Chlamydia trachomatis and reproductive health

Tiina Rantsi

Research output: ThesisDoctoral ThesisCollection of Articles

Abstract

Chlamydia trachomatis infection is the most common bacterial sexually transmitted infection (STI) worldwide. It has been linked to severe reproductive morbidity, including tubal factor infertility (TFI), ectopic pregnancy (EP), miscarriage and preterm delivery (PTD), but the evidence has mostly been based on clinical case-control studies, and the data retrieved from population-based studies have been limited. The aim of this thesis was to study the role of C. trachomatis infection in adverse pregnancy outcomes and subfertility. To evaluate the link between C. trachomatis infection and EP, miscarriage and PTD, we performed a population-based, biobank health registry study. We used national health registries to identify the cases with adverse pregnancy outcomes (n=2950). The cases were linked to the Finnish Maternity Cohort serum bank to obtain samples for serological analysis. C. trachomatis major outer membrane protein (MOMP)–specific IgG antibodies were determined from the serum samples. Our results confirmed the association between C. trachomatis infection and EP, alhough C. trachomatis seroprevalence was lower than expected. The seroprevalence rate and the link between antichlamydial antibodies and EP were strongest among women over 35 years of age. We did not find a serological link between C. trachomatis infection and miscarriage or PTD. Cell-mediated immune response is crucial in the resolution of C. trachomatis infection, but it may play an important role in the pathogenesis of Fallopian tube damage. The link between serum C. trachomatis IgG antibodies and TFI has been well established, and chlamydia antibody testing (CAT) has been introduced as a screening test for TFI in the initial infertility workup to select high-risk patients for further tubal evaluation. We studied the role of C. trachomatis infection in subfertility by measuring C. trachomatis–specific immune responses in a cohort of subfertile women (n=258). Cell-mediated immune response was analyzed from peripheral blood samples by an in vitro lymphocyte proliferation test using C. trachomatis elementary body (EB) and recombinant chlamydial 60 kDA heat shock protein (cHSP60) as lymphocyte-stimulating antigens. Serum C. trachomatis–specific IgG antibody responses were studied using C. trachomatis MOMP, cHSP60, and C. trachomatis TroA and HtrA as antigens. Our aim was to develop a specific and sensitive non-invasive test for TFI prediction in subfertile women to simplify infertility workup. According to our results, the accuracy of C. trachomatis serology in evaluating TFI can be improved by combining serum C. trachomatis MOMP and cHSP60 IgG antibody tests or combining markers of C. trachomatis–specific cell-mediated and humoral immune responses. C. trachomatis may impair fertility by mechanisms other than occluding the Fallopian tubes, such as causing functional tubal damage or inflammation in the endometrium. We studied the role of C. trachomatis infection in unexplained infertility by analyzing C. trachomatis–specific immune responses in women with no specific etiology for subfertility. Neither humoral nor cell-mediated immune response to C. trachomatis were associated with unexplained infertility. The presence of serum antichlamydial IgG antibodies was linked to a prolonged time for spontaneous pregnancy, but pregnancy outcomes, including live birth rate, did not differ between seropositive and seronegative women. The highest prevalence of C. trachomatis infection is seen in young, sexually active women aged 20–25 years. Studies estimating the risk of long-term sequelae following C. trachomatis infection are important, because women diagnosed with chlamydial infection are usually worried and need counseling for their future fertility. Our study, together with other population-based data, suggests that the long-term risks following chlamydial infection are lower than previously thought. Since the development of TFI is multifactorial, C. trachomatis immune markers in TFI prediction are only of modest value. TFI prevalence was low in our study (8.5%), which is in line with the declining trend of C. trachomatis–associated reproductive problems in the population. This results most likely from the successful C. trachomatis screening programs, which have led to the effective treatment of chlamydial infections before they ascend to the upper genital tract. The risk of reproductive problems is, however, significantly higher after recurrent chlamydial infection, and preventive strategies should be planned to recognize the core group at the highest risk for recurrent infection.
Original languageEnglish
Supervisors/Advisors
  • Tiitinen, Aila, Supervisor
  • Joki-Korpela, Päivi, Supervisor
Award date25 Jan 2019
Place of PublicationHelsinki
Publisher
Print ISBNs978-951-51-4787-5
Electronic ISBNs978-951-51-4788-2
Publication statusPublished - 2018
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • Chlamydia trachomatis
  • Chlamydia Infections
  • +complications
  • +immunology
  • Reproductive Health
  • Pregnancy, Ectopic
  • Abortion, Spontaneous
  • Premature Birth
  • Bacterial Outer Membrane Proteins
  • Immunoglobulin G
  • Infertility
  • Female
  • Immunity, Cellular
  • Immunity, Humoral
  • Biomarkers
  • Pregnancy Outcome
  • Reproductive Techniques, Assisted
  • Fallopian Tubes
  • +pathology
  • +physiopathology
  • Pelvic Inflammatory Disease
  • 3123 Gynaecology and paediatrics

