Recovery of Chlamydia trachomatis from the endometrium of women at risk for chlamydial infection

Chlamydia trachomatis is the most common sexually transmitted disease in Western Society today and is a major cause of salpingitis and tubal infertility. However, the frequency with which it produces upper genital tract infection in asymptomatic women has not been determined. Endometrial, endocervical, and urethral cultures for C. trachomatis were obtained from 60 women who were at risk for chlamydial infection but who did not have evidence of endometritis or salpingitis on physical examination. Chlamydia was isolated from the lower genitourinary tract in 26 (43%) and from the endometrium in 12 (20%). Thus 12 of 29 (41%) women infected with C. trachomatis had endometrial infections. Upper genital infections appear to be common in women at risk for chlamydial infection, and spread to the upper tract may occur shortly after the infection is acquired.     

Ectopic pregnancy and antibodies to Chlamydia trachomatis

Ectopic pregnancy is one of the most serious sequelae to acute salpingitis. Chlamydia trachomatis seems to be the most common etiologic agent of acute salpingitis. In the present study, we tested whether women with ectopic pregnancy had serologic evidence of a current or past chlamydial infection. Sixty-five percent of the women with ectopic pregnancy had IgG serum antibodies to C. trachomatis, and 21% of women pregnant in utero had such antibodies. Eleven percent of women with infertile husbands, 42% of women with cervicitis, and 69% of women with salpingitis had IgG serum antibodies to C. trachomatis. In women with ectopic pregnancy, there was a correlation between the occurrence of IgG antibodies and a history of salpingitis or gross evidence of a previous tubal inflammation. We conclude that previous chlamydial salpingitis may be a major etiologic factor leading to ectopic pregnancy.     

Endometritis: the clinical-pathologic syndrome

OBJECTIVE: The purpose of this study was to evaluate histologically proved endometritis as a clinical syndrome that is distinct from laparoscopically confirmed salpingitis. STUDY DESIGN: This was a cross-sectional study of 152 women in an urban hospital with a suspected pelvic inflammatory disease. All women provided a standardized medical history and underwent physical examination, endometrial biopsy, and laparoscopy. We defined endometritis by the presence of plasma cells in endometrial stroma and neutrophils in the endometrial epithelium. RESULTS: Of 152 women who were enrolled, 43 women had neither endometritis nor salpingitis; 26 women had endometritis alone without salpingitis, and 83 women had salpingitis. Those women with endometritis alone more often had douched recently, had a current intrauterine device, and were in menstrual cycle day 1 to 7, compared with women with no endometritis or salpingitis (P =.007,.04,.005, respectively) or women with acute salpingitis (P =.03,.01,.02, respectively). Infection with Neisseria gonorrhoeae and/or Chlamydia trachomatis was found more frequently in women with endometritis alone than in women with no endometritis or salpingitis (P <.001) and less frequently than in women with salpingitis (P =.05). Lower quadrant, adnexal, cervical motion, rebound tenderness, peritonitis, tenderness score, fever, and laboratory abnormalities that indicated inflammation and detection of gonorrheal or chlamydial infection were significantly less common in women with endometritis alone than in women with salpingitis but were somewhat more common in women with endometritis alone than among women with no salpingitis or endometritis. CONCLUSION: Among women with suspected pelvic inflammatory disease, the histopathologic manifestations of endometritis were associated with clinical manifestations, infection, and specific risk factors that were intermediate in frequency between women with salpingitis and women with neither endometritis nor salpingitis.     

Lower genital tract infection with Neisseria gonorrhoeae and Chlamydia trachomatis in women requesting induced abortion and in their sexual partners

The prevalence and patterns of gonococcal and chlamydial infection were investigated in a prospective microbiological study on 3,395 women requesting abortion and the sexual partners of culture positive women (organism identified). Neisseria gonorrhoeae was found in only 1.8% of 3,395 women during the whole study period of 7 years, but Chlamydia trachomatis in 13.5% of 1,635 women in the last 3 years. Women with positive cultures were significantly younger (p less than 0.001), and more frequently single (p less than 0.001) than those with negative cultures. Single women had more partners (mean 1.5) than those in an established relationship (mean 1.1). Almost all women with gonorrhea were single. Of the males, 62.7% were examined, of whom 47.3% had positive cultures. Twenty per cent of culture positive males had gonorrhea. A high prevalence of positive cultures in the males was only found where chlamydial cultures had been positive in the female. All women and men with positive culture results received antibiotic treatment before or after the abortion procedure. The incidence of laparoscopically verified post-abortion salpingitis was low, at 0.57%, while a clinical diagnosis of endometritis was made in 3.3%. Routine pre-operative microbial screening for Chlamydiae trachomatis should be considered for all women requesting abortion. Tracing and screening for chlamydial and gonorrheal infection of sexual partners of culture-positive women is necessary as a preventive measure.     

Oral contraceptive use modifies the manifestations of pelvic inflammatory disease

A case-control study was performed on 94 women with acute salpingitis and 12 women with salpingitis and perihepatitis; all patients included in the study were infected with Chlamydia trachomatis, and all had been subjected to diagnostic laparoscopy. None of the 12 patients with, but 38 (40%) of the 94 patients without, perihepatitis used oral contraceptives (P = 0.002). The geometric mean titre of serum IgG antibodies to C. trachomatis was higher among patients with (1:1021) than among patients without (1:69) perihepatitis (P = 0.0001). Oral contraceptive users had lower geometric mean titre of antibodies to the organism (1:25) than non-users (1:109, P = 0.001). The study suggests that oral contraceptive use may modify the clinical manifestations of chlamydial pelvic inflammatory disease.     

Immunofluorescence detection in Chlamydia trachomatis in cervical smears using monoclonal antibodies

The early detection of chlamydial infections is very important because they may cause cervicitis, endometritis and salpingitis and because of that reason for sterility in women. In routine cervical smears the morphologic picture is aspecific. One of the most specific methods for identification of Chlamydia trachomatis is the direct immunofluorescence with monoclonal antibodies (DIF). 100 women of age 18 - 45 years are examined with DIF test produced by Orion Diagnostica. In the cytological smears of 15 women morphological signs, inclusion and vacuolization, suspicious of Chlamydia trachomatis infection were seen. Using DIF, positive reactions have been found in 17 women. A conclusion for the high specificity of DIF with monoclonal antibodies is made.     

Oral contraceptive use modifies the manifestations of pelvic inflammatory disease

Summary. A case-control study was performed on 94 women with acute salpingitis and 12 women with salpingitis and perihepatitis; all patients included in the study were infected with Chlamydia trachomatis and all had been subjected to diagnostic laparoscopy. None of the 12 patients with, but 38 (40%) of the 94 patients without, perihepatitis used oral contraceptives (P=0.002). The geometric mean titre of serum IgG antibodies to C. trachomatis was higher among patients with (1:1021) than among patients without (1:69) perihepatitis (P=0001). Oral contraceptive users had lower geometric mean titre of antibodies to the organism (1:25) than non-users (1:109, P=0.001). The study suggests that oral contraceptive use may modify the clinical manifestations of chlamydial pelvic inflammatory disease.     

Endometritis and acute salpingitis associated with Chlamydia trachomatis and herpes simplex virus type two

A patient who had endometritis confirmed by endometrial biopsy and acute salpingitis confirmed by laparoscopy is reported. Chlamydia trachomatis and herpes simplex virus type two were isolated from the endometrial cavity and the fallopian tube. The histopathologic findings of the endometritis were similar to those frequently seen in chronic chlamydial eye disease or chlamydial cervicitis.     

