Asian Research Journal of Gynaecology and Obstetrics

Prevalence and Immunogenetic Aspects of Chlamydia trachomatis Infection Associated with Conjugal Infertility

Maria Antónia da Silva Gustavo Sampaio *

Faculty of Medicine, Agostinho Neto University, Luanda, Angola.

Paulo Adão de Campos

Department of Gynaecology/Obstetrics, Faculty of Medicine, Agostinho Neto University, Luanda, Angola.

Moisés Francisco

Department of Microbiology and Medical Parasitology, Faculty of Medicine, Agostinho Neto University, Luanda, Angola.

Pascoal Micolo Diogo de Campos

National Centre for Scientific Research, Ministry of Higher Education, Science, Technology and Innovation, Luanda, Angola.

*Author to whom correspondence should be addressed.

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Abstract

Chlamydia trachomatis is a mandatory intracellular bacterium whose only natural host is humans. It is the main cause of sexually transmitted bacterial infections worldwide and is most prevalent in young women and men (14-25 years) probably due to its asymptomatic course, inadequate treatment of the partner and delayed development of protective immunity. Chlamydia trachomatis infects squamocolumnar or transition epithelial cells, causing cervicitis in women and urethritis in men. Symptoms are mild or absent. Infection by Chlamydia trachomatis exacerbates the host's inflammatory response to support its mandatory intracellular developmental cycle. Infertility is the most relevant sequel and affects 15% of couples of reproductive age. The factors responsible for infertility are dominated by Chlamydia trachomatis, which can cause serious complications, such as tubal obstructions, ectopic pregnancy, epididymitis, and total irreversible azoospermia. Infertility remains neglected or underdiagnosed in Angola and in most sub-Saharan African countries. The present study aims to estimate the prevalence of Chlamydia trachomatis and its impact on the reproductive health of couples worldwide, particularly in Sub-Saharan Africa. This review was performed by searching the relevant literature using keywords in the databases MEDLINE, PubMed and Uptodate without language or year restrictions, including Marital Infertility, Chlamydia trachomatis, and Angola. The prevalence of Chlamydia trachomatis infection is high, and the impact on human reproduction in Africa lacks screening programs and studies of greater scientific relevance. The high rates of asymptomatic infections, especially in women, suggest that diagnostic tests are available free of charge, as well as national screening programs for Chlamydia trachomatis, which already exist in other countries. This makes it possible to formulate policies to fight the disease, make diagnostic tests available free of charge, and develop clinical protocols for better guidance in clinical decisions.

Keywords: Conjugal infertility, Chlamydia trachomatis, diagnosis, Angola

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References

WHO. Global health sector strategy on sexually transmitted infections 2016-2021: Implementation framework for the African Region. Geneva, World Health Organization, document AFR/RC67/7; 2017.

Olguín Magaña C. Updated review of generalities and diagnosis of Chlamydia Trachomatis [monography]. [Chile]: University of Talca. School of Medical Technology; 2020.

Brunham RC, Rappuoli R. Chlamydia trachomatis control requires a vaccine. Vaccine. 2013;31(15):1892–1897.

DOI: 10.1016/j.vaccine.2013.01.024

Owusu-Edusei K, Chesson HW, Gift TL, Brunham RC, Bolan G. Cost-effectiveness of Chlamydia vaccination programs for young women. Emerging Infectious Diseases. 2015;21(6):960–968.

DOI: 10.3201/eid2106.141270

Centers for Disease Control and Prevention (CDC). Sexually transmitted disease surveillance. Atlanta: US. Department of Health & Human Services; 2018.

Felicita A, Torres N, Achig M. Detection of Chlamydia trachomatis by real-time PCR in newborns at Isidro Ayora Hospital, Quito-Ecuador. Investigative Nursing. 2020;5(3): 46-52.

O'Connell C, Ferone M. Chlamydia trachomatis Genital Infections. Microbial Cell. 2016;3(9):390-403.

DOI: 10.15698/mic2016.09.525

Reis-Góes F, Lima F, Amorim C, Santa Izabel T. Prevalence of Chlamydia trachomatis infection in the Brazilian female population: A review article. Research, Society and Development. 2020;9(7):e567974483.

DOI: 10.33448/rsd-v9i7.4483

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. Clinical Infectious Diseases. 2019;69(9): 1517-1525.

DOI: 10.1093/cid/ciz429

Fernandes LB, Arruda JT, Approbato MS, Garcia-Zapata MTA. Chlamydia trachomatis and Neisseria gonorrhoeae infection: Factors associated with infertility in women cared for in a public human reproduction service. Brazilian Journal of Gynecology and Obstetrics. 2014;36(8): 353–358.

DOI: 10.1590/SO100-720320140005009

Peters R, Dubbink J, van der Eem L, Verweij S, Bos M, Ouburg S, et al. Cross-sectional study of genital, rectal, and pharyngeal Chlamydia and Gonorrhea in women in rural South Africa. Sexually Transmitted Diseases. 2014;41(9): 564-569.

DOI: 10.1097/OLQ.0000000000000175

Herkenhoff ME, Gaulke R, Vieira LL, Ferreira PS, Pitlovanciv AK, Remualdo VR. Prevalence of Chlamydia trachomathis in endocervical samples of women in São Paulo and Santa Catarina by PCR. Brazilian Journal of Pathology and Laboratory Medicine. 2012;48(5):323–327.

DOI: 10.1590/S1676-24442012000500004

Martins J, Luis CR, De Aguiar TC, Marcos JMG, & Brito MJR. Chlamydia trachomatis infection in the first year of life. Annals of Pediatrics. 2011;74(5):298-302.

Hegazy AA, Al-Rukban MO. Male circumcision: Review and authors perspective. The Health. 2012;3(1):24-30.

Hegazy AA, Hegazy MA. Anal intercourse and idiopathic infertility: Anatomical considerations and authors’ perspective. Trends Med. 2019 Jan 3;19:1-3.

Rocco F. Evaluation of molecular methodologies for diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis infections [dissertation]. [Brazil]: Institutional Repository of the University of Santa Catarina; 2018.

Siqueira CR. Genital infection caused by Chlamydia trachomatis bacteria and or laboratory diagnosis [monography]. [Brazil]: Faculty of Sudoeste Paulista de Itapetininga; 2017.

Marques CAS, Menezes MLB, Coelho IMG, Marques CRC, Celestino LC, Melo MC, et al. Genital infection by Chlamydia trachomatis in homes treated in a conjugal sterility outpatient clinic. DST Brazilian Journal of Sexually Transmitted Diseases. 2007;19(1):5-10.

Bonetti T, Silva IDCG. Chlamydia trachomatis and reproduction. Brazilian Journal of Human Reproduction. 2008; 6(3).

Moraes JSV. Evaluation of tests for the diagnosis of Chlamydia trachomatis infections and profile of infected people [dissertation]. [Brazil]: Federal University of Minas Gerais; 2009.

Crosby RA, DiClemente RJ, Wingood GM, Salazar LF, Rose E, Levine D, et al. Associations between sexually transmitted disease diagnosis and subsequent sexual risk and sexually transmitted disease incidence among adolescents. Sexually Transmitted Diseases. 2004;31(4): 205-8.

DOI:10.1097/01.olq.0000114940.07793.20

Fernandes SLT. Chlamydia trachomatis genital infection screening and female morbidity reduction - An evidence-based review. RPMGF. 2018;34(6):384-97.

DOI: 10.32385/rpmgf.v34i6.12249

McKeithen D, Omosun Y, Ryans K, Mu J, Xie Z, Simoneaux T, et al. The emerging role of ASC in dendritic cell metabolism during Chlamydia infection. PLOS ONE. 2017;12(12):e0188643.

DOI: 10.1371/journal.pone.0188643

Gwyn S, Mitchell A, Dean D, Mkocha H, Handali S, Martin DL. Lateral flow-based antibody testing for Chlamydia trachomatis. Journal of Immunological Methods. 2016;435:27-31.

DOI: 10.1016/j.jim.2016.05.008

Assis LV, Novais DFF, De Moura ES, Oliveira JRA, Rodrigues KMR, Franco LA, et al. Chlamydia trachomatis and the risk of pelvic inflammatory disease evolving to female infertilityna: A bibliographic review. Scientific Collection. 2021;19:e5669.