Cite this

Rantsi, T. (2018). Chlamydia trachomatis and reproductive health. Helsinki: [T. Rantsi].
Rantsi, Tiina. / Chlamydia trachomatis and reproductive health. Helsinki : [T. Rantsi], 2018. 85 p.
@phdthesis{b3632ef789a1443eabc4edde13fd35da,
title = "Chlamydia trachomatis and reproductive health",
abstract = "Chlamydia trachomatis infection is the most common bacterial sexually transmitted infection (STI) worldwide. It has been linked to severe reproductive morbidity, including tubal factor infertility (TFI), ectopic pregnancy (EP), miscarriage and preterm delivery (PTD), but the evidence has mostly been based on clinical case-control studies, and the data retrieved from population-based studies have been limited. The aim of this thesis was to study the role of C. trachomatis infection in adverse pregnancy outcomes and subfertility. To evaluate the link between C. trachomatis infection and EP, miscarriage and PTD, we performed a population-based, biobank health registry study. We used national health registries to identify the cases with adverse pregnancy outcomes (n=2950). The cases were linked to the Finnish Maternity Cohort serum bank to obtain samples for serological analysis. C. trachomatis major outer membrane protein (MOMP)–specific IgG antibodies were determined from the serum samples. Our results confirmed the association between C. trachomatis infection and EP, alhough C. trachomatis seroprevalence was lower than expected. The seroprevalence rate and the link between antichlamydial antibodies and EP were strongest among women over 35 years of age. We did not find a serological link between C. trachomatis infection and miscarriage or PTD. Cell-mediated immune response is crucial in the resolution of C. trachomatis infection, but it may play an important role in the pathogenesis of Fallopian tube damage. The link between serum C. trachomatis IgG antibodies and TFI has been well established, and chlamydia antibody testing (CAT) has been introduced as a screening test for TFI in the initial infertility workup to select high-risk patients for further tubal evaluation. We studied the role of C. trachomatis infection in subfertility by measuring C. trachomatis–specific immune responses in a cohort of subfertile women (n=258). Cell-mediated immune response was analyzed from peripheral blood samples by an in vitro lymphocyte proliferation test using C. trachomatis elementary body (EB) and recombinant chlamydial 60 kDA heat shock protein (cHSP60) as lymphocyte-stimulating antigens. Serum C. trachomatis–specific IgG antibody responses were studied using C. trachomatis MOMP, cHSP60, and C. trachomatis TroA and HtrA as antigens. Our aim was to develop a specific and sensitive non-invasive test for TFI prediction in subfertile women to simplify infertility workup. According to our results, the accuracy of C. trachomatis serology in evaluating TFI can be improved by combining serum C. trachomatis MOMP and cHSP60 IgG antibody tests or combining markers of C. trachomatis–specific cell-mediated and humoral immune responses. C. trachomatis may impair fertility by mechanisms other than occluding the Fallopian tubes, such as causing functional tubal damage or inflammation in the endometrium. We studied the role of C. trachomatis infection in unexplained infertility by analyzing C. trachomatis–specific immune responses in women with no specific etiology for subfertility. Neither humoral nor cell-mediated immune response to C. trachomatis were associated with unexplained infertility. The presence of serum antichlamydial IgG antibodies was linked to a prolonged time for spontaneous pregnancy, but pregnancy outcomes, including live birth rate, did not differ between seropositive and seronegative women. The highest prevalence of C. trachomatis infection is seen in young, sexually active women aged 20–25 years. Studies estimating the risk of long-term sequelae following C. trachomatis infection are important, because women diagnosed with chlamydial infection are usually worried and need counseling for their future fertility. Our study, together with other population-based data, suggests that the long-term risks following chlamydial infection are lower than previously thought. Since the development of TFI is multifactorial, C. trachomatis immune markers in TFI prediction are only of modest value. TFI prevalence was low in our study (8.5{\%}), which is in line with the declining trend of C. trachomatis–associated reproductive problems in the population. This results most likely from the successful C. trachomatis screening programs, which have led to the effective treatment of chlamydial infections before they ascend to the upper genital tract. The risk of reproductive problems is, however, significantly higher after recurrent chlamydial infection, and preventive strategies should be planned to recognize the core group at the highest risk for recurrent infection.",
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Chlamydia trachomatis and reproductive health. / Rantsi, Tiina.

