The Prevalence of Chronic Chlamydial Infections and of Infections of the Lower Female Genital Tract in Unselected Infertile Patients - A Prospective Study

Abstract

Objective: Data on upper genital tract infections in females in subfertile couples are well known. However, there are only few data available on lower genital tract infections in this patient group. In addition to the frequently discussed question which infections should be screened, we wanted to evaluate what we can expect if we screen unselected infertile patients. Material and Methods: In a prospective study 163 consecutive unselected infertile women (32.2 ± 4.8 years; mean ± standard deviation) were screened for chronic chlamydial (chlamydial serology - IgG, IgA) and other genital infections (human papilloma virus [HPV] in cervical smear, bacteriological investigation of the vaginal smear) during their first visit to our department. Results: The chlamydial serology detected IgG in 21.6 % and IgA in 7.6 %. The prevalence of positive bacteriology in the vaginal smear was 43.7 % (mainly Gardnerella vaginalis and Ureaplasma urealyticum). The prevalence of HPV DNA in the cervical smear was 18.2 %. Conclusions: The published association between chronic chlamydial infection and tubal factor, between the different infections of the female genital tract and infertility/reproductive outcome and the prevalence in this study justify a screening in infertile patients which includes chlamydial serology and bacteriological investigation of the vaginal smear. Because a recent study showed a decreased pregnancy rate in HPV-positive women, routine testing of HPV DNA in the cervical smear should also be discussed as a part of routine screening. Additional studies must further evaluate the cost-benefit ratio of HPV screening in infertility.

Zusammenfassung

Ziel der Studie: Zu Infektionen des oberen weiblichen Genitaltraktes bei sterilen Paaren existieren valide Daten. Hingegen gibt es nur wenige Informationen über Infektionen des unteren Genitaltraktes in dieser Patientinnengruppe. Neben der oft diskutierten Frage, nach welchen Infektionen gesucht werden soll, wollten wir herausfinden, zu welchen Ergebnissen ein Infektionsscreening bei unselektierten sterilen Frauen führt. Methoden und Patienten: In einer prospektiven Studie wurden 163 konsekutive unselektierte sterile Frauen (32,2 ± 4,8 Jahre; Mittelwert ± Standardabweichung) während ihrer Erstvorstellung in unserem Zentrum hinsichtlich einer chronischen Chlamydieninfektion (Chlamydienserologie - IgG, IgA) sowie anderer genitaler Infektionen (humanes Papillomavirus [HPV] im Zervixabstrich, bakteriologische Untersuchung des Vaginalabstriches) gescreent. Ergebnisse: Chlamydiales IgG wurde in 21,6 %, IgA in 7,6 % aller Fälle nachgewiesen. Die Prävalenz einer positiven Bakteriologie im Vaginalabstrich betrug 43,7 % (hauptsächlich Gardnerella vaginalis und Ureaplasma urealyticum), die der HPV-DNA im Zervixabstrich 18,2 %. Schlussfolgerung: Die häufig publizierte Koinzidenz einer chronischen Chlamydieninfektion mit einem tubaren Faktor, zwischen verschiedenen Infektionen des weiblichen Genitale und einer Sterilität sowie die in dieser Studie gefundenen Prävalenzen rechtfertigen bei Sterilität die Durchführung einer Chlamydienserologie sowie eines bakteriologischen Vaginalabstriches. Da eine aktuelle Studie eine verminderte Schwangerschaftsrate bei HPV-positiven Frauen zeigte, sollte die HPV-DNA-Bestimmung im Zervikalsekret als Screeningbestandteil diskutiert werden. Zur Kosten-Nutzen-Analyse eines HPV-Screenings bei Sterilität sind weitere Studien nötig.

Key words

Chlamydia trachomatis - genital infections - human papilloma virus - infertility - screening

Schlüsselwörter

Chlamydia trachomatis - genitale Infektionen - humanes Papillomavirus - Sterilität - Screening

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