Gloria E Anyalechi1, Jaeyoung Hong1, Robert D Kirkcaldy1, Harold C Wiesenfeld2, Paddy Horner3, Gillian S Wills4, Myra O McClure4, Karen R Hammond5, Catherine L Haggerty6, Dmitry M Kissin7, Edward W Hook8, Michael P Steinkampf5, Kyle Bernstein1, William M Geisler8. 1. From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA. 2. University of Pittsburgh School of Medicine and Magee-Womens Research Institute, Pittsburgh, PA. 3. Population Health Sciences and National Institute for Health Research, Health Protection Research Unit in Behavioural Science and Evaluation in Partnership with Public Health England, University of Bristol, Bristol. 4. Section of Infectious Diseases Jefferiss Research Trust Laboratories Wright-Fleming Institute, Faculty of Medicine, Imperial College London, St Mary's Campus, London, United Kingdom. 5. Alabama Fertility Specialists, Birmingham, AL. 6. University of Pittsburgh Graduate School of Public Health Department of Epidemiology and Magee-Womens Research Institute, Pittsburgh, PA. 7. Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA. 8. Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
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.
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.
Authors: Patrick J Horner; Gillian S Wills; Rosy Reynolds; Anne M Johnson; David A Muir; Alan Winston; Andrew J Broadbent; David Parker; Myra O McClure Journal: Sex Transm Infect Date: 2013-02-21 Impact factor: 3.519
Authors: A E Ades; M J Price; D Kounali; V A Akande; G S Wills; M O McClure; P Muir; P J Horner Journal: Am J Epidemiol Date: 2017-01-06 Impact factor: 4.897
Authors: Rachel J Gorwitz; Harold C Wiesenfeld; Pai-Lien Chen; Karen R Hammond; Karen A Sereday; Catherine L Haggerty; Robert E Johnson; John R Papp; Dmitry M Kissin; Tara C Henning; Edward W Hook; Michael P Steinkampf; Lauri E Markowitz; William M Geisler Journal: Am J Obstet Gynecol Date: 2017-05-19 Impact factor: 8.661
Authors: Gillian S Wills; Patrick J Horner; Rosy Reynolds; Anne M Johnson; David A Muir; David W Brown; Alan Winston; Andrew J Broadbent; David Parker; Myra O McClure Journal: Clin Vaccine Immunol Date: 2009-04-08
Authors: Anne Z Steiner; Michael P Diamond; Richard S Legro; William D Schlaff; Kurt T Barnhart; Peter R Casson; Gregory M Christman; Ruben Alvero; Karl R Hansen; William M Geisler; Tracey Thomas; Nanette Santoro; Heping Zhang; Esther Eisenberg Journal: Fertil Steril Date: 2015-09-25 Impact factor: 7.329
Authors: Paula B Blomquist; Stephanie J Mighelsen; Gillian Wills; Eleanor McClure; Anthony E Ades; Daphne Kounali; J Kevin Dunbar; Myra O McClure; Kate Soldan; Sarah C Woodhall; Patrick Horner Journal: PLoS One Date: 2018-12-17 Impact factor: 3.240