European Journal of Epidemiology

, Volume 8, Issue 5, pp 645–649 | Cite as

Chlamidial genital infections and laparoscopic findings in infertile women

  • A. Lucisano
  • G. Morandotti
  • R. Marana
  • F. Leone
  • G. Branca
  • S. Dell'Acqua
  • A. Sanna


Several studies have shown that previous chlamydial genital infection, reflected by serological markers, is strongly associated with tubal damage leading to tubal infertility. In 105 women undergoing laparoscopy, multiple samples were collected from the lower (urethra and cervix) and upper (endometrium, peritoneal fluid, tubal lumen) genital tract, in order to isolateChlamydia trachomatis in cell culture.

Chlamydia trachomatis was isolated from at least one site in 13 (30.9%) of 42 infertile women with tubal infertility, in 5 (12.1%) of 41 women with unexplained infertility, in 1 of 4 women affected by acute salpingitis and in 1 (5.5%) of 18 women with endometriosis or uterine malformations. The latter group was the control group. Thirteen (65%) of the 20 positive women harbouredChlamydia trachomatis in their upper genital tract alone and 16 women were positive in one or both tubes. Only one of the positive women showed laparoscopic signs of acute pelvic infection. Four of the 5 positive women with unexplained infertility harbouredChlamydia trachomatis in the tubal lumen. This study confirms that chlamydial infection is strongly associated with tuba] damage. It suggests that cervical cultures are inadequate for excluding a tubal infection and that chlamydial colonization of the tubal mucosa is possible in the absence of symptoms and laparoscopic signs of active infection.

