The prevalence and outcome of asymptomatic chlamydial infection screening among infertile women attending gynecological clinic in Ibadan, South West Nigeria

Abstract

Background:Chlamydial trachomatis infection is the most common cause of tubal infertility among women world-wide. Serological diagnosis of Chlamydial infection that may suggest previous, persistent or on-going infection is now incorporated into routine pre-treatment evaluation of infertile women including assisted conception.Aim:The aim of this study is to determine the prevalence and predictors of asymptomatic Chlamydial infection screening among infertile women and also to compare the screening outcome with findings on hysterosalpingogram (HSG).Subjects and Methods:This was an observational study conducted among 132 infertile women that were attending Adeoyo Maternity Hospital Ibadan. A total volume of 2-3 ml of venous blood was collected for Chlamydia serology using ImmunoComb Bivalent immunoglobulin G kit (Code 50416002) and the results were compared with their HSG. Other information collected was socio-demographics and clinical parameters. Descriptive, bivariate and multivariate tests were performed using Statistical Package for the Social Sciences 15.0 (Chicago, IL USA) and statistical significance was set at (P < 0.05).Results:A total of 130 women were studied with a mean age of 31.6 years (standard deviation = 4.7). Majority - 72.0% (95/132) - had been infertile for 5 years or less. The prevalence of Chlamydial trachomatis was 20.5% (27/132). Bivariate analysis between the biosocial variables and serology result showed a significant association with education (P < 0.01) and religion (P < 0.01). Logistic regression analysis revealed that Muslim women were 3.6 times more likely than Christians to have positive Chlamydial serology result (95% confidence interval odds ratio = 1.18-11.11). Of those with HSG result (64), the accuracy of the test kit showed low sensitivity - 44.2% (19/43) and negative predictive value 40.0% (16/40) (but, high specificity - 76.2%(16/21), and positive predictive value - 79.2% (19/24).Conclusion:Asymptomatic Chlamydial infection is common among infertile women and it positively predict HSG blockage. The serological test may prove invaluable in predicting the presence of tubal blockage; therefore, prophylactic antibiotics may be justified to be included in their care.

Polymerase chain reaction versus enzyme-linked immunosorbent assay in detection of <i>Chlamydia trachomatis</i> infection among gynaecological patients in southwestern Nigeria

“…Israel et al reported Chlamydia IgG antibodies in 74% of symptomatic women with history of recurrent or chronic infection in Port-Harcourt, Nigeria [20]. The difference in the prevalence rate can be attributed to the type of assay used.…”

Study of Chlamydia trachomatis Infection in Infertile Females at a Tertiary Care Hospital in Mumbai, India

“…In a study reported from Zaria, Nigeria by Koledade et al [18] , there were no significant statistical association between the sociodemographic characteristics of the patients considered and seropositivity for Chlamydia trachomatis, except for the statistically significant association between educational status and patients who were seropositive for Chlamydia trachomatis IgG, with primary educational status having the most and tertiary having the least association. In study conducted by Morhason-Bello et al [17] , the proportion of women with primary education or less 44.1% (15/34) with positive results was significantly higher than in those with higher education. This correlated well with the present study stating prevalence of Chlamydia trachomatis infection is less educated group.…”

“…On the contrary, In Ghosh et al, study [14] , a total of 7 out of 80 (8.75%) infertile patients were diagnosed as infected. In study conducted by Morhason-Bello et al, [17] , the prevalence of C. trachomatis was 20.5% (27/132). In the study by Malik et al [9] , the overall Chlamydial positivity in the infertile women was found in 28.1% cases who were positive for one or both Chlamydial markers while 3.3% healthy at term control women were found positive for C. trachomatis.…”

“…Hence, a statistical significance was proved in patients with 10 years or more than 10 years of infertility and C. trachomatis infection. In a study by Morhason-Bello et al (2014) [17] , 72.0% had been infertile for 5 years or less, another 20% for 6-10 years while the remaining 6.8% had been infertile for more than 10 years. The findings of the present study were comparable with this study.…”

Correlates of genital Chlamydial trachomatis infection in a cohort of infertile women in Ibadan, Nigeria

“…2,5 A study in Ibadan found the prevalence of Chlamydia cervicitis to be 17.6% among women undergoing hysterosalphingography for infertility evaluation while several studies have proven that C. trachomatis infections rates are higher among infertile than fertile women. 3,[5][6][7][8][9][10][11][12][13][14][15] Patients with positive Chlamydia assay are 1.7 times at risk of infertility compared with patients with negative assay. 5 A study reported that Chlamydia trachomatis IgG was significantly higher among patients presenting with infertility than those that did not.…”