Helsinki : [T. Rantsi], 2018. 85 p.

Research output: ThesisDoctoral ThesisCollection of Articles

TY - THES

T1 - Chlamydia trachomatis and reproductive health

AU - Rantsi, Tiina

N1 - M1 - 85 s. + liitteet

PY - 2018

Y1 - 2018

N2 - Chlamydia trachomatis infection is the most common bacterial sexually transmitted infection (STI) worldwide. It has been linked to severe reproductive morbidity, including tubal factor infertility (TFI), ectopic pregnancy (EP), miscarriage and preterm delivery (PTD), but the evidence has mostly been based on clinical case-control studies, and the data retrieved from population-based studies have been limited. The aim of this thesis was to study the role of C. trachomatis infection in adverse pregnancy outcomes and subfertility. To evaluate the link between C. trachomatis infection and EP, miscarriage and PTD, we performed a population-based, biobank health registry study. We used national health registries to identify the cases with adverse pregnancy outcomes (n=2950). The cases were linked to the Finnish Maternity Cohort serum bank to obtain samples for serological analysis. C. trachomatis major outer membrane protein (MOMP)–specific IgG antibodies were determined from the serum samples. Our results confirmed the association between C. trachomatis infection and EP, alhough C. trachomatis seroprevalence was lower than expected. The seroprevalence rate and the link between antichlamydial antibodies and EP were strongest among women over 35 years of age. We did not find a serological link between C. trachomatis infection and miscarriage or PTD. Cell-mediated immune response is crucial in the resolution of C. trachomatis infection, but it may play an important role in the pathogenesis of Fallopian tube damage. The link between serum C. trachomatis IgG antibodies and TFI has been well established, and chlamydia antibody testing (CAT) has been introduced as a screening test for TFI in the initial infertility workup to select high-risk patients for further tubal evaluation. We studied the role of C. trachomatis infection in subfertility by measuring C. trachomatis–specific immune responses in a cohort of subfertile women (n=258). Cell-mediated immune response was analyzed from peripheral blood samples by an in vitro lymphocyte proliferation test using C. trachomatis elementary body (EB) and recombinant chlamydial 60 kDA heat shock protein (cHSP60) as lymphocyte-stimulating antigens. Serum C. trachomatis–specific IgG antibody responses were studied using C. trachomatis MOMP, cHSP60, and C. trachomatis TroA and HtrA as antigens. Our aim was to develop a specific and sensitive non-invasive test for TFI prediction in subfertile women to simplify infertility workup. According to our results, the accuracy of C. trachomatis serology in evaluating TFI can be improved by combining serum C. trachomatis MOMP and cHSP60 IgG antibody tests or combining markers of C. trachomatis–specific cell-mediated and humoral immune responses. C. trachomatis may impair fertility by mechanisms other than occluding the Fallopian tubes, such as causing functional tubal damage or inflammation in the endometrium. We studied the role of C. trachomatis infection in unexplained infertility by analyzing C. trachomatis–specific immune responses in women with no specific etiology for subfertility. Neither humoral nor cell-mediated immune response to C. trachomatis were associated with unexplained infertility. The presence of serum antichlamydial IgG antibodies was linked to a prolonged time for spontaneous pregnancy, but pregnancy outcomes, including live birth rate, did not differ between seropositive and seronegative women. The highest prevalence of C. trachomatis infection is seen in young, sexually active women aged 20–25 years. Studies estimating the risk of long-term sequelae following C. trachomatis infection are important, because women diagnosed with chlamydial infection are usually worried and need counseling for their future fertility. Our study, together with other population-based data, suggests that the long-term risks following chlamydial infection are lower than previously thought. Since the development of TFI is multifactorial, C. trachomatis immune markers in TFI prediction are only of modest value. TFI prevalence was low in our study (8.5%), which is in line with the declining trend of C. trachomatis–associated reproductive problems in the population. This results most likely from the successful C. trachomatis screening programs, which have led to the effective treatment of chlamydial infections before they ascend to the upper genital tract. The risk of reproductive problems is, however, significantly higher after recurrent chlamydial infection, and preventive strategies should be planned to recognize the core group at the highest risk for recurrent infection.

