Chlamydia – Impact on Fertility

Chlamydia trachomatis is the most common sexual transmited bacterium worldwide.
Genital Chlamydia infection affects people of all social classes . Generally , chlamydial infection presents less overtly than other STDs , persists longer and carries more serious consequences . Chlamydia trachomatis the causative organism is spread primarily through sexual contact . It has a long latent period . About 20% of all chlamydial infected women suffer from partial or complete tubal occlusion . Unfortunately chlamydial infection customarily is asymptomatic and atypical as compared with other STDs . Also complicating the diagnosis is the fact that lower genital tract culture results may be negative.

Chlamydia is a major cause of PID . Infection with this organism includes an inflammatory response that causes necrosis of secretory cells and subsequent scarring , ascending upward to destroy ciliated cells lining tubal mucosa , causing endometritis .The passage of ova or sperm is inhibited , and implantation is prevented . Although total tubal obstruction is not found , the presence of Chlamydia does prevent pregnancy : 60% to 70% of tubal sterility is traced to Chlamydia .Evidence of past chlamydial infection was determined by the presence of anti-chlamydial IgG antibodies by commercial ELISA test. The risk for tubal obstruction in women with positive serology for Chlamydia is 3.22 compared to 0.85 risk in the women with negative serology for Chlamydia . Women with evidence of past chlamydial infection are 4 times more likely to have obstructed fallopian tubes compared to women who had no such evidence .
The presence of elevated serum Chlamydia IgG Ab was associated with a significantly lower implantation rate , a trend toward a lower PR and a trend toward a higher early pregnancy loss rate as compared to women with negative Ab titers . This group may represent a subset of assisted reproductive technology patients who are less likely to benefit from GIFT.

Diagnosis
Diagnosis and identification of Chlamydia may be hampered by lack of rapid , easy , sensitive and specific methods . Systematic and local antibodies regularly develop in genital infection caused be chlamydia trachomatis . Such antibodies may often persist for years after the infection and may not be a sigh of parent infection . Chlamydia antibodies have been useful for demonstrating association between Chlamydia trachomatis and tubal factors in infertility . Antibodies to Chlamydia heat shocked protein 60 predict a presence of tubal scarring . It is mandatory to examine the patient for chlamydial serology at the beginning of the diagnostic protocol in order to ensure adequate management prior to more invasive procedures such as hysterosalpingography or laparoscopy.
Genotyping is powerful epidemiological tool but is not yet ready for routine clinical use . However resistant strains causing treatment failures with problem of emerging antibiotic resistant strains cannot be neglected .

Treatment Approaches
Erythromycin , tetracycline , or doxycycline has shown clinical efficacy . Penicilin is ineffective . Chlamydia may not actually be eradicated after treatment despite apparently negative culture results . Clindamycin may be used if other treatments are ineffective .

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