Burden of Chlamydia trachomatis infection amongst infertile women compared with pregnant controls in North-central Nigeria

George I. Ogbu, Stephen A. Anzaku, Chris Aimakhu


Background: Female infertility due to tubal damage resulting from pelvic infections including Chlamydia trachomatis is common among women in our environment. The study aimed at determining the prevalence of Chlamydia trachomatis antibody amongst infertile women and to assess the relationship between exposure to Chlamydia trachomatis infection and tubal infertility in Garki Hospital, Abuja, Nigeria.

Methods: This was a case control study among 76 infertile patients with tubal occlusion diagnosed with hysterosalpingography and confirmed by laparoscopy compared with 81 pregnant women recruited from the antenatal clinic. Both cases and control were investigated with a study protocol which solicited information on socio-demographic variables, sexual and reproductive risk factors and history of previous pelvic infection. Each subject and control had 5 ml of blood collected for serological assay for Chlamydial antibody titre using the immunocomb Chlamydia trachomatis 1gG kit. The data was analyzed using the SPSS version 20 (IBM, Armonk, NY, USA). A p-value of < 0.05 was considered statistically significant.

Results: The prevalence of serum Chlamydial antibody was 57 (75.0%) and 19 (23.5%) among the cases and the pregnant controls respectively (P-value < 0.001). The results showed statistically significant associations between tubal infertility and early age at sexual debut, three or more sexual partners, nulliparity and positive Chlamydia trachomatis antibody titre (P-values < 0.001).

Conclusions: The prevalence of Chlamydia trachomatis antibody titre was higher among women with infertility compared to the pregnant controls. The findings suggest that tubal infertility is associated with exposure to Chlamydial trachomatis infection.


Chlamydia trachomatis, Infection, Nigeria, Tubal infertility

Full Text:



Essig A. Chlamydia and Chlamydia philia. In: Murray PR, Baron EJ, Jorgensen JH, Landry ML, Pfaller MA, Eds. Manual of clinical microbiology, 9th Ed. Washinton DC: ASM press. 2007.

Caray AJ, Beagley KW. Chlamydia Trachomatis, a hidden epidermic: effects on female reproductive tract infection and option for treatment. Am J Reprod Immunol. 2010;63(6):576-86.

Siemer J, Theile O, Larbi Y, Fasching PA, Danso KA, Kreienberg R, et al. Chlamydia Trachomatis infection as a risk factor for infertility among women in Ghana, west Africa. Am J Trop Med Hyg. 2008;78(2):323-7.

Watson EJ, Templeton A, Russell I, Paavonen J, Mardh PA, Stary A, et al. The accuracy and efficacy of screening tests for Chlamydia Trachomatis: a systematic review. J Med Microbial. 2002;51:1021-31.

Maclean AB. Pelvic infections. In: Edmonds DK, eds. Dewhurst’s text book of Obstetrics and Gynaecology for postgraduate, 7th Ed. Blackwell Science. 2007;414-420.

Ostergard L. Microbiological aspects of the diagnosis of Chlamydia Trachomatis. Best practice and Research. Clin Obstetr Gynaecol. 2002;16(6):789-99.

Debattista J, Tirmms P, Alten J. Immuno pathogenesis of Chlamydia Trachomatis in women. Fertil Steril. 2003;79(60):1273-87.

Land JA, Evers LHJ. Chlamydial infections and subfertility. Best Practice Res Clin Obstetr Gynaecol. 2002;16(6):901-12.

Kelly KA. Cellular immunity and Chlamydia genital infection; induction, recruitment and effects or mechanism. Int Rev Immunol. 2003;22(1):3-41.

Sharma K, Aggarwal A, Arora U. Sero prevalence of Chlamydia Trachomatis in women with bad obstetrics history and infertility. Indian J Med Sci. 2002;56(5):216-7.

Jones CS, Maple PAC, Andrews NJ, Paul ID, Caul EO. Measurement of 1gG antibodies to Chlamydia Trachomatis by commercial enzyme immuno assays and immunofluorescence in sera from pregnant women and patients with infertility, pelvic inflammatory disease, ectopic pregnancy and laboratory diagnosed psittaci and c pneumonia infection. J Clin Pathol. 2003;56:225-9.

Norman J. Epidemiology of female genital Chlamydia Trachomatis infection. Best Practice Res Clin Obstetr Gynaecol. 2002;16(6):775-87.

Fenton KA, Korovessis C, Johnson AM, McCