Antichlamydial antibodies in pelvic inflammatory disease

Importance of chlamydial antibodies in acute salpingitis in central Africa

Of 35 women with acute salpingitis on laparoscopy, 86% had chlamydial antibodies at a titre of 1/16 or higher and 49% at a titre of 1/512 or higher. Geometric mean titres of chlamydial antibodies correlated significantly with a laparoscopic observation of chronic salpingitis (p less than 0.001), with a history of infertility (p less than 0.05), and with severe inflammation (p less than 0.10), but not with a history of salpingitis or a positive cervical culture for Chlamydia trachomatis. In the subgroup of infertile women, the geometric mean titre of antibodies to chlamydiae correlated significantly with the presence of chronic salpingitis (p less than 0.005). These data indicate that chlamydial infections play a major part in salpingitis and infertility in central Africa. In this area, which is known as the "infertility belt", programmes to control chlamydial infections should be implemented.

Chlamydial pelvic infection in cats: a model for the study of human pelvic inflammatory disease

The inoculation of feline keratoconjunctivitis agent (Chlamydia psittaci) directly into the oviducts of eight cats produced an acute disease that was characterised by hyperaemia of the tissue and pronounced polymorphonuclear leucocyte infiltration of the epithelium and subepithelial stroma. The lumens of the tubes contained exudates of desquamated epithelial cells and polymorphonuclear leucocytes. After about 30 days the disease subsided leaving chronic inflammation with the tissue infiltrated with both polymorphonuclear and mononuclear cells. Fimbrial scarring and formation of adhesions were apparent by 40 to 50 days after inoculation. Chlamydiae were isolated in McCoy cell cultures from most cats, in one for as long as 51 days after inoculation. Inclusions were seen in histological sections or smears of cells from the fimbriae of four of the eight cats. Six of the eight cats developed antibodies to feline keratoconjunctivitis agent, which were detectable as early as 12 days after inoculation. To facilitate repeated examinations of the cats' fallopian tubes, techniques for laparoscopy in cats and for the collection of specimens while under laparoscopic examination were developed. The latter technique has since been applied successfully in man.

Serum IgG and IgA antibodies specific for Chlamydia trachomatis in salpingitis patients as determined by the immunoperoxidase assay

The feasibility of applying elevated Chlamydia trachomatis specific IgG antibody and serum IgA antibodies as a non-invasive screening test for C. trachomatis associated salpingitis was analysed in 54 salpingitis patients and 294 apparently healthy women by the single antigen (L2) immunoperoxidase assay (IPA). The prevalence rate of C. trachomatis IgG antibody (titre greater than or equal to 64) was significantly higher in the salpingitis patients in comparison to control (67% versus 23%). The prevalence rate of elevated C. trachomatis IgG titres (greater than or equal to 128, greater than or equal to 256 and greater than or equal to 512) was significantly higher in the salpingitis patients as compared to the controls. For example, at an IgG titre of greater than or equal to 128 the prevalence rate was 57% in the salpingitis patients and 8% in the healthy controls (p less than 0.0001). The prevalence of C. trachomatis IgA antibodies (titre greater than or equal to 16) was significantly higher in salpingitis patients in comparison to controls (37% versus 4%). The prevalence of elevated IgA titres (greater than or equal to 32 and greater than or equal to 64) was found to be significantly higher in salpingitis patients as compared to controls. All the IgG seropositive salpingitis patients were also found to have C. trachomatis IgG antibodies. It appears that testing for IgG antibodies at a serum dilution of 1:128, and for IgA antibodies at a dilution of 1:16 by the IPA test comprises the best combination for the differentiation between the salpingitis patients and apparently healthy controls, and it is suggested that this be used as a marker of active C. trachomatis infection.

