Background The common asymptomatic nature of Chlamydia infections and consequential PIDs plus the delayed appearance of any damaging effect thereof on the reproductive tract hamper timely interventions for individuals prone to complications. In infertile women, Chlamydia antibodies in serum relate to tubal pathology and lower conception rates. The current ‘proof of principle study’ aimed to assess whether Chlamydia antibodies are detectable in easier, non-invasive vaginal mucosa samples, and if these could predict the risk for complications.
Patients and Method We compared outcomes of Chlamydia antibody tests in serum and vaginal swabs in two groups: (a) 77 women attending a fertility clinic, of whom 25 tested positive for anti-chlamydia IgG in serum and (b) 107 women visiting an STI centre, including 30 Chlamydia PCR-positive subjects. The presence of IgG/IgA antibodies was compared (Kappa-test) and determinants investigated (regression).
Results In women in the STI clinic, active Chlamydia infections were linked to both IgG and IgA antibodies in serum (p < 0.001) and IgA in vaginal mucosa (p < 0.001), but not IgG in mucosa; mucosa-IgA correlated with IgG in serum (p = 0.001). In women in the fertility clinic, IgG in vaginal mucosal material had a stronger correlation with IgG in serum (p = 0.02) than IgA in mucosa (p = 0.06). Women with tubal pathology or Chlamydia history more commonly had IgG in serum and IgA in vaginal mucosa (both p < 0.001), whereas this link was weaker for mucosa-IgG (p = 0.03); for tubal pathology alone mucosa-IgA had a higher Kappa than serum-IgG (0.41 versus 0.36).
Discussion Chlamydia IgG/IgA are detectable in vaginal mucosal material. IgG antibodies in serum had stronger associations with current or past Chlamydia infections. However, IgA antibodies in vaginal mucosa also showed associations with (past) infection and complications. IgA presence in vaginal mucosa might indicate an on-going hidden Chlamydia infection in the upper genital tract, and warrants further epidemiological studies.
- Chlamydia trachomatis
- immunological markers
- vaginal mucosa
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