Chlamydia trachomatis infection and tubal ectopic pregnancy in Jos, Plateau State, Nigeria

Onyeji John; Kingsley C. Ozele; Lucious C. Imoh; Samuelson C. Keneolisa; Didamson D. Gloria; Chimezie N. D. Nwachukwu; Amaka N. Ocheke

doi:10.18203/2320-1770.ijrcog20242469

Authors

Onyeji John Department of Obstetrics and Gynecology, College of Medicine and Allied Health Sciences, Bingham University, Jos Campus, Nigeria
Kingsley C. Ozele Department of Medical and Health Services, National Institute for Policy and Strategic Studies (NIPSS) Kuru, Jos, Plateau State, Nigeria
Lucious C. Imoh Department of Chemical Pathology, Jos University Teaching Hospital, Jos Plateau State, Nigeria
Samuelson C. Keneolisa Department of Obstetrics and Gynecology, College of Medicine and Allied Health Sciences, Bingham University, Jos Campus, Nigeria
Didamson D. Gloria Department of Obstetrics and Gynecology, College of Medicine and Allied Health Sciences, Bingham University, Jos Campus, Nigeria
Chimezie N. D. Nwachukwu Department of Obstetrics and Gynaecology, Maitama District Hospital, FCTA Abuja, Nigeria
Amaka N. Ocheke Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos Plateau State Nigeria

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20242469

Keywords:

Chlamydia trachomatis infection, JUTH, Tubal ectopic pregnancy

Abstract

Background: Chlamydia trachomatis is an obligate intracellular organism that is sexually transmitted and mostly asymptomatic. It is capable of tubal damage with subsequent tubal ectopic pregnancy. IgG anti-Chlamydia antibody can be measured in women with past or latent Chlamydia trachomatis infection. This study aimed to determine association between prior Chlamydia trachomatis infection and tubal ectopic pregnancy, and predictive value of Chlamydia trachomatis IgG for tubal ectopic pregnancy.

Methods: This was a case control study carried out within Jos metropolis within 6 months period (November 2018 to April 2019). Study groups comprised of 40 women with tubal ectopic pregnancy and 40 uncomplicated second trimester pregnant women recruited from Jos University Teaching Hospital, Plateau State Specialist Hospital Jos, and Faith Alive Hospital Jos by convenience sampling. The subjects’ socio-demographic factors, obstetric history, sexual and reproductive risk factors were obtained using study pro forma. Five milliliter of venous blood was collected from subjects to determine proportions and serum levels of IgG anti-Chlamydia antibody in cases and controls using BIOS Chlamydia T. IgG ELISA kits. Data obtained were analyzed using IBM-SPSS version 26.

Results: Patients with tubal ectopic pregnancy demonstrated significant evidence of prior Chlamydia trachomatis infection compared with intrauterine pregnant controls (45.0% versus 15.0%, p value =0.003), 4.6-fold risk association for tubal ectopic pregnancy (OR =4.63, 1.593-13.494; p value =0.005), and 75% positive predictive value.

Conclusions: This study revealed an association between prior Chlamydia trachomatis infection and tubal ectopic pregnancy with Chlamydia IgG having good predictive value for tubal pregnancy.

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References

Huai P, Li F, Chu T, Liu D, Liu J, Zhang F. Prevalence of genital Chlamydia trachomatis infection in the general population: a meta-analysis. BMC Infect Dis. 2020;20:1-8.

Jeremiah I, Okike O, Akani C. The prevalence of serum immunoglobulin g antibody to chlamydia trachomatis in subfertile women presenting at the University of Port Harcourt Teaching Hospital, Nigeria. Int J Biomed Sci. 2011;7(2):120-4.

Mawak JD, Dashe N, Agabi YA, Panshak B. Prevalence of genital chlamydia trachomatis infection among gynaecologic clinic attendeec in Jos, Nigeria. Shiraz E-Medi J. 2011;12(2):100-6.

Ikeme AC, Ezegwui HU, Ikeako LC, Agbata I, Agbata E. Seroprevalence of Chlamydia trachomatis in Enugu, Nigeria. Niger J Clin Pract. 2011;14(2):176-80.

Centers for Disease Control and Prevention. National overview of STDs, 2021, 2023. Available at: https://www.cdc.gov/std/statistics/2021/overview.htm#Chlamydia. Accessed 01 March 2024.

Liu L, Li C, Sun X, Liu J, Zheng H, Yang B, et al. Chlamydia infection, PID, and infertility: further evidence from a case-control study in China. BMC Women's Health. 2022;22(1):294.

Mohseni M, Sung S, Takov V. Chlamydia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.

Aliyu RM, Adesiyun AG, Bawa US, Olorukooba AA, Aliyu S. Chlamydia trachomatis seropositivity and associated risk factors among women attending a Northern Nigerian Tertiary Hospital. J West Afr Coll Surg. 2023;13(1):40-3.

Shui J, Xie D, Zhao J, Ao C, Lin H, Liang Y, et al. Seroepidemiology of Chlamydia trachomatis Infection in the General Population of Northern China: The Jidong Community Cohort Study. Front Microbiol. 2021;12:729016.

Xia Q, Wang T, Xian J, Song J, Qiao Y, Mu Z, Liu H, Sun Z. Relation of Chlamydia trachomatis infections to ectopic pregnancy: A meta-analysis and systematic review. Medicine (Baltimore). 2020;99(1):e18489.