Chlamydial genital infection in prostitutes in Iran

The prevalence of chlamydial genital infection was studied in 177 prostitutes in Iran; 100 in Teheran and 77 in the port of Bandar Abbas. Chlamydia trachomatis was isolated in eight (6.9%) of 116 patients with valid cultures. Type-specific antibodies were found against C trachomatis serotypes D to K (genital serotypes) in 94.2% and against serotypes A to C (trachoma serotypes) in 2% of the prostitutes. Type-specific IgM at a titre of greater than or equal to 8, indicating current infection, was found in 29.2%, whereas type-specific IgG at a titre greater than or equal to 64, suggesting a current or recent infection, was present in 71.5%. The lower chlamydial isolation rate in these women may have been due to previous treatment with antichlamydial drugs and because of immune responses resulting from repeated reinfection with chlamydiae. The results indicate that in Iran prostitutes are commonly infected with C trachomatis and are probably a major reservoir of chlamydial genital infection.

Chlamydial genital infection in Addis Ababa, Ethiopia. A seroepidemiological survey

A seroepidemiological survey was undertaken in Addis Ababa to assess the prevalence of chlamydial genital infections among patients attending a sexually transmitted diseases (STD) clinic and patients with no overt genital symptoms. In the STD clinic patients antibodies to Chlamydia trachomatis serotypes D to K (genital types) were detected in 68 of 210 (32.4%) men and in 72 of 159 (45.3%) women, a rate of exposure as high or higher than that found in Europe. Serological evidence of active chlamydial infection was present in 26.7% of men and 28.9% of women. Women were at risk of contracting STD, including chlamydial infections, at the age of 14 years or earlier. The titres of antichlamydial IgG were extremely high in some patients attending the STD clinic, with titres of between 1/512 and 1/8192 in 9.5% of men and 13.2% of women. This suggests that some patients had severe or disseminated chlamydial disease. The prevalence of exposure to chlamydial genital infections among 148 patients with no overt genital disease was 14.2%, which is significantly higher than that found in the United Kingdom. Among the total of 517 patients tested the prevalence of exposure to trachoma, lymphogranuloma venereum, and Chlamydia psittaci agents was very low.

Chlamydia and the Curtis-Fitz-Hugh syndrome

Ten women with acute right upper-quadrant abdominal pain but negative results for biliary investigations had a current or past history of pelvic inflammatory disease. A diagnosis of the Curtis-Fitz-Hugh syndrome was made and was confirmed in five patients by laparoscopy. Neisseria gonorrhoeae was not isolated from the cervical and urethral swabbings of seven patients tested. Chlamydia trachomatis was isolated from the endocervical canal in one of six patients examined. Of sera from nine patients tested by a micro-immunofluorescence test, nine and six samples respectively showed type-specific IgG and IgM antibodies against C trachomatis serotypes D-K. Type-specific IgG and IgA antibodies were also detected in the cervical and urethral discharge of two out of five patients and in the peritoneal aspirate of two. The presence of high titres of IgG or IgM in sera and IgG or IgA in the local discharges of our patients suggests that C trachomatis was probably the cause of the CFH syndrome.

Epidemiological and clinical correlates of chlamydial infection of the cervix

Of 474 women studied to identify epidemiological and clinical correlates of chlamydial infection of the cervix, Chlamydia trachomatis was isolated from 158 (33.3%) of all women, from 48.3% of those infected with Neisseria gonorrhoeae, from 43% of the sexual consorts of men with nongonococcal urethritis, and from 74% of those whose consorts were also infected with C trachomatis. C trachomatis was the sole pathogen found in 58 women. Age, marital state, occupation, past history of gonorrhoea, menstrual state, and symptoms had no predictive value. The isolation of C trachomatis was significantly associated with N gonorrhoeae, the use of oral contraceptives, cervical ectopy, cervicitis, and last sexual exposure more than one week previously. Except for three patients, none of the criteria alone or in combination was reliable enough to predict with acceptable accuracy that the 30 chlamydia-positive women among the 191 who were not infected with N gonorrhoeae and whose consorts were not known to have urethritis harboured chlamydia.