Chlamydial Pgp3 Seropositivity and Population-Attributable Fraction Among Women With Tubal Factor Infertility

Gloria E Anyalechi, Jaeyoung Hong, Robert D Kirkcaldy, Harold C Wiesenfeld, Paddy Horner, Gillian S Wills, Gillian Wills, Myra O McClure, Karen R Hammond, Catherine L Haggerty, Dmitry M Kissin, Edward W Hook, Michael P Steinkampf, Kyle T. Bernstein, Kyle Bernstein, William M Geisler
Sexually transmitted diseases · 2021 · vol. 49(8) , pp. 527–533 · doi:10.1097/olq.0000000000001434 · PMID:34110735 · W3154670541
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Abstract

BACKGROUND: Chlamydial infection is associated with tubal factor infertility (TFI); however, assessment of prior chlamydial infection and TFI is imperfect. We previously evaluated a combination of serological assays for association with TFI. We now describe the chlamydial contribution to TFI using a newer Chlamydia trachomatis Pgp3-enhanced serological (Pgp3) assay. METHODS: In our case-control study of women 19 to 42 years old with hysterosalpingogram-diagnosed TFI (cases) and non-TFI (controls) in 2 US infertility clinics, we assessed possible associations and effect modifiers between Pgp3 seropositivity and TFI using adjusted odds ratios with 95% confidence intervals (CIs) stratified by race. We then estimated the adjusted chlamydia population-attributable fraction with 95% CI of TFI. RESULTS: All Black (n = 107) and 618 of 620 non-Black women had Pgp3 results. Pgp3 seropositivity was 25.9% (95% CI, 19.3%-33.8%) for non-Black cases, 15.2% (95% CI, 12.3%-18.7%) for non-Black controls, 66.0% (95% CI, 51.7%-77.8%) for Black cases, and 71.7% (95% CI, 59.2%-81.5%) for Black controls. Among 476 non-Black women without endometriosis (n = 476), Pgp3 was associated with TFI (adjusted odds ratio, 2.6 [95% CI, 1.5-4.4]), adjusting for clinic, age, and income; chlamydia TFI-adjusted population-attributable fraction was 19.8% (95% CI, 7.7%-32.2%) in these women. Pgp3 positivity was not associated with TFI among non-Black women with endometriosis or among Black women (regardless of endometriosis). CONCLUSIONS: Among non-Black infertile women without endometriosis in these clinics, 20% of TFI was attributed to chlamydia. Better biomarkers are needed to estimate chlamydia TFI PAF, especially in Black women.

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Condition tags

mesh:D004715endometriosisinfertility

MeSH descriptors

Chlamydia Infections Chlamydia Infections Chlamydia Infections Chlamydia Infections Endometriosis Endometriosis Endometriosis Infertility, Female Infertility, Female Infertility, Female Adult Antibodies, Bacterial Case-Control Studies Chlamydia trachomatis Female Humans Young Adult

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