Dockterman J, Coers J. Immunopathogenesis of genital Chlamydia infection: insights from mouse models. Pathog Dis. 2021;79(4):ftab012.

Tavares BVG, Delfino LS, Ignarro IS, Baccaro LF. Changing paradigms in the initial treatment of ectopic pregnancy at a University Hospital in Brazil. Rev Bras Ginecol Obstet. 2023;45(4):192-200.

Linhares IM, Witkin SS. Immunopathogenic consequences of Chlamydia trachomatis 60 kDa heat shock protein expression in the female reproductive tract. Cell Stress Chaperones. 2010;15(5):467-73.

Gitsels A, Sanders N, Vanrompay D. Chlamydial infection from outside to inside. Front Microbiol. 2019;10:2329.

Odelola OI, Akadri AA. Chlamydia trachomatis seropositivity among women with tubal factor infertility and fertile controls: a comparative study. Pan Afr Med J. 2023;44(1):178.

Agholor K, Omo-Aghoja L, Okonofua F. Association of anti-Chlamydia antibodies with ectopic pregnancy in Benin city, Nigeria: a case-control study. Afr Health Sci. 2013;13(2):430-40.

Musa J, Daru PH, Mutihir JT, Ujah IA. Ectopic pregnancy in Jos Northern Nigeria: prevalence and impact on subsequent fertility. Niger J Med. 2009;18(1):35-8.

Mullany K, Minneci M, Monjazeb R, C Coiado O. Overview of ectopic pregnancy diagnosis, management, and innovation. Womens Health (Lond). 2023;19:17455057231160349.

Adewunmi AA, Orekoya OO, Rabiu KA, Ottun TA. The association between Chlamydia trachomatis and ectopic pregnancy in Lagos, Nigeria-a case control study. Open J Obstetr Gynecol. 2015;5(2):115-22.

Andola S, Kumar R R, Desai RM, S A K. Study of Risk factors and treatment modalities of ectopic pregnancy. J Family Med Prim Care. 2021 Feb;10(2):724-9.

Ibe V, Jeremiah I, Ikeanyi E. Chlamydia trachomatis Infection: serological evidence in women with ectopic pregnancy in Port Harcourt. Int STD Res Revi. 2016;4(3):1-9.

Hoenderboom BM, van Bergen JEAM, Dukers-Muijrers NHTM, Götz HM, Hoebe CJPA, de Vries HJC, et al. Pregnancies and time to pregnancy in women with and without a previous chlamydia trachomatis infection. Sex Transm Dis. 202;47(11):739-47.

den Heijer CDJ, Hoebe CJPA, Driessen JHM, Wolffs P, van den Broek IVF, Hoenderboom BM, et al. Chlamydia trachomatis and the risk of pelvic inflammatory disease, ectopic pregnancy, and female infertility: a retrospective cohort study among primary care patients. Clin Infect Dis. 2019;69(9):1517-25.

Mayavannan A, Shantz E, Haidl ID, Wang J, Marshall JS. Mast cells selectively produce inflammatory mediators and impact the early response to Chlamydia reproductive tract infection. Front Immunol. 2023;14:1166068.

Hoenderboom BM, van Benthem BHB, van Bergen JEAM, Dukers-Muijrers NHTM, Götz HM, Hoebe CJPA, et al. Relation between Chlamydia trachomatis infection and pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in a Dutch cohort of women previously tested for chlamydia in a chlamydia screening trial. Sex Transm Infect. 2019;95(4):300-6.

Dahlberg J, Hadad R, Elfving K, Larsson I, Isaksson J, Magnuson A, et al. Ten years transmission of the new variant of Chlamydia trachomatis in Sweden: prevalence of infections and associated complications. Sex Transm Infect. 2018;94(2):100-4.

Tukur J, Shittu SO, Abdul AM. A case control study of active genital Chlamydia trachomatis infection among patients with tubal infertility in northern Nigeria. Trop Doct. 2006;36(1):14-6.

Okoror LE, Agbonlahor DE, Esumeh FI, Umolu PI. Prevalence of chlamydia in patients attending gynecological clinics in south eastern Nigeria. Afr Health Sci. 2007;7(1):18-24.

Isibor JO, Ugbomoiko D, Nwobu GO, Ekundayo AO, Enweani IB, Okogun GRA. Detection of chlamydia antigen in cervical specimens from antenatal clinic attendees in Benin City, Nigeria. Afr J Clin Experim Microbiol. 2005;6(3):208-11.

Olaleye O, Olamijulo JA. The value of chlamydial antibody level for predicting tubal blockage among women undergoing hysterosalpingography in Lagos, Nigeria. Int J Gynaecol Obstet. 2016;134(1):33-6.

Onyeabochukwu AD, Izuka EO, Onyegbule OA, Onumajuru CC, Ejelonu UT, Duke-Onyeabo CP, et al. Association between serum chlamydial antibody levels and tubal infertility in tertiary health facility in South-East Nigeria: a case-control study. Ghana Med J. 2021;55(3):183-9.

A El-Tamamy E, H Mohamed A, R Hablas W, H Abd El-Rahman S. Anti-chalmydial antibody as a predictive test for tubal factor infertility. Al-Azhar Medi J. 2020;49(1):229-40.

Shreffler J, Huecker MR. Diagnostic Testing Accuracy: Sensitivity, Specificity, Predictive Values and Likelihood Ratios. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.