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Human Reproduction, Vol. 17, No. 8, 1938-1941, August 2002
© 2002 European Society of Human Reproduction and Embryology

Debates continued

Chlamydia trachomatis in subfertile women undergoing uterine instrumentation

An alternative to direct microbial testing or prophylactic antibiotic treatment

Steven S. Witkin1,3 and Iara M. Linhares1,2

1 Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, 515 East 71st St, New York 10021, USA and 2 Department of Gynecology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil

Chlamydia trachomatis is the major cause of tubal occlusion, and is also associated with IVF failure and spontaneous abortion. These infections are asymptomatic in most individuals and can persist in the genital tract for long periods of time in a form resistant to immune destruction. A significant percentage of couples seeking treatment for infertility might, therefore, harbour C. trachomatis in their genital tract. An unresolved question is what to do about this possible chlamydial persistence. Cervical, endometrial and semen samples can be tested for C. trachomatis and only positive individuals treated. Alternatively, all couples undergoing infertility treatment can receive prophylactic antibiotics. We advocate a third option, to screen and treat only individuals who are positive for systemic and/or local anti-chlamydial antibody production. Detection of species-specific C. trachomatis antibodies in peripheral blood will determine which individuals have been exposed to this organism and who, therefore, may be at risk for harbouring persistent forms. Identification of IgA antibodies in genital tract secretions may be an even better indicator of the presence of C. trachomatis in the genital tract. Circulating antibodies to the chlamydial 60kDa heat shock protein (hsp60) is a specific indicator of tubal occlusion and, furthermore, correlates with the continued presence of this micro-organism in the genital tract of non-human primates. Screening for both cervical IgA antibodies to C. trachomatis and serum IgG anti-chlamydial hsp60 appears to provide the best indication as to which women may be harbouring C. trachomatis.

Key words: antibodies/Chlamydia trachomatis/endocervix/heat shock protein/tubal infertility

3 To whom correspondence should be addressed. E-mail: switkin{at}mail.med.cornell.edu


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