Chlamydia trachomatis: impact on human reproduction

Chlamydia trachomatis infections are the most prevalent bacterial sexually transmitted infections (STI) recognized throughout the world. Worldwide, the magnitude of morbidity associated with sexually transmitted chlamydial infections is enormous. C.trachomatis is a common cause of urethritis and cervicitis, and sequelae include pelvic inflammatory disease (PID), ectopic pregnancy, tubal factor infertility, epididymitis, proctitis and reactive arthritis. The sharp worldwide increase in the incidence of PID during the past two decades has led to the secondary epidemics of tubal factor infertility and ectopic pregnancy. Chlamydial PID is the most important preventable cause of infertility and adverse pregnancy outcome. Chlamydial infections, like STI in general, are primarily a woman's health care issue since the manifestations and consequences are more damaging to the reproductive health in women than in men. Based on the available evidence, approximately 20% of women with chlamydial lower genital tract infection will develop PID, approximately 4% develop chronic pelvic pain, 3% infertility, and 2% adverse pregnancy outcome. However, these estimates are based on relatively weak evidence. Research on the link between C.trachomatis and male aspects of infertility has been much more limited. Currently recommended treatment regimens include azithromycin in a single dose or doxycycline for 7 days. These therapies are highly efficacious. Timely management of sex partners is essential for decreasing the risk for re-infection. Immunopathogenesis of C.trachomatis infection is one of the main focal points of current research into Chlamydia. Chlamydial infection fills the general prerequisites for disease prevention by screening, i.e. chlamydial infections are highly prevalent, usually asymptomatic, are associated with significant morbidity, can be reliably diagnosed, and are treatable. Screening programmes for C.trachomatis will be of paramount importance in the prevention of long-term sequelae. The cost of screening is only a fraction of the health care costs incurred due to complications resulting from undiagnosed and untreated chlamydial infections. Current strategies to control C.trachomatis still largely depend on clinic-based screening of symptomatic patients, and have not been successful. The development of highly sensitive and specific nucleic acid amplification tests for the diagnosis of chlamydial infections has been an important advance in the ability to conduct population-based screening programmes to prevent complications. Thus, the case for screening is clearly made, but much detail remains to be worked out.     

Compliance and adverse drug reactions: a prospective study with ethinylestradiol using continuous compliance monitoring

Summary This study examined the relationship between adverse reactions and patient compliance with ethinylestradiol at 40 g twice daily versus 20 g four times daily. In a randomized study 61 female patients with primary- infertility were prescribed the drug twice daily (n = 31) or four times daily (n = 30). Ethinylestradiol was administered for 7 days before the sperm cervical mucus penetration-test was performed for hormonal standardization of the cervical mucus quality. Drug compliance was measured by continuous monitoring using the Medication Event Monitoring System. Two parameters were evaluated: percentage of prescribed doses taken (administration compliance) and adherence to the prescribed dose schedule (regimen compliance, number of days with two or four dosing events recorded). Adverse drug reactions were assessed using a standardized questionnaire. Fourty-four women experienced side effects, of which 81% were rated by patients as being mild. Patient compliance was higher with the twice daily than with the four times daily regimen: 85% versus 65% prescribed doses taken (P<0.05). There was no significant difference in compliance comparing patients with and without adverse reactions (82% versus 72%, respectively), but compliance was lower and more irregular with at least 3 versus one or two adverse reactions reported: 54% versus 84% in administration compliance and 31% versus 58% in regimen compliance (P<0.05). Compliance was also lower in patients with nausea and vomiting than in those without these symptoms, 59% versus 91% and 34% versus 66% (P<0.005), respectively, and lower with moderate or severe compared to mild side effects; 48% versus 85% and 25% versus 59% (P<0.005). Thus the mere occurrence of side effects was not associated with low compliance. However, the number and nature of symptoms and their intensity as perceived by patients may have considerably influenced drug use behavior.Abbreviations ADR adverse drug reactions - SCMPT sperm cervical mucus penetration-test Prof. Dr. E. Weber died 7 December 1992     

Therapie des Uterus myomatosus mit einem GnRH-Analogon

Ohne Zusammenfassung     

Antisperm antibodies and microorganisms in genital secretions—a clinically significant relationship?