Key words

Chlamydia trachomatis Genital infection Infertility 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Centers for Disease Control (1985):Chlamydia trachomatis infections: policy guidelines for prevention and control - M.M.W.R.34 (suppl.): 53S–74S.Google Scholar
  2. 2.
    Conway D., Caul E.0., Hull M.G.R., Glazener C.M.A., et al. (1984): Chlamydial serology in fertile and infertile women - Lancet :191–193.Google Scholar
  3. 3.
    Embil J.A.,Thiebaux H.S.,Manuel F.R.,Pereira L.H.,et al. (1983): Sequential cervical specimens and the isolation ofChlamydia trachomatis: factors affecting detection - Sex. Trans. Dis.10,2: 62–67.Google Scholar
  4. 4.
    Fish A.N.J.,Fairweather D.V.I.,Oriel J.D. andRidgway G.L. (1989):Chlamydia trachomatis infection in a gynaecology clinic population: identification of high-risk groups andthe value of contact tracing - Eur. J. Obstet. Gynecol. and Reprod. Biol.31: 67–74.Google Scholar
  5. 5.
    Henry-Suchet J. (1984): Consequences des maladies sexuelles transmissibles chez les femmes: les salpingites - Rev. Fr. Gynecol. Obstet.79,10: 625–630.Google Scholar
  6. 6.
    Henry-Suchet J.,Utzmann C.,Debrux J.,Ardoin P. andCatalan F. (1987): Microbiologic study of chronic inflammation associated with tubal factor infertility: role ofChlamydia trachomatis - Fertil. Steril.47: 274–277.Google Scholar
  7. 7.
    Jones R.B.,Ardery B.R.,Hui S.L. andCleary R.E. (1982): Correlation between serum antichlamydial antibodies and tubal factor as a cause of infertility -Fertil. Steril.38: 553–558.Google Scholar
  8. 8.
    KaneJ.L.,Woodland R.M.,Forsey T.,Darougar S. andElder M.G. (1984): Evidence of chlamydial infection in infertile women with and without fallopian tube obstruction - Fertil. Steril.42: 843–848.Google Scholar
  9. 9.
    Marana R.,Lucisano A.,Leone F.,Sanna A.,Dell'Acqua S. andMancuso S. (1990): High prevalence of silentChlamydia trachomatis colonization of the tubal mucosa in infertile women - Fertil. Steril.53: 354–356.Google Scholar
  10. 10.
    Mardh P.A.,Ripa T.,Svensson L. andWestrom L. (1977):Chlamydia trachomatis infection in patients with acute salpingitis - New Eng. J. Med.24: 1377–1379.Google Scholar
  11. 11.
    McCormack W.M. andMardh P. (1982): Symposium on human chlamydial infection - Sex. Transmitt. Dis.9: 217–221.Google Scholar
  12. 12.
    Oriel J.D., (1983): Epidemiology of genital chlamydial infection - Infect.10suppl.: S719–5746.Google Scholar
  13. 13.
    Osser S. andPersson K. (1984): Postabortal pelvic infection associated withChlamydia trachomatis and the influence of humoral immunity - Am. J. Obstet. Gynecol.150: 699–703.Google Scholar
  14. 14.
    Osser S.,Persson K. andLeidholm P. (1989): Tubal infertility and silent chlamydial salpingitis - Human. Reprod.4,3: 280–284.Google Scholar
  15. 15.
    Patton D.L.,Wolner-Hanssen P.W.,Cosgrove S.J. andHolmes K.K. (1990): The effects ofChlamydia trachomatis on the female reproductive tract of the Macaca nemestrina after a single tubal challenge following repeated cervical inoculation - Obst. Gynecol.76,4: 643–650.Google Scholar
  16. 16.
    Punnonen R.,Terho P.,Nikkanen Y. andMeurman O. (1979): Chlamydia serology in infertile women by immunofluorescence - Fertil. Steril.31: 656–659.Google Scholar
  17. 17.
    Ripa K.T.,Moller B.R.,Mardh P.A.,Freundt E.A.,et al. (1979): Experimental acute salpingitis in grivet monkeys provoked byChlamydia trachomatis - Acta Pathol. Microbiol. Scand.87: 65–70.Google Scholar
  18. 18.
    Sarov I.,Lunenfeld E.,Sarov B.,Hanuka N.,et al. (1988): Chlamydia-specific IgG and IgA in women with obstructive infertility as determined by immunoblotting and immunoperoxidase assays -Eur. J. Epidem.4,2: 216–223.Google Scholar
  19. 19.
    Schachter J. andGrossman M. (1981): Chlamydiae infections - An. Rev. Med.32: 54–58.Google Scholar
  20. 20.
    Svensson L.,Westrom L.,Ripa K.T. andMardh P.A. (1980): Differences in some clinical and laboratory parameters in acute salpingitis related to culture and serologic findings - Am. J. Obstet. Gynecol.138: 1017–1021.Google Scholar
  21. 21.
    Tjiam K.H.,Zeilmaker G.H.,Alberda A.T.,vanHeist B.Y.,et al. (1985): Prevalence of antibodies toChlamydia trachomatis, Neisseria gonorrhoeae andMycoplasma hominis in infertile women - Genitourin. Med.61: 175–178.Google Scholar
  22. 22.
    Walters M.D.,Eddy C.A.,Gibbs R.S.,Schachter J.,et al. (1988): Antibodies toChlamydia trachomatis and risk for tubal pregnancy - Am. J. Obstet. Gynecol.159: 942–946.Google Scholar
  23. 23.
    Westrom L. andMardh P.A. (1983): Chlamydial salpingitis - Brit.:Med. Bull.39: 145–150.Google Scholar
  24. 24.
    Wolner-Hanssen P.,Mardh P.A.,Svensson L. andWestrom L. (1983): Laparoscopy in women with chlamydial infection and pelvic pain: comparison of patients with and without salpingitis - Obst. Gynecol.61,3: 299–303.Google Scholar
  25. 25.
    Zana J.,Thomasd,Muffat-Joly M.,de Brux J.,et al. (1990): An experimental model for salpingitis due toChlamydia trachomatis and residual tubal infertility in the mouse - Hum. Reprod.5,3: 274–278.Google Scholar

Copyright information

© Gustav Fischer 1992

Authors and Affiliations

  • A. Lucisano
  • G. Morandotti
    • 1
  • R. Marana
  • F. Leone
    • 1
  • G. Branca
    • 1
  • S. Dell'Acqua
  • A. Sanna
    • 1
  1. 1.Institute of MicrobiologyUniversità Cattolica del Sacro CuoreRomeItaly

Personalised recommendations