Microbiological and histopathological findings in acute pelvic inflammatory disease

Upper genital tract infection was investigated in 45 women admitted to hospital for suspected acute pelvic inflammatory disease (PID). Salpingitis was diagnosed by laparoscopy in 30 (67%) women. Histopathological evidence of endometritis was found significantly more often in the 30 women with salpingitis (87%) than in the other 15 women without salpingitis (33%). C. trachomatis or N. gonorrhoeae, or both, were isolated from the upper genital tract in 14 of the 31 women who had both salpingitis and endometritis or endometritis only but in none of the four women who had salpingitis alone and in none of the 10 women who had no evidence of PID. Bacterial vaginosis was associated with histopathological evidence of upper tract infection. Non-chlamydial non-gonococcal organisms were frequently isolated from the upper genital tract. No organisms were isolated from the upper genital tract from 9 of 35 women with laparoscopic or histopathological evidence of PID compared with 7 of 10 women without evidence of PID. C. trachomatis or N. gonorrhoeae in the endometrium was associated with lymphoid follicles comprising transformed lymphocytes, and correlated with the density of plasma cells on biopsy. The microbiological results support the recommendations of broad spectrum antimicrobial therapy for PID.     

Detection of Chlamydia trachomatis in formalin-fixed endometrial tissue

Formalin-fixed tissue biopsies from 29 women with the histological diagnosis of severe endometritis were examined for chlamydial antigen by fluorescein-conjugated monoclonal chlamydial antibodies (SYVA) technique; 15 (52%) were positive. In nine patients also samples for isolation of Chlamydia trachomatis by cell-culture technique were obtained peroperatively; seven were culture-positive. In all these patients fluorescent chlamydial antigen was detected, whereas the two culture-negative patients had no such antigen. The technique presented makes it possible to examine series of formalin-fixed endometrical biopsies to evaluate the significance of C. trachomatis being etiologic agent in endometritis in females.     

Amniotic fluid findings in women with high levels of chlamydial antibody

A study was undertaken to examine possible transplacental passage of Chlamydia trachomatis from pregnant women who were seropositive for chlamydia, but with no cervical C. trachomatis infection. Forty asymptomatic pregnant women, scheduled for diagnostic amniocentesis at 15-19 weeks of gestation, were tested for the presence of high serum IgA and IgG chlamydial specific antibodies and for cervical chlamydia infection. Five (12.5%) had both high serum IgA and IgG antibody levels and 10 (25%) had high serum IgG antibody levels. Overall, 15 (37.5%) had high serum chlamydia specific antibody levels (all were free of cervical chlamydial infection). The evaluation of the amniotic fluid specimens of these 15 seropositive pregnant women, who were free of cervical chlamydial infection, proved negative for direct C. trachomatis antigen detection and for chlamydial IgA and IgG specific antibodies. These negative results could be attributed to the lack of transplacental passage of C. trachomatis or to the antimicrobial activity of amniotic fluid against C. trachomatis, which has been previously described. The discrepancy between maternal infection and maternal serum antibody levels may suggest that the serologic test does not predict the presence of an antigen in the cervix.     

Antibodies to Chlamydia trachomatis in sera of women with recurrent spontaneous abortions.

OBJECTIVE: The relationship between high-titer immunoglobulin G antibodies to Chlamydia trachomatis and recurrent spontaneous abortions was evaluated. STUDY DESIGN: Sera from the female partners of 258 couples with unexplained infertility, no history of chlamydial infection, and negative cervical cultures were diluted 1:128 and tested for immunoglobulin G antibodies to Chlamydia trachomatis. A subset of patients was also tested for antibodies to cytomegalovirus, cardiolipin, nuclear antigens, lactoferrin, and spermatozoa. RESULTS: Seven (41%) of 17 women with three abortions and 6 (60%) of 10 women with four abortions had chlamydial antibodies as opposed to 20 (13.5%) of 148 with no abortions, 6 (12.8%) of 47 with one abortion, and 4 (12.1%) of 33 with two abortions (p < 0.01). The incidence of > or = 3 spontaneous abortions was 31.8% among women with high-titer chlamydial antibodies and 7.5% among women who had seronegative results (p < 0.001). There was no relation between any of the other antibodies and > or = 3 abortions or antibodies to Chlamydia trachomatis. CONCLUSION: High-titer immunoglobulin G antibody to Chlamydia trachomatis was associated with recurrent spontaneous abortions. The mechanism may involve reactivation of a latent chlamydial infection, endometrial damage from a past chlamydial infection, or an immune response to an epitope shared by a chlamydial and a fetal antigen.     

Dose previous Chlamydia trachomatis infection influence the pregnancy rate of in vitro fertilization and embryo replacement?

