Prevalence of Chlamydia trachomatis infection in patients treated for infertility

Czech version

Authors: A. Sobek jr.; B. Hladíková; O. Koutná; L. Kučerová; Z. Dostálová; A. Sobek
Authors‘ workplace: Fertimed, Olomouc/Polanka nad Odrou, vedoucí doc. MUDr. A. Sobek, CSc.
Published in: Ceska Gynekol 2012; 77(5): 476-479

Overview

Aim of the study:
To determine the prevalence of Chlamydia trachomatis infection in patients treated for infertility.

Study type:
A retrospective analysis.

Setting:
Fertimed, infertility treatment center, Olomouc.

Method:
At Fertimed, we used DNA detection of Chlamydia trachomatis by the PCR method of the company GeneProof to examine, between 2009–2011, 785 women undergoing one of the infertility treatment methods and their 113 partners. In the second group, we examined 121 oocyte donors and 30 men before sperm donation. We appraised the frequency of Chlamydia trachomatis detection in the specific groups and the clinical impact of the infection on the female reproductive organs.

Results:
In the group of women treated for infertility, we detected 20 (2.5%) women with an active infection. After treatment, 9 of them underwent an examination of Fallopian tube patency using the UTHL (ultrasonographically guided transvaginal hydrolaparoscopy) method. In 7 cases, we indicated a bilateral salpingectomy due to a sactosalpinx and in one case severe pelvic adhesions were found (88.9%), and in one patient, the result was normal. In the control group of 43 PCR-negative women who were examined for Fallopian tube patency, 9.3% rate of tubal pathology was found (p<0.001).

In the oocyte donor group, we detected the presence of Chlamydia trachomatis in 12 (9.9%) women, and in the sperm donor group, in 7.6% men. Treatment with 500 mg of Sumamed (azithromycin), given in 3 doses, was successful in all of the positive patients.

Conclusion:
We found that Chlamydia trachomatis detection was lower in the women treated for infertility than in the female donor group. Women with a confirmed infection had a high prevalence of inflammatory changes in the Fallopian tubes compared with women devoid of a confirmed infection. The treatment with azithromycin is effective.

Key words:
Chlamydia trachomatis, infertility, adhesions, azithromycin, real time PCR.

Sources

1. Cunningham, KA., Beagley, KW. Male genital tract chlamydial infection“ implication for patology and infertility. Biol Reprod, 2008, 79, 2, p. 180–189.

2. Hosseinzadeh, S., Brewis, IA., Eley, A., Pacey, AA. Co-incubation of human spermatozoa with Chlamydia trachomatis cause premature sperm death. Human Reprod, 2001, 10, 2, p. 293–299.

3. Chaim, W., Edelstein, Z., Sarov, B., Sarov, I. The long term follow up of asymtomatic women with Chlamydia trachomatis. Arch Gynecol Obstet, 1992, 251, p. 159–164.

4. Krause, W., Bohring, C. Male infertility and genital infection victim or predator? Andrologia, 2003, 35, 4, p. 209–216.

5. Macmillan, S., Templeton, A. Screening for Chlamydia trachomatis in subfertile women. Hum Reprod, 1999, 14, 12, p. 3009–3012.

6. Mardh, PA. Treatment of chlamydial infections. Scand J Infect Dis Suppl, 1990, 68, p. 23–30.

7. Mašata, J., Řezáčová, J., Sodja, I. Léčba chlamydiové urogenitální infekce. Čes Gynek, 1998, 63, 4, s. 279–282.

8. Mašata, J., Řezáčová, J., Sodja, I., Drbohlav, P. Chlamydia trachomatiss – epidemiologická situace. Čes Gynek, 1998, 63, 3, s. 217–220.

9. Mašata, J., Řezáčová, J., Jedličková, A., Drbohlav, P. Současné možnosti léčby chlamydiové urogenitální infekce. Prakt Gyn, 1999, 4, s. 8–11.

