The Accuracy and Efficacy of Screening Tests for Chlamydia trachomatis: A Systematic Review. Journal of Medical Microbiology, 51, 1021-1031.
http://dx.doi.org/10.1099/0022-1317-51-12-1021

[53]   Thejls, H., Gnarpe, J. and Gnarpe, H. (1994) Expanded Gold Standard in the Diagnosis of Chlamydia trachomatis in a Low Prevalence Population: Diagnostic Efficacy of Tissue Culture, Direct Immunofluorescence, Enzyme Immunoassay, PCR and Serology. Sexually Transmitted Infections, 70, 300-303. http://dx.doi.org/10.1136/sti.70.5.300

[54]   Jalgaonkar, S.V., Pathak, A.A. and Thakur, Y.S. (1990) Enzyme Immunoassay for Rapid Detection of Chlamydia trachomatis in Urogenital Infections. Indian Journal of Sexually Transmitted Infections, 1, 23-26.

[55]   Schachter, J., Stamm, W.E. and Quinn, T.C. (1996) Discrepant Analysis and Screening for Chlamydia trachomatis. The Lancet, 348, 1308-1309. http://dx.doi.org/10.1016/S0140-6736(05)65783-2

[56]   Mylonas, I. (2012) Female Genital Chlamydia trachomatis Infection: Where Are We Heading? Archives of Gynecology and Obstetrics, 285, 1271-1285. http://dx.doi.org/10.1007/s00404-012-2240-7

[57]   Mahony, J.B., Luinstra, K.E., Sellors, J.W. and Chernesky, M.A. (1993) Comparison of Plasmid- and Chromosome-Based Polymerase Chain Reaction Assays for Detecting Chlamydia trachomatis Nucleic Acids. Journal of Clinical Microbiology, 31, 1753-1758.

[58]   Schachter, J., Hook, W.E., Martin, D.H., Willis, W., Fine, P., Fuller, D., Jordan, J., Janda, W.M. and Chernesky, M. (2005) Confirming Positive Results of Nucleic Acid Amlification Tests (NAATs) for Chlamydia trachomatis: All NAATs Are Not Created Equal. Journal of Clinical Microbiology, 43, 1372-1373.
http://dx.doi.org/10.1128/JCM.43.3.1372-1373.2005

[59]   Mushanski, L.M., Brandt, K., Coffin, N., Levett, P.N., Horsman, G.B. and Rank, E.L. (2012) Comparison of the BD Viper System with XTR Technology to the GenProbe APTIMA COMBO 2 Assay Using the TIGRIS DTS System for the Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in Urine Specimens. Sexually Transmitted Infections, 39, 514-517.
http://dx.doi.org/10.1097/OLQ.0b013e31824f2f5b

[60]   Van Der Pol, B., Liesenfeld, O., Williams, J.A., Taylor, S.N., Lillis, R.A., Body, B.A., Nye, M., Eisenhut, C. and Hook, E.W. (2012) Performance of the Cobas CT/NG Test Compared to the Aptima AC2 and Viper CTQ/GCQ Assays for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae. Journal of Clinical Microbiology, 50, 2244-2249.
http://dx.doi.org/10.1128/JCM.06481-11

[61]   Stamm, W.E., Jones, R.B. and Batteiger, B.E. (2005) Chlamydia trachomatis (Trachoma, Perinatal Infections, Lymphogranuloma Venereum and Other Genital Infections). In: Mandell, G.L., Dolin, R., Bennette, J.E., Eds., Principles and Practice of Infectious Diseases, Elsevier Churchill Livingstone, Philadelphia, 2239-2251.

[62]   Price, M.J., Ades, A.E., De Angelis, D., Welton, N.J., Macleod, J., Soldan, K., Simms, I., Turner, K. and Horner, P.J. (2013) Risk of Pelvic Inflammatory Disease Following Chlamydia trachomatis Infection: Analysis of Prospective Studies with a Multistate Model. American Journal of Epidemiology, 178, 484-492.
http://dx.doi.org/10.1093/aje/kws583

[63]   Wiesenfeld, H.C., Hillier, S.L., Meyn, L.A., Amortegui, A.J. and Sweet, R.L. (2012) Subclinical Pelvic Inflammatory Disease and Infertility. Obstetrics & Gynecology, 120, 37-43.
http://dx.doi.org/10.1097/AOG.0b013e31825a6bc9

 
 
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