Summary. In asymptomatic infertility patients, no significant relationship was found between the presence of antisperm antibodies (ASA) in serum and in semen samples (IgG and/or IgA ASA), differentiated with the mixed antiglobulin reaction (MAR), and the microbial colonization of ejaculates covering a broad spectrum of microorganisms. Likewise, there was no significant association of ASA with microbial findings in patients' female partners, who also presented without symptoms of genital tract infection and were screened at the same time. Furthermore, ASA in semen (IgG and IgA) were not significantly related to several potential markers of subclinical male sexual gland infection or inflammation (leukocytes, PMN elastase, albumin, C_3c) evaluated in aliquots of the same ejaculates used for immunological testing.     

Relationship between local anti-sperm antibodies and sperm-mucus interaction in vitro and in vivo

Sperm-mucus interaction under in-vitro or in-vivo conditions can be affected by local anti-sperm antibodies (ASA). In a prospective study, a mixed antiglobulin reaction (MAR) test, using immunoglobulin-coated red cells and spermatozoa, was used to detect the presence of IgG and/or IgA on the spermatozoal surface in 209 males of infertile partnerships. The results of direct MAR tests range from 0 to 100% and a significant correlation between MAR % IgG and MAR % IgA (r = 0.74) was found. MAR positive semen samples were significantly more frequent in the group of patients with an inadequate outcome of postcoital testing (PCT). The sperm-mucus interaction in vitro, evaluated by means of the in-vitro sperm-cervical mucus penetration test (SCMPT) with cervical mucus (CM) of patients' partners, was particularly related to spermatozoal surface antibodies of the IgA class: MAR IgA positive ejaculates were seen in 13.9% of males with inadequate SCMPT versus 4.4% when SCMPT was adequate. The significant correlation between MAR IgA and the sperm penetration ability in vitro could also be proven when donors' CM was taken for the SCMPT, but not when a non-human material was used for in-vitro penetration testing. Microbial colonization of semen specimens did not interfere with the outcome of MAR testing. The pregnancy rate after 12 months was 23% (48/209) and was significantly lower when greater than 30% of spermatozoa were covered with surface ASA of the IgG or IgA class.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of antimicrobial therapy on sperm-mucus interaction

Sperm-mucus interaction under in-vitro or in-vivo conditionsmight be affected by microorganisms colonizing the reproductivetract. In order to study the influence of antimicrobial therapy,an extensive microbial screening was performed including Chlamydiatrachomatis, Mycoplasma hominis, Ureaplasma urealyticum, Neisseriagonorrhoeae, a broad spectrum of potentially pathogenic aerobicand anaerobic bacteria, Trichomonas vaginalis, herpes simplexvirus and yeasts. One-hundred-and-six couples with a mean durationof infertility of 5.5 years (range 1–12 years) and withisolation of potentially pathogenic microorganisms in semensamples and/or cervical swabs were submitted to a prospectivepilot study. None of the patients displayed signs or symptomsof infection in the lower genital tract. Before and after specifictherapy, based on antimicrobial susceptibility testing, spermanalyses and in-vitro sperm penetration meter tests (SPMT) (Kremer)were performed. SPMT was evaluated with cervical mucus of patients'wives, collected after a standardized oral treatment with oestrogensand, additionally, in a crossed manner with cervical mucus andspermatozoa of fertile donors. The success of antimicrobialtherapy was controlled by repeating the same mkrobial screeningand was 96%. However, there was a marked change in the mkrobialpattern. A comparison of the results of sperm analyses beforeand after treatment revealed neither significant differencesfor sperm volume, sperm count, propulsive motility, morphology,vitality, pH, fructose concentration or number of round cells,nor was there a significant influence on the cervical indexand the number of leukocytes in cervical mucus. In the SPMTpenetration distance, sperm density, quality and duration ofmotility were not significantly influenced by antimicrobialmedication, but were improved in the group of patients withvery poor SPMT results before treatment. The overall pregnancyrate was low (17% after 6 months, 21% after 12 months). Theresults suggest that microbial colonization is of minor importancefor sperm-mucus interaction and that the benefits of antimicrobialtherapy in asymptomatic couples are limited.