Human Reproduction, Vol. 17, No. 3, 525-527,
March 2002
© 2002 European Society of Human Reproduction and Embryology
Chlamydia trachomatis in subfertile women undergoing uterine instrumentation
Screen or treat?*
1 Research Institute Growth and Development (GROW), Department of Obstetrics and Gynaecology and 2 Department of Medical Microbiology, Maastricht, The Netherlands
Women who undergo uterine instrumentation are considered at risk for pelvic infections by Chlamydia trachomatis, which may derive either from ascending endocervical infections or from reactivation of micro-organisms persisting in the genital tract after previous chlamydia infections. Women presenting at fertility clinics frequently undergo uterine instrumentation (e.g. hysterosalpingography and laparoscopy with hydrotubation). Studies in subfertile women using DNA amplification techniques have shown that the prevalence of endocervical chlamydia infections is low (1.8%). In contrast, in 30–60% of subfertile women chlamydia IgG antibodies can be found in serum, indicating previous chlamydia infections. It has been demonstrated that, several years after chlamydia infections, viable micro-organisms may still be present in the upper genital tract. Therefore, subfertile women with chlamydia antibodies should be considered at risk for reactivation of persistent chlamydia infections after uterine instrumentation, even after exclusion of endocervical chlamydia infections. Moreover, in subfertile women without chlamydia antibodies, the presence of viable micro-organisms in the genital tract cannot be excluded. As a consequence, prophylactic antibiotics before uterine instrumentation should be considered in all subfertile women, instead of endocervical screening for C. trachomatis and treatment of positive cases only.
Key words: Chlamydia trachomatis/prophylactic antibiotics/screening/subfertility/uterine instrumentation
3 Department of Obstetrics and Gynaecology, Academisch Ziekenhuis Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: jlan{at}sgyn.azm.nl.
* Part of this work has been presented at the IVth European Chlamydia Congress (August 20-23, 2000) in Helsinki, Finland.
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