DOI: 10.25248/reac.e5669.2021

Fonseca GMT. Psychopathology and infertility [dissertation]. [Portugal]: Open Repository of the Superior Institute Miguel Torgas; 2016.

Palma CAPT. Infertility in women and the occurrence of sexually transmitted infections in childbearing age [dissertation]. [Portugal]: Universidade Nova Repository of Universidade Nova Lisboa; 2011.

Torrone E, Papp J, Weinstock H, Centers for Disease Control and Prevention (CDC). Prevalence of Chlamydia trachomatis genital infection among persons aged 14-39 years--United States, 2007-2012. Morbidity and Mortality Weekly Report. 2014;63(38):834-838.

Santos L, Ulian W, Trindade J, Sousa F, Oliveira J, Pereira C, et al. Prevalence of endocervical Chlamydia trachomatis infection in university students in the state of Pará, Amazon Region, Brazil. Pan-Amazonian Health Magazine. 2017;8(3):27-33.

DOI: 10.5123/S2176-62232017000300004

Pereira JDS. Detection of Chlamydia trachomatis in endocervical samples from HIV-positive women from Palhoça/SC [dissertation]. [Brazil]: Federal University of Santa Catarina, Faculty of Medicine; 2016.

Magalhães ZV. Chlamydia trachomatis infection: Knowledge, attitudes and practices of a population of university health students [dissertation]. [Portugal]: Universidade Nova Repository of Universidade Nova Lisboa; 2010.

Fernandes LB, Arruda JT, Approbato MS, García-Zapata MTA. Chlamydia trachomatis and Neisseria gonorrhoeae infection: Factors associated with infertility in women attending a public human reproduction service. Brazilian Journal of Gynecology and Obstetrics. 2014;36(8):353-8.

DOI: 10.1590/SO100-720320140005009

Grajales-Zapata JC, Vélez-Gómez D, Villegas-Castaño A, McEwen-Ochoa JG, Martínez A. Sexual transmission networks of Chlamydia trachomatis Neisseria gonorrhoeae in inhabitants of Calle de la Ciudad de Medellín: Final results. Iatreia. 2020;33(1-S):S16-S17.

Faria AMV, Grassi VMT, Telles TM, Silva MSN. Detection of Chlamydia trachomatis in cervical specimens by the Polymerase Chain Reaction. ULBRA Scientific Initiation Journal. 2018 [cited 2022 Mar 14];1(16).

Naglak E, Morrison S, Morrison R. Neutrophils are central to antibody-mediated protection against genital Chlamydia. Infection and Immunity. 2017; 85(10).

DOI: 10.1128/IAI.00409-17

Lozano LAT, Orozco LIZ, Arias JAC. Prevalence of Chlamydia trachomatis in sexual workers: Systematic review. Medicine Archives. 2018;14(3):5-9.

Freitas NSL. Detection of Chlamydia trachomatis by the Polymerase Chain Reaction (PCR) technique in women treated at the infertility clinic at Hospital Dona Francisca Mendes, Manaus - Amazonas [dissertation]. [Brazil]: Digital Library of Theses and Dissertations of the Federal University of Amazonas; 2007.

Roshani D, Ramazanzadeh R, Farhadifar F, Ahmadi A, Derakhshan S, Rouhi S, et al. A PRISMA systematic review and meta-analysis on Chlamydia trachomatis infections in Iranian women (1986–2015). Medicine. 2018;97(16):e0335.

DOI: 10.1097/MD.00000000000010335

Lewis D, Newton D, Guy R, Ali H, Chen M, Fairley C, et al. The prevalence of Chlamydia trachomatis infection in Australia: A systematic review and meta-analysis. BMC Infectious Diseases. 2012;12(1).

DOI: 10.1186/1471-2334-12-113

Vaz Pereira F, Borges da Costa J. Chlamydia Trachomatis genital infection in Portuguese adolescents. Journal of the Portuguese Society of Dermatology and Venereology. 2020;78(3):237-243.

DOI: 10.29021/spdv.78.3.1226

Castro MA. Prevalence of Chlamydia trachomatis infection in women screened opportunistically [dissertation]. [Brazil]: Faculty of Medical Sciences of Santa Casa de São Paulo; 2019.

