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Diagnostika
Chlamydia trachomatis
Updatedn
Infertility due to
Chlamydia trachomatis infections
New discoveries, diagnostics
and therapy
Gesellschaft für klinische Spezialpräparate mbH · GE-Diagnostika · Theaterstraße 6 · D-22880 Wedel Phone ++49 / 4103 / 8006-0 · Fax ++49 / 4103 / 8006-359 · www.medac.de Childlessness
Every 7. marriage is nowadays affected by involuntary infertility.
Its causes may be found in the man as well as in the woman.
Disorders of fertility
Disorders of fertility are frequently acquired during the course of life.
Acquired infertility (sterility) has various causes:
Hormonal disorders in the woman and/or the man, with the result that
the egg cell (ovum) and the sperm cell (spermatozoon) are incapable of
fertilization.
Mechanical abnormalities in the woman and/or the man, with the result
that egg cell and sperm cell cannot unite.
Infection with Chlamydia trachomatis
Mechanical abnormalities arise in consequence of infections of the
genital tract. In this connection Chlamydia trachomatis, a very small
bacterium, plays an important
Transmission of the pathogen
Chlamydia trachomatis is transmitted during sexual intercourse.
Chlamydia trachomatis is one of the commonest sexually transmitted
pathogens.
Spread of infection
Chlamydia trachomatis initially penetrates into the mucosal cells of the
womb (cervix) where it multiplies.
Only in exceptionel cases, the intrinsic defences of the body are capable
of destroying this pathogen.
Furthermore, as the infection is seldom accompanied by any signs or
symptoms, it remains unrecognized and becomes chronic.
Under these conditions the pathogens spread upwards into the upper
reaches of the genital tract (Fig. 1). They pass through the womb (uterus)
and ultimately arrive in the fallopian tubes (tubes).
Fig. 1: The pathway taken by the egg cell and sperm cells in the genital tract
Healthy genital
Diseased genital
The fallopian tube has beenblocked:Spermatozoa can no longerreach the ovum.
Fertilization is prevented.
Chlamydia trachomatis
climbs upwards through thewomb (uterus) as far as thefallopian tube. Here it causesrepeated episodes of inflam-mation and scarring of themucous membrane, and theseprogressively narrow thefallopian tube.
with the spermatozoa,
Chlamydia trachomatis
finds its way into the genital
Consequences of infection
On their way into the fallopian tube the bacteria multiply.
Inflammatory reactions begin and spread.
The surface of the mucous membrane (epithelium) becomes diseased The mucous membrane lining the fallopian tube is at special risk. As a result of repeated episodes of inflammation, the mucous membraneundergoes scarring and can no longer perform its natural function.
Ultimately, the fallopian tubes will become blocked (occluded) and become impassable for egg cell and sperm cells.
The natural process of fertilization of the egg cell in the fallopian tube is Further clinical pictures
Sexually transmitted Chlamydia trachomatis infection may have other
consequences besides causing inflammation of the fallopian tubes.
There are various possible clinical pictures, some of them sex-specific.
They include infections of the urinary and genital tracts (urogenital
infections), and smear infections transferred from the genitals to the eye
(oculogenital infections).
Inflammation of the womb
Inflammation of the prostate gland
Inflammation of the mucosa lining the womb
Inflammation of the epididymis
Inflammation of the ovaries and the fallopian
tube (adnexitis)
Infertility
Abdominal pregnancy (ectopic pregnancy)
Miscarriage (abortion)
Premature births
Inflammation of the covering of the liver
(perihepatitis)
Inflammation of the covering of the spleen
(perisplenitis)
Inflammation of the tissue sourrounding
the appendix (periappendicitis)
Inflammation of the lining of the abdominal
cavity (peritonitis)
Inflammation of the urethra (urethritis)
Inflammation of the joints (reactive arthritis)
Inflammation of the rectum (proctitis)
Inflammation of the white of the eye (conjunctivitis)
Special case in newborn infants: Conjunctivitis and inflammation of the lung.
The newborn acquires the infection from the contaminated birth canal during delivery.
Prevalence of Chlamydia trachomatis
infections
In nearly 90% of all women who have diseased fallopian tubes previous infections with Chlamydia trachomatis are responsible.