The association between previous chlamydial infection, as reflected by the presence of chlamydial antibodies (specific serum immunoglobulin G antibodies with a titer greater than or equal to 32) and pregnancy outcome after in vitro fertilization and embryo replacement was studied in 121 infertile women with tubal damage. The antibody prevalence was 74.4%; the overall pregnancy rate was 26.4%. No difference in seropositivity was detected between those who became pregnant and those who did not (71.9% versus 75.3%). The geometric mean titers were also similar in the two groups. Even after subdivision of the cases into primary or repeated in vitro fertilization attempts, or after stratification of the material according to the number of embryos used for replacement, there was no correlation between chlamydial antibodies and pregnancy rate. Thus, past infection with Chlamydia trachomatis did not influence the outcome of in vitro fertilization and embryo replacement treatment in this study.     

Chlamydial infections in obstetrics and gynecology

Although Chlamydia trachomatis causes important diseases in both men and women, this review focuses on the genital tract disease associated with chlamydial infection in women and on neonatal chlamydial infection. 8 of the 15 serotypes of C. trachomatis are sexually transmitted agents. The unique growth cycle which distinguishes the chlamydiae from all other organisms is described and they are compared to bacteria and viruses. The prevalence and risk factors for chlamydial infections are then discussed. The symptoms, complications, prevalence, diagnosis, and treatment of male genital tract infections are outlined. Experimental and clinical evidence of the role of chlamydiae in lower genital tract diseases of women including Bartholinitis, cervicitis, endometritis, and acute urethral syndrome; in acute salpingitis; and in the Fitz-Hugh-Curtis syndrome is presented and discussed, followed by a discussion of the incidence and prevalence, diagnosis, prognosis, and treatment of neonatal inclusion conjunctivitis and pneumonia due to C. trachomatis. Some possible control measures for neonatal chlamydial infections are recommended and the relative costs and benefits for populations with different incidences are evaluated. Other possible neonatal clinical manifestations and a possible role in preterm labor and delivery, low birth weight, and perinatal mortality are noted. The diagnosis of chlamydial infections by cytology, serology, and culture are discussed, and recommended therapy is outlined.     

The role of chlamydial antibodies in an in vitro fertilization program

The reported incidence of antibodies to Chlamydia trachomatis in patients attending infertility clinics is at least 30%. It has been reported that chlamydial antibodies are associated with decreased pregnancy rates following in vitro fertilization (IVF). A study was performed to investigate the significance of chlamydial antibodies in an established IVF program. The results did not show a decreased pregnancy rate in the presence of chlamydial antibodies. Of the women achieving pregnancy, 41% were seropositive compared with 38% seropositivity in women who did not become pregnant. There was no apparent benefit of the use of prophylactic antibiotics. The results also suggested that past infection with C. trachomatis in men did not adversely affect semen analysis or fertilization.     

Epidemiologic and serodiagnostic aspects of chlamydial salpingitis

Cultural, serologic, and epidemiologic aspects of Chlamydia trachomatis in acute salpingitis were assessed. Of 111 patients, 52 (47%) harbored C trachomatis in the cervix urethra, or both. Neisseria gonorrhoeae was isolated in 41 patients of 209 (20%). A majority (79%) of women with gonorrhea were also infected with C trachomatis. A fourfold titer rise of chlamydial IgG antibodies or significant IgM titer, or both, was demonstrated in 37 patients of 72 (51%) from whom paired sera were obtained. The serologic response distinguished 3 different phases of chlamydial infection: acute, subacute, and chronic or reinfection. The patients' male sex partners were examined on a voluntary basis, and C trachomatis was detected in 68%, indicating a need for effective partner examination and treatment.     

