Epidemiological aspects of chlamydial infections and tubal abnormalities in infertile couples

Ruijs, G. J. H. M.; Kauer, Frank M.; Jager, Siemen; Schröder, F. P.; Schirm, J; Kremer, J.A.M.

doi:10.1016/0028-2243(90)90056-7

Cited by 14 publications

(8 citation statements)

References 25 publications

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“…Nevertheless, despite using two different sampling sites and diagnostic tests, the results show a broadly similar prevalence of genitourinary chlamydial infection in patients with differing clinical presentations, with the exception of infertile women, in whom the prevalence was much lower. The latter, however, are more likely to be older, married and monogamous and therefore at low risk of sexually transmitted infection 15 . Furthermore, while we cannot exclude the possibility of a small number of false positive results, the performance of ligase chain reaction in low prevalence populations has already been established 16 .…”

Section: Discussionmentioning

confidence: 95%

Which women should be tested for Chlamydia trachomatis?

Macmillan

McKenzie

Flett

et al. 2000

BJOG

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ObjectiveDesign Cross sectional study. SettingPopulation Two thousand thirty-five sexually active women attending various outpatient settings. Main outcome measures ResultsTo assess the prevalence of genitourinary Chlamydia trachomatis infection among women in different clinical settings, with a view to making decisions about who should be tested routinely.One regional hospital and family planning clinic serving an urban centre.Prevalence of positivity by clinical setting, stratified by age.Overall, prevalence of lower genital tract chlamydial infection was similar in a variety of clinical settings. Infertile women were the only exception, demonstrating a much lower prevalence. Stratifying the study population by age found a clear trend towards high prevalence in teenagers and virtually no infection in women over the age of 30 years.The prevalence of chlamydial infection in women is related to age, regardless of clinical presentation. In practice, opportunistic screening should target sexually active women under 30 years of age.

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Section: Discussionmentioning

confidence: 95%

Which women should be tested for Chlamydia trachomatis?

Macmillan

McKenzie

Flett

et al. 2000

BJOG

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“…Of the 32 studies, 18 studies used a case-control design [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] and 14 studies were cohort studies. [31][32][33][34][35][36][37][38][39][40][41][42][43][44] The exact definition of tubal pathology was not described in nine studies. 14,15,18,22,24,[27][28][29]31 In the other 23 articles, the definition was mentioned according to predefined criteria.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…[31][32][33][34][35][36][37][38][39][40][41][42][43][44] The exact definition of tubal pathology was not described in nine studies. 14,15,18,22,24,[27][28][29]31 In the other 23 articles, the definition was mentioned according to predefined criteria.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…[13][14][15][16][17][18][19][20][21][22][23][24][25]30,39 This was mainly performed in casecontrol studies where pregnant women or women who delivered a liveborn child were used as control group. Ten studies showed differential verification bias as they used a HSG if women did not report a positive history of assumed risk factors, whereas DLS was used in case of a positive medical history 14,15,17,18,20,[23][24][25]36,39 In the other 22 studies, the same reference test was performed in all women to identify tubal pathology.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…In 18 studies, both HSG and DLS were used as reference tests. [13][14][15]17,18,20,[23][24][25]27,32,33,[35][36][37][38][39]43 In five studies, a HSG was used to identify tubal pathology. 16,22,30,40,44 Eight studies reported laparoscopy as the reference standard.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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The value of medical history taking as risk indicator for tuboperitoneal pathology: a systematic review

Luttjeboer

Verhoeve

Dessel

et al. 2009

BJOG

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Background Guidelines recommend diagnostic laparoscopy in subfertile women with known co-morbidities in their medical history. Aggregated evidence underpinning these recommendations is, however, currently lacking.Objective The objective of this study was to perform a systematic review and meta-analysis of the available evidence on the association between items reported during medical history taking and tuboperitoneal pathology. Selection criteria All relevant studies that compared medical history with the presence or absence of tubal pathology.Data collection and analysis Studies comparing medical history with the presence or absence of tubal pathology were included. A diagnosis of tubal pathology had to be made by hysterosalpingography, laparoscopy or a combination of both. In the absence of invasive tubal testing, tuboperitoneal pathology was considered to be absent in case of intrauterine pregnancy. Homogeneity between studies was assessed, and the association between medical history and tubal pathology was expressed as a common odds ratio with a 95% CI. No language restriction was applied. Main resultsWe included 32 studies. In cohort studies, strong associations were found for a history of complicated appendicitis (OR 7.2, 95% CI 2.2-22.8), pelvic surgery (OR 3.6, 95% CI 1.4-9.0) and pelvic inflammatory disease (PID) (OR 3.2, 95% CI 1.6-6.6), and in case-control studies, for a history of complicated appendicitis (OR 3.3, 95% CI 1.8-6.3), PID (OR 5.5, 95% CI 2.7-11.0), ectopic pregnancy (OR 16.0,, endometriosis (OR 5.9, 95% CI 3.2-10.8) and sexually transmitted disease (OR 11.9,3).Author's conclusions Subfertile women reporting a history of PID, complicated appendicitis, pelvic surgery, ectopic pregnancy and endometriosis are at increased risk of having tuboperitoneal pathology. In these women, diagnostic laparoscopy should be offered early in the fertility work-up.

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Chlamydia trachomatis infection, immunity, and pregnancy outcome

Witkin

Neuer

Giraldo

et al. 1997

Infect. Dis. Obstet. Gynecol.

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Chlamydia trachomatis can ascend from the cervix to the fallopian tubes and survive for long periods of time without causing symptoms. The immune response to infection clears the extracellular organisms but leads to development of a persistent intracellular infection. Repeated cycles of productive infection and persistence eventually induce tubal occlusion and infertility. Persistently infected cells continue to synthesize the chlamydial 60 kD heat shock protein (hsp60). Immunity to conserved regions of hsp60 may result in autoimmunity to human hsp60. Expression of hsp60 by the embryo and decidua during early pregnancy may reactivate hsp60‐sensitized lymphocytes, disturb pregnancy‐induced immune regulatory mechanisms, and lead to immune rejection of the embryo. Due to this mechanism women with tubal infertility who are sensitized to the human hsp60 may have a decreased probability of successful outcome after undergoing in vitro fertilization and embryo transfer. Infect. Dis. Obstet. Gynecol. 5:128–132, 1997. © 1997 Wiley‐Liss, Inc.

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Epidemiological aspects of chlamydial infections and tubal abnormalities in infertile couples

Cited by 14 publications

References 25 publications

Which women should be tested for Chlamydia trachomatis?

Which women should be tested for Chlamydia trachomatis?

The value of medical history taking as risk indicator for tuboperitoneal pathology: a systematic review

Chlamydia trachomatis infection, immunity, and pregnancy outcome

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