Genital Chlamydia trachomatis is common among young, sexually active people. Infections are most often asymptomatic but have potential long-term consequences for female reproductive health. The link between C. trachomatis and ectopic pregnancy is mainly based on early seroepidemiological case-control studies including women who had their sexual debut at a time at which testing was sparse. The purpose of the present review is to summarize recent findings in C. trachomatis and ectopic pregnancy epidemiology.
The number of prevalence studies is high but results are specific for the setting in which the study was conducted. High prevalences are often found among adolescents and young adults. At the same time, decreased ectopic pregnancy rates are reported. Registry studies from the Scandinavian countries have shown low ectopic pregnancy rates among women tested for C. trachomatis and diverging results considering whether women are at increased risk following infection.
Recent studies on C. trachomatis infection and ectopic pregnancy are few. The recent Scandinavian registry studies include women with diagnosed, and hence presumably treated, infections. The observation of low complication rates in these studies cannot be used as an argument against the importance of screening for C. trachomatis infections.
"Much of the current assumptions on risk of subsequent infertility are based on retrospective case-control studies (Walters et al., 1988; Chrysostomou et al., 1992; Weström et al., 1992; Odland et al., 1993; Van Valkengoed et al., 2004; Low et al., 2006; Bakken et al., 2007; Bjartling et al., 2007; and Machado et al., 2007). Many of these studies have been performed on populations where infertility was at the extremes of the distribution i.e., extremely common or rare, or used data that did not account for misdiagnoses, and there is considerable error in their estimates of risk ratios (Van Valkengoed et al., 2004; Bakken, 2008; Garnett, 2008). Moreover, retrospective and prospective case control studies on infertility are prone to confounding variables that have not always been accounted for, such as the effect of other sexually transmitted infections (e.g. "
[Show abstract][Hide abstract] ABSTRACT: Chlamydia trachomatis infection of the genital tract is the most common sexually transmitted infection and has a world-wide distribution. The consequences of infection have an adverse effect on the reproductive health of women and are a common cause of infertility. Recent evidence also suggests an adverse effect on male reproduction. There is a need to standardise the approach in managing the impact of C. trachomatis infection on reproductive health. We have surveyed current UK practice towards screening and management of Chlamydia infections in the fertility setting. We found that at least 90% of clinicians surveyed offered screening. The literature on this topic was examined and revealed a paucity of solid evidence for estimating the risks of long-term reproductive sequelae following lower genital tract infection with C. trachomatis. The mechanism for the damage that occurs after Chlamydial infections is uncertain. However, instrumentation of the uterus in women with C. trachomatis infection is associated with a high risk of pelvic inflammatory disease, which can be prevented by appropriate antibiotic treatment and may prevent infected women from being at increased risk of the adverse sequelae, such as ectopic pregnancy and tubal factor infertility. Recommendations for practice have been proposed and the need for further studies is identified.
Human Fertility 09/2010; 13(3):115-25. DOI:10.3109/14647273.2010.513893 · 0.91 Impact Factor
"Current assumptions on the risks of subsequent pregnancy problems, following pelvic infection, are based on retrospective case –control studies (Walters et al., 1988; Chrysostomou et al., 1992; Odland et al., 1993; van et al., 2004; Low et al., 2006; Bjartling et al., 2007; Machado et al., 2007; Bakken, 2008). Many of these studies were performed on populations where tubal ectopic pregnancy is extremely common (or rare), or used data that do not account for misdiagnoses, and thus there is considerable error in the estimates of risk ratios (van et al., 2004; Bakken, 2008; Garnett, 2008). Both retrospective and prospective case control studies on tubal ectopic pregnancy are prone to confounding variables which have not always been accounted for, such as the effect of other sexually transmitted infections (e.g. "
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND An ectopic pregnancy is a pregnancy which occurs outside of the uterine cavity, and over 98% implant in the Fallopian tube. Tubal ectopic pregnancy remains the most common cause of maternal mortality in the first trimester of pregnancy. The epidemiological risk factors for tubal ectopic pregnancy are well established and include: tubal damage as a result of surgery or infection (particularly Chlamydia trachomatis), smoking and in vitro fertilization. This review appraises the data to date researching the aetiology of tubal ectopic pregnancy. METHODS Scientific literature was searched for studies investigating the underlying aetiology of tubal ectopic pregnancy. RESULTS Existing data addressing the underlying cause of tubal ectopic pregnancy are mostly descriptive. There are currently few good animal models of tubal ectopic pregnancy. There are limited data explaining the link between risk factors and tubal implantation. CONCLUSIONS Current evidence supports the hypothesis that tubal ectopic pregnancy is caused by a combination of retention of the embryo within the Fallopian tube due to impaired embryo-tubal transport and alterations in the tubal environment allowing early implantation to occur. Future studies are needed that address the functional consequences of infection and smoking on Fallopian tube physiology. A greater understanding of the aetiology of tubal ectopic pregnancy is critical for the development of improved preventative measures, the advancement of diagnostic screening methods and the development of novel treatments.
Human Reproduction Update 06/2010; 16(4):432-44. DOI:10.1093/humupd/dmp057 · 10.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Secretory leukocyte protease inhibitor (SLPI) and elafin are anti-protease and anti-microbial molecules with a role in innate immune defence. They have been demonstrated at multiple mucosal surfaces including those of the female reproductive tract.
This study details their expression in human Fallopian tubes (ampullary region) throughout the menstrual cycle (n = 18) and from women with ectopic pregnancy (n = 6), and examined their regulation by infection with Chlamydia trachomatis in an in-vitro model. Quantitative real-time PCR analysis showed that SLPI and elafin were constitutively expressed in the Fallopian tube during the menstrual cycle but were increased in ectopic pregnancy (P < 0.05 versus early-mid luteal phase, P < 0.01 versus all phases, respectively). SLPI and elafin were immunolocalised to the Fallopian tube epithelium in biopsies from non-pregnant women and those with ectopic pregnancy. An in-vitro culture model of C. trachomatis infection of the OE-E6/E7 oviductal epithelial cell line showed that elafin mRNA expression was upregulated in response to chlamydial infection.
These data suggest that SLPI and elafin have a role in the innate immune defence of the Fallopian tube in infection and ectopic pregnancy. Their role is likely to include regulation of protease activity, wound healing and tissue remodelling.
Human Reproduction 03/2009; 24(3):679-86. DOI:10.1093/humrep/den452 · 4.57 Impact Factor
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