Anatomic sites of upper genital tract infection

The microbiologic correlates of upper genital tract infection were studied among 36 women with suspected upper genital tract infection and 11 control women undergoing tubal ligation. Laparoscopic evidence of confirmed salpingitis was seen in 25 (69%) of the 36 women. Pathologic evidence of endometritis was present in 26 women (72%), and 22 (85%) of them had salpingitis as well. Thus, four women had endometritis but no salpingitis, three women had salpingitis but no endometritis, and seven women had neither. Among the 25 women with salpingitis, one or more organisms were isolated from the fallopian tubes of nine women (36%) and from the cul-de-sac of six women (24%), versus none and one (9%), respectively, among the 11 cases without salpingitis, and one (9%) and none among the 11 control women. Among the 26 cases with endometritis, one or more organisms were isolated from the endometrium of 19 women (73%) versus 12 (67%) among the 18 women without endometritis. Chlamydia trachomatis was isolated from the uterine cavity of nine women and from the fallopian tubes of three women with upper genital tract infection. The corresponding figures for Neisseria gonorrhoeae were three and two. Other nongonococcal nonchlamydial organisms were commonly isolated from the fallopian tubes and/or culde-sac of women with salpingitis. Bacteria frequently were isolated from the endometrium of both study cases and control subjects, but the latter were more likely to have nonpathogens of low virulence.     

Recovery of Chlamydia trachomatis from the endometrium in infertile women with serum antichlamydial antibodies

Upper genital tract infection with Chlamydia trachomatis appears to be a frequent cause of salpingitis and tubal infertility. However, the prevalence of active infection in women with infertility has not been well-defined. To examine this question, endocervical and endometrial cultures for C. trachomatis were obtained from infertile women with serum antibodies to C. trachomatis. The first 19 consecutive patients with titers greater than or equal to 1/32 were cultured. C. trachomatis was recovered from the endometrium or endocervix in six (32%) of the women examined and from the endometrium in five (26%). These findings indicate that a significant portion of infertile women with serum antichlamydial antibodies may have active upper genital tract infection with C. trachomatis at the time of presentation.     

Chlamydia trachomatis in term pregnancy. isolation and serological study with a case report

The prevalence of cervical Chlamydia trachomatis infection in healthy, symptomless full-term pregnant women (n = 92) was found to be low (1.1%). Chlamydial cervical IgA antibodies, as measured by solid-phase radioimmunoassay (RIA), were found in 5.3%, but amniotic fluid chlamydial RIA IgA antibodies were almost absent. Serum IgG antibodies were measured with indirect immunofluorescence (IF). Of the mothers 9.8% had a titer greater than or equal to 1:64, correlating closely with the figure of 10.9% for infants' cord-blood IF serology. Finally, a case report is presented. A child born to a Chlamydia trachomatis positive mother developed isolation positive chlamydial pneumonia.     

Gynaecological and microbiological findings in women attending for a general health check-up.

Two hundred apparently healthy sexually active women, 17-34 years of age, who had presented for a general health check-up at the Clinic of Dermatology and Venereology, Medical University, Plovdiv, Bulgaria, were asked about genital symptoms, sexual behaviour, contraceptive use and smoking habits, and examined for signs of genital infections. They were searched for genital chlamydial infection, gonorrhoea, trichomoniasis, bacterial vaginosis (BV) and vulvovaginal candidosis, syphilis and HIV. Polymerase chain reaction (PCR) was used for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine samples and the results were compared with direct immunofluorescence (DFA) and enzyme immunoassays (EIA) for C. trachomatis in urethral, cervical and urine samples. In 56 (28%) women, an STD and/or an STD-related condition were diagnosed. The prevalence of genital chlamydial infection, trichomoniasis, BV and vulvovaginal candidosis was 4.5%, 0.5%, 17.5% and 7.5% respectively. On direct questioning 39 (19.5%) women reported symptoms suggestive of an infection, while 58 (29%) had signs that may have been caused by genital infection. In urine the PCR tests detected more (3.5%) chlamydia-positive women than the DFA (2.5%) and EIA tests (1.5%). The urine PCR test was as sensitive as the DFA when testing cervical samples. The chlamydia-positive women and women with BV were less likely to have a steady partner than the controls. No woman had syphilis or HIV infection. The women with BV were more frequent users of an intrauterine device and were more likely to smoke heavily compared with other women. STDs and STD-related conditions are common among adult women who consider themselves gynaecologically healthy. Screening for genital infections among women in reproductive age attending for health check-up could improve women's reproductive health.