Sir,
Chlamydial infections run as an insidious and chronic course, thereby causing irreversible tissue damage in unidentified and untreated cases. Being asymptomatic, these infections have severe ramifications for the reproductive health of women leading to the long-term complications like infertility. Screening women for Chlamydia trachomatis are highly desirable in developing countries.[1,2]
The serum samples of 111 infertile women patients of reproductive age group seeking help in the In vitro fertility center of our multi-super specialty center were subjected to enzyme linked immunosorbent assay (ELISA) (Calbiotech, Inc.)[3] for detection of immunoglobulin G (IgG) antibody. The sensitivity of the test was 93.8% and specificity was 92.2%. All assays and calculations were performed according to the manufacturer's instructions.
The aim of this study was to highlight the importance of serological, noninvasive diagnostic tool as well as to rule out Chlamydia as one of the causes of infertility. Of the 111 serum samples considered for the study, five (4.5%) samples were found to be positive and seven (6.3%) samples were borderline positive by ELISA IgG antibody detection test. On retesting after 1-month, out of five positive samples, four samples showed a 4-fold rise in titer, whereas one sample showed a reduction in titer giving a borderline positive result. This may be because the patient would have been in the peak of infection during the initial testing and the IgG titer would have reduced during the second testing. Out of the seven borderline positive samples, five samples showed a rise in antibody titer while two samples showed negative results. This indicated that these two samples had produced false positive results during the initial testing. The overall sero-positivity detected after paired sera analysis was 9.0%, almost similar to other studies.[4,5]
IgG antibody detection is an effective and noninvasive tool for detection of Chlamydia and a more viable option than other techniques in India. Our results were found to be consistent with the studies made by Moaiedmohseni (5% of all patients and 10% of infertile women), Dwibedi et al (7%) and Demetra et al (ranging from 3-9%).[2,4,5]
Serological tests are useful in identifying chlamydial etiology in ascending upper genital tract infections where direct and specific tests fail to identify the organism. Noninvasive serological testing reduces the risk of introducing infections to the upper genital tract, thereby avoiding instrumentations such as hysterosalpingography and laparoscopy. Paired sera analysis is useful in confirming the positive results and avoiding false positive results.
Therefore, to conclude, IgG antibody detection is an effective and noninvasive tool for the detection of Chlamydia and a more viable option than any other techniques in India. C. trachomatis should be preferred as a routine baseline investigation in infertility clinics.[4] Screening of infertile women for C. trachomatis is recommended for early therapeutic options.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
The authors would like to thank the Chairperson and Dean of the institute for providing laboratory facilities and a healthy working atmosphere during the study period. The authors are also thankful to the technical staff of the institute for providing the necessary helping hand during the endeavor.
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