Approbato FC. Prevalence of Chlamydia trachomatis by polymerase chain reaction (PCR) technique in infertile women [dissertation]. [Brazil]: Repository of the Federal University of Goiás; 2012.

Masese L, Baeten J, Richardson B, Deya R, Kabare E, Bukusi E, et al. Incidence and correlates of Chlamydia trachomatis infection in a high-risk cohort of Kenyan Women. Sexually Transmitted Diseases. 2013;40(3):221-225.

DOI: 10.1097/OLQ.0b013e318272fe45

Siemer J, Theile O, Larbi Y, Fasching PA, Danso KA, Kreienberg R, Essig A. Chlamydia trachomatis infection as a risk factor for infertility among women in Ghana, West Africa. The American Journal of Tropical Medicine and Hygiene. 2008;78(2):323–327.

Ngandjio A, Clerc M, Fonkoua M, Thonnon J, Njock F, Pouillot R, et al. Screening of Volunteer Students in Yaounde (Cameroon, Central Africa) for Chlamydia trachomatis infection and genotyping of isolated C. trachomatis strains. Journal of Clinical Microbiology. 2003;41(9):4404–4407.

DOI: 10.1128/JCM.41.9.4404–4407.2003

Sturm-Ramirez K, Brumblay H, Diop K, Gueye-Ndiaye A, Sankale J, Thior I, et al. Molecular epidemiology of genital Chlamydia trachomatis infection in high-risk women in Senegal, West Africa. Journal of Clinical Microbiology. 2000;38(1):138-145.

DOI: 10.1128/JCM.38.1.138–145.2000

Becker D. Detection of Chlamydia trachomatis in cervical samples by polymerase chain reaction [dissertation]. [Brazil]: Digital Repository of the Federal University of Rio Grande do Sul; 2005.

Ramadhani M, Mirambo M, Mbena H, Kihunrwa A, Mshana S. High prevalence of Chlamydia trachomatis infection among infertile women in Mwanza City, Tanzania: A need to introduce screening and treatment programme. Sexually Transmitted Infections. 2017;93(2):111-111. DOI: 10.1136/sextrans-2016-052795

Cappuccinelli P, Gomes E, Rubino S, Zanetti S, Lemos C, Calundungo R, et al. Chlamydia trachomatis in gynecological infections in Luanda, Angola. Genitourinary Medicine. 1995;71(5):326-327.

DOI: 101136/sti71.5.326

Witkin S, Minis E, Athanasiou A, Leizer J, Linhares I. Chlamydia trachomatis: The persistent pathogen. Clinical and Vaccine Immunology. 2017;24(10).

Santos LM. Prevalence and genotypic variability of Chlamydia trachomatis in cervical females of university students in Belém, Pará, Brazil. [dissertation]. [Brazil]: Repository of the Federal University of Pará; 2015.

Vieira MLV. Detection of Chlamydia trachomatis in asymptomatic women aged 18 to 30 years using self-collection to obtain the sample [dissertation]. [Brazil]: Institutional Repository of the Federal University of Santa Catarina; 2016.

Vinegar JGP. Chlamydia trachomatis infection, tubal obstruction and genetic polymorphism at codon 54 of the gene encoding mannose-binding lectin (MBL) in Brazilian women [dissertation]. [Brazil]: Digital Library of the University of São Paulo; 2018.

DOI: 10.11606/D.5.2019.tde-20032019-122417

Valladão AS, Costa CMSP, Camargoe JÁ, Soares VCG. The effects of Chlamydia trachomatis on human reproduction. Journal of the Adolfo Lutz Institute. 2011;70(4):457–462.

Wyżewski Z, Gregorczyk KP, Szczepanowska J, Szulc-Dąbrowska L. Functional role of Hsp60 as a positive regulator of human viral infection progression. Acta Virologica. 2018;62(01):33-4.

DOI: 10.4149/av_2018_104

Jonhson S, Oda H, Lundin E, Olsson J, Idahl A. Chlamydia trachomatis, chlamydial heat shock protein 60 and anti-chlamydial antibodies in women with epithelial ovarian tumors. Translational Oncology. 2018;11(2):546–51.

DOI: 10.1016/j.tranon.2018.02.008