In Germany an estimated 1.15 million women are infected with
Chlamydia trachomatis. New infections occur in about 300.000
women anually. The incidence of infection is closely dependent on age.
Most of these infections are acquired by men and women when they
begin sexual activity between the ages of 15 and 25 years (Fig. 2).
Fig. 2: Chlamydia trachomatis frequency (prevalence) in women and men in
Prevalence of Chlamydia trachomatis (%)
Ascertainment of the infection (diagnosis)
Pathogen/antigen detection (direct detection)
Chlamydia trachomatis can be detected directly from smears taken
from the neck of the womb (cervical smears).
The sensitivity of the method employed will determine whether every
infection is detected.
Methods that lack adequate sensitivity may fail to detect some
chlamydial infections (false negative results).
Molecular biological techniques such as PCR (Polymerase Chain
Reaction) offer the highest degree of sensitivity. In contrast, rapid tests
suffer from too low sensitivity.
Warning:
Pathogens which have already climbed up into the fallopian tubes,
residing here for years and causing persisting abnormal reactions, can
no longer, or only in exceptional cases, be detected by direct testing of
cervical smears. The same is true of males: in cases of ascending
infection Chlamydia trachomatis can seldom be found in urethral
smears or in the urine.
In cases of this kind false negative results in employing antigen
detection methods must be expected.
Test for antibodies (indirect detection)
Chlamydia trachomatis
The body attempts to defend itself against the pathogens which have
gained entry, and it does this by producing defence substances
(antibodies
As explained earlier, only in exceptional cases do the defensive powers of the body suffice to combat Chlamydia
trachomatis successfully. Various antibodies are formed (IgG, IgA,
IgM) which indicate what phase of disease has reached in men and
women. These antibodies can be determined and from the results the
doctor can decide whether treatment is necessary and, if so, for how
long it should continue.
Diagnosis must also include the partner. If tests for Chlamydia
trachomatis are positive, both partners must undergo treatment
(therapy). Otherwise, renewed infection by the so-called "ping-pong"
effect cannot be excluded. Even after recovery from an infection the
body does not retain any lasting protection against the pathogen and
can be reinfected with Chlamydia trachomatis.
Chlamydial Heat Shock Protein
Heat shock proteins (HSP) are proteins that occur in the cells of all
organisms. They serve to protect the cell and maintain its metabolism.
The formation of HSP is markedly increased in response to physical and
chemical stress stimuli. The entry of Chlamydia into the human host
produces stress situations: a hostile environment results for the
pathogen because the host initiates an immune response to the foreign
organisms. Principally, antibodies are formed to chlamydial HSP
(cHSP). Due to the immune response in the host, the effect of protracted
(persistent) and/or renewed chlamydial infections may be to destroy
tissue. In this process the function of the tiny hair filaments (kinocilia)
may be adversely affected initially. Kinocilia are located on the surface
of the tissue (epithelium) lining the fallopian tubes and their motility
helps to transport the ovum towards the uterus. In advanced-stage
damage the fallopian tubes may even adhere, potentially causing them
to be totally blocked. Infertility due to total fallopian tube blockage or
functional loss (tubal factor infertility, TFI) is one of the late sequelae of
undiagnosed chronic Chlamydia trachomatis infections of the upper
genital tract. The determination of antibodies against cHSP (and
against Chlamydia trachomatis) has a high predictive value for this
event.
Recommendation for diagnosis
Highly specific and sensitive assay methods in Chlamydia trachomatis
serology permit precise diagnosis. Laboratory results can be assessed
as follows:
Laboratory result
C. trachomatis-
Interpretation
ELISA medac
Active Chlamydia trachomatis infection, *C. trachomatis IgA antibodies in seminal plasma are indicative of a local event.
Current therapeutics
The antibacterials mainly used for treatment of chlamydia infections aretetracyclines and macrolides. Quinolones are also employed.
Category
Antibacterial agent
Azithromycin, clarithromycin, erythromycin, The duration of treatment will depend on the severity of the infectionand on the course of disease.
medac GmbH, Diagnostic Division, Theaterstrasse 6, D-22880 Wedel, Germany Gesellschaft für klinische Spezialpräparate mbH · GE-Diagnostika · Theaterstraße 6 · D-22880 Wedel Phone ++49 / 4103 / 8006-0 · Fax ++49 / 4103 / 8006-359 · www.medac.de

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