10. Mašata, J., Řezáčová, J., Drbohlav, P. Urogenitální chlamydiové infekce. Prakt Gyn, 2001, 3, s. 27–31.

11. Mazzoli, S., Cai, T., Addonisio, P., Bechi, A., et al. Chlamydia trachomatis infection is related to poor semen quality in Prostatitis Patients. Eur Urol, 2010, 57, 4, p. 708–714.

12. Medková, Z. Zkušenosti s přímým průkazem Chlamydia trachomatis z urogenitálních výtěrů a z moči metodou PCR. Urologie pro praxi, 2002, 1, s. 26–29.

13. Mullis, KB., Falkony, FA. Specific synthesis of DNA in vitro via a polymerase-catalyzed chain reaction. Methods Enzymol, 1987, 155, p. 335–350.

14. Munoz, MG., Witkin, SS. Autoimmunity to spermatozoa, asymptomatic Chlamydia trachomatis genital tract infection and gamma delta T lymphocytes in seminal fluid from the male partners of couples with unexplained infertility. Hum Reprod, 1995, 5, 10, p. 1070–1074.

15. Paavonen, J. Is screening for Chlamydia trachomatis infection cost – effective? Genitour Med, 1997, 73, p. 103–104.

16. Pilka, L., Malý, Z. Chlamydiové infekce a gynekologické záněty. Gynekolog, 1999, 8, 5, s. 203–206.

17. Pospíšil, L., Zralý, Z. Nové pohledy na chlamydie jako příčinu neplodnosti. Gynekolog, 2000, 9, 2, s. 59–62.

18. Pospíšil, L, Pilka, L., Malý, Z. Pohlavní nemoci a jejich vztah k zánětům v gynekologii. Gynekolog, 1999, 8, 6, s. 292–297.

19. Satta, A., Stivala, A., Garozzo, A., et al. Experimental Chlamydia trachomatis infection cause apoptosis in human sperm. Hum Reprod, 2009, 21, 1, p. 34–137.

20. Středa, R., Štěpán, J. Prevalence bakteriální, chlamydiové a mykotické infekce u neplodných žen při mimotělním oplodnění. Gynekolog, 2007, 16, 5, s. 190–192.

21. Sweet, RL. Fertil Steril, 1982, 11, 38, p. 530–533.

22. Šimončičová, M., Šimko, J. Porovnanie metód Clearview Chlamydia MF a PCR (Polymerase Chain Reaction) pro detekcii Chlamydia trachomatis u gynekologických pacientok. Gynekolog, 2000, 9, 2, s.56–59.

23. Šulová, A., Strmisková, J., Pilka, L., et al. Přímý a nepřímý průkaz chlamydií u neplodných manželských párů zařazených do programu asistované reprodukce. Čes Gynek, 1997, 62, 3, s. 134–137.

24. Thomas, K., Coughlin, L., Mannion, PT., Haddad, NG. The value of Chlamydia trachomatis antibody testing as part of routine infertility investigations. Hum Reprod, 2000, 15, p. 1079–1082.

25. Věžník, Z., Pospíšil, L., Švecová, D., et al. Chlamydie v ejakulátu: ovlivnění kvality semene a morfologie spermií. Prakt Gyn, 2005, 9, 2, s. 6–9.

26. Witkin, SS. Circulating antibodies to Chlamydia trachomatis in women: relationship to antisperm and antichlamydial antibodies in semen of male partners. Hum Reprod, 1996, 11, 8, p. 1635–1637.

27. Witkin, SS., Jeremias, J., Neuer, A., et al. Immune recognition of the 60kD heat shock protein: Implications for subsequent fertility. Inf Dis Obstet Gynecol, 1996, 4, p, 152–158.

28. Witkin, SS., Kligman, I., Grifo, JA., Rosenwaks, Z. Chlamydia trachomatis detection by polymeraze Chain reaction in cervices of culture–negative women correlates with adverse in vitro fertilization outcome. J Infect Dis, 1995, 171, 6, p. 1657–1659.

29. Witkin, SS., Neuer, A., Giraldo, P., et al. Chlamydia trachomatis infection, imunity and pregnancy outcome. Infect Dis Obstet Gynaec, 1997, 5, p. 128–132.