Infertility in Central Africa: Infection is the cause

Abstract

Determinants of infertility were studied in 340 women in Eastern Gabon, an area situated in the "infertility belt" of Central Africa. Fallopian tube occlusion was diagnosed in 82.8% of cases, showing the importance of infection-related causes. Women with tubal occlusion did not differ significantly from women with normal tubes in obstetrical history or prevalence of Neisseria gonorrhoeae or Chlamydia trachomatis on endocervical culture. Antecedents of pelvic inflammatory disease or a pelvic mass were significantly more common in the group with tubal occlusion. This group also had a significantly higher prevalence of serum chlamydial antibodies at a titer of 1/64 or higher. Hormonal factors were found in 31.7% of women, a cervical factor in 29.0% and mechanical factors in 5.6%. No diagnosis could be made in 12.2% of cases. During the investigation, 4.4% of women became pregnant. The predominance of infectious related causes of infertility makes it imperative to focus resources on prevention programs of upper genital tract infections in women.

Filling the Immunological Gap

“…routes of immunization are of great interest in order to target the growing global burden of sexually transmitted infections (Rosenthal and Gallichan, 1997). Indeed, in central Africa there is an "infertility belt" due to occlusion of women's fallopian tubes resulting from infections with Chlamydia trachomatis and Neisseria gonorrhoeae that cause pelvic inflammatory disease and infertility (Collet et al, 1988;Frost et al, 1987). IVAG immunization with recombinant viral vectors has been successful in murine models (Zhang et al, 2012).…”

Seroprevalence of HIV, hepatitis B, and syphilis in an urban population and isolated villages in Gabon

“…1 Public health eVorts have been made to reduce the impact of sexually transmitted diseases (STDs), but they have not concerned isolated communities where healthcare provision is commonly lacking.…”

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

“…[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.…”

“…[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.…”

“…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.…”