The molecular and serological detection of Chlamydia trachomatis in women with reproductive abnormalities.

The primary aim of this study was to evaluate the role of C. trachomatis in women with ectopic pregnancy (EP), miscarriage and tubal factor infertility (TFI) using PCR, non- isotopic in situ hybridization (NISH) and serology when compared to controls. Also, the influence of polymorphisms in the TNF gene were investigated in a pilot study to determine if there was an association between chlamydial infection and the development of tubal pathology. The primary study included patients from the UK and Trinidad. A secondary study was also conducted to assess the impact of anti-chlamydial IgG on ovarian response to gonadotropin stimulation prior to in vitro fertilization (IVF). Significant levels of anti-chlamydial IgG were found in the UK patients presenting with TFI, and a similar association was seen in the Trinidad EP group. In the case of miscarriage the detection of anti-chlamydial antibody was not significant. The IVF study showed that women undergoing IVF, who also detectable levels of anti-chlamydial IgG were statistically more likely to respond poorly to gonadotropin ovarian stimulation prior to IVF. The presence of chlamydial DNA, as determined by both PCR and ISH was significant in the UK TFI group. There was an increased detection of chlamydial DNA in both EP groups, although this association was found not to be significant. Statistically the presence of chlamydial DNA in the Trinidad miscarriage group was not suggestive of a role for C. trachomatis in the development of this condition. Within the EP and TFI groups investigated, the presence of either anti-chlamydial IgG or chlamydial DNA was suggestive of tubal damage. In the case of the EP patients, a large number of patients had detectable levels of anti-chlamydial IgM and/or chlamydial DNA in serum and tissue samples respectively; whereas in the TFI group there was increased detection of anti-chlamydial IgG and/ or chlamydial DNA. From theses data it is proposed that EP is positively associated with a concurrent C. trachomatis infection of the genital tract as supported by both serological evidence, and the detection of chlamydial DNA in genital specimens. In the case of tubal damage found in TFI patients the presence of anti-chlamydial IgG and/ or chlamydial DNA suggests that this condition is associated with a repeated past/persistent C. trachomatis infection as opposed to a current genital chlamydial infection