AB - Chlamydia trachomatis infection is the most common bacterial sexually transmitted infection (STI) worldwide. It has been linked to severe reproductive morbidity, including tubal factor infertility (TFI), ectopic pregnancy (EP), miscarriage and preterm delivery (PTD), but the evidence has mostly been based on clinical case-control studies, and the data retrieved from population-based studies have been limited. The aim of this thesis was to study the role of C. trachomatis infection in adverse pregnancy outcomes and subfertility. To evaluate the link between C. trachomatis infection and EP, miscarriage and PTD, we performed a population-based, biobank health registry study. We used national health registries to identify the cases with adverse pregnancy outcomes (n=2950). The cases were linked to the Finnish Maternity Cohort serum bank to obtain samples for serological analysis. C. trachomatis major outer membrane protein (MOMP)–specific IgG antibodies were determined from the serum samples. Our results confirmed the association between C. trachomatis infection and EP, alhough C. trachomatis seroprevalence was lower than expected. The seroprevalence rate and the link between antichlamydial antibodies and EP were strongest among women over 35 years of age. We did not find a serological link between C. trachomatis infection and miscarriage or PTD. Cell-mediated immune response is crucial in the resolution of C. trachomatis infection, but it may play an important role in the pathogenesis of Fallopian tube damage. The link between serum C. trachomatis IgG antibodies and TFI has been well established, and chlamydia antibody testing (CAT) has been introduced as a screening test for TFI in the initial infertility workup to select high-risk patients for further tubal evaluation. We studied the role of C. trachomatis infection in subfertility by measuring C. trachomatis–specific immune responses in a cohort of subfertile women (n=258). Cell-mediated immune response was analyzed from peripheral blood samples by an in vitro lymphocyte proliferation test using C. trachomatis elementary body (EB) and recombinant chlamydial 60 kDA heat shock protein (cHSP60) as lymphocyte-stimulating antigens. Serum C. trachomatis–specific IgG antibody responses were studied using C. trachomatis MOMP, cHSP60, and C. trachomatis TroA and HtrA as antigens. Our aim was to develop a specific and sensitive non-invasive test for TFI prediction in subfertile women to simplify infertility workup. According to our results, the accuracy of C. trachomatis serology in evaluating TFI can be improved by combining serum C. trachomatis MOMP and cHSP60 IgG antibody tests or combining markers of C. trachomatis–specific cell-mediated and humoral immune responses. C. trachomatis may impair fertility by mechanisms other than occluding the Fallopian tubes, such as causing functional tubal damage or inflammation in the endometrium. We studied the role of C. trachomatis infection in unexplained infertility by analyzing C. trachomatis–specific immune responses in women with no specific etiology for subfertility. Neither humoral nor cell-mediated immune response to C. trachomatis were associated with unexplained infertility. The presence of serum antichlamydial IgG antibodies was linked to a prolonged time for spontaneous pregnancy, but pregnancy outcomes, including live birth rate, did not differ between seropositive and seronegative women. The highest prevalence of C. trachomatis infection is seen in young, sexually active women aged 20–25 years. Studies estimating the risk of long-term sequelae following C. trachomatis infection are important, because women diagnosed with chlamydial infection are usually worried and need counseling for their future fertility. Our study, together with other population-based data, suggests that the long-term risks following chlamydial infection are lower than previously thought. Since the development of TFI is multifactorial, C. trachomatis immune markers in TFI prediction are only of modest value. TFI prevalence was low in our study (8.5%), which is in line with the declining trend of C. trachomatis–associated reproductive problems in the population. This results most likely from the successful C. trachomatis screening programs, which have led to the effective treatment of chlamydial infections before they ascend to the upper genital tract. The risk of reproductive problems is, however, significantly higher after recurrent chlamydial infection, and preventive strategies should be planned to recognize the core group at the highest risk for recurrent infection.

KW - Chlamydia trachomatis

KW - Chlamydia Infections

KW - +complications

KW - +immunology

KW - Reproductive Health

KW - Pregnancy, Ectopic

KW - Abortion, Spontaneous

KW - Premature Birth

KW - Bacterial Outer Membrane Proteins

KW - Immunoglobulin G

KW - Infertility

KW - Female

KW - Immunity, Cellular

KW - Immunity, Humoral

KW - Biomarkers

KW - Pregnancy Outcome

KW - Reproductive Techniques, Assisted

KW - Fallopian Tubes

KW - +pathology

KW - +physiopathology

KW - Pelvic Inflammatory Disease

KW - 3123 Gynaecology and paediatrics

M3 - Doctoral Thesis

SN - 978-951-51-4787-5

PB - [T. Rantsi]

CY - Helsinki

ER -

Rantsi T. Chlamydia trachomatis and reproductive health. Helsinki: [T. Rantsi], 2018. 85 p.