The prevalence, risks, and management of Chlamydia trachomatis infections in fertile and infertile patients from the high socioeconomic bracket of the South African population.

OBJECTIVE: The main objective of the study was to evaluate the prevalence of Chlamydia trachomatis endocervicitis in an infertile population. DESIGN: Forty consecutive patients were enrolled in the study group and 41 in the control group. SETTING: The study was undertaken in the Department of Obstetrics and Gynaecology of the University of the Orange Free State, Bloemfontein, Republic of South Africa. PATIENTS: Infertile white females, visiting an infertility clinic in an academic hospital and fertile white female patients visiting an antenatal clinic. INTERVENTIONS: Endocervical swabs were taken, and monoclonal direct immunofluorescence for C. Trachomatis were done on each. MAIN OUTCOME MEASURES: A difference was expected between the prevalence of C. trachomatis infection in the fertile and infertile population. RESULTS: In the study group, 14(35.9%) positive, 25(64.1%) negative, and 1 fallout were obtained. In the control group, 3 patients (7.32%) tested positive. CONCLUSION: Although no correlation was found between C. trachomatis infection of the female genital tract and the clinical history, it showed a significant correlation with infertility. This justifies routine screening tests and antibiotic treatment of positive infertile couples. Analysis of cost-effectiveness showed that empirical treatment of new infertile couples is justified in some populations.

PIP: Health workers at the Department of Obstetrics and Gynecology of the University of the Orange Free State in Bloemfontein, South Africa enrolled 40 consecutive infertile white couples 41 consecutive pregnant white females into a case control study to determine the prevalence of Chlamydia trachomatis infections in an infertile population. Both groups were from the middle to upper socioeconomic class. Laboratory personnel used the monoclonal direct immunofluorescence test to each cervical cytology smear. They had to repeat the test on 5% of the smears. Prevalence of C. trachomatis in the study group stood much higher than it did in the control group (35.9% vs. 7.3%; p.002). No association existed between clinical history and presence of C. trachomatis in the fertile group. 19.5% of the fertile patients had taken antibiotics during the 3 months prior to the study. None reported earlier episodes of salpingitis and/or pelvic inflammatory disease. The researchers proposed a possible reason for the very high rate of C. trachomatis in infertile patients. Perhaps the infertile clinic only examined unresolved infertile cases who may have had an exceptionally high rate of C. trachomatis. The infertility clinic chose to treat all new couples with lymecycline because studies showed that it is always effective against C. trachomatis. Indeed this treatment proved to be the most beneficial at the lowest cost.

Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections in women. Prevalence, risks and management at a South African infertility clinic.

Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections not only jeopardize fertility but also pose a risk for infertility treatment and resulting pregnancies. Routine screening tests or empirical antibiotic treatment of infertile couples may be justified by the prevalence of these organisms. We studied the wives in 40 consecutive infertile couples. Monoclonal direct immunofluorescence (DIF) for C trachomatis was performed on fixed smears from endocervical swabs. M hominis and U urealyticum were isolated by inoculation of Hayflick (HF) medium, HF broth and Ureaplasma A7 agar with endocervical swabs. Using DIF, 11 (27.5%) specimens were positive, 25 (62.5%) were negative, and 4 (10.0%) were equivocal. DIF was repeated on smears from three of the last four patients; all three were positive for C trachomatis. One patient was lost to follow-up and excluded from the study. For the total 39 specimens the final results were 14 (35.9%) positive and 25 (64.1%) negative. M hominis was isolated from 3 (7.5%) endocervical swabs. None of the endocervical swabs yielded a culture positive for U urealyticum. Statistical analysis showed no correlation between the clinical history and presence of infection with any of the three organisms. The prevalence of 35.9% for C trachomatis was surprisingly high for an infertile population and, if supported by culture confirmation, justifies routine screening. The potential adverse effects of these organisms on the success rate of highly specialized infertility treatments are essentially unresolved. Since our analysis of cost effectiveness as applicable to our unit, all new infertile couples are treated empirically with lymecycline.

[The prevalence of Chlamydia trachomatis infections in new patients at the Infertility Clinic, UOFS, Bloemfontein]. / Die prevalensie van Chlamydia trachomatis-infeksie in nuwe pasiënte aan die Infertiliteitskliniek, UOVS, Bloemfontein.

Chlamydia trachomatis is a common sexually transmitted agent causing infertility. Routine screening tests or empirical antibiotic treatment of infertile couples may be justified by the prevalence of this organism. In this study the female partner of 40 consecutive infertile couples was investigated. As a screening test direct immunofluorescence (DIF) was performed on fixed smears from endocervical swabs. Of a total of 40 specimens, 11 (27.5%) were positive, 25 (62.5%) were negative and 4 (10.0%) were equivocal. DIF was repeated on smears from 3 of the last 4 patients and all 3 specimens were positive for C. trachomatis. One patient was lost to follow-up and excluded from the study. Of a total of 39 specimens the final results yielded 14 (35.9%) positive and 25 (64.1%) negative. Statistical analysis showed no correlation between the clinical history and the presence of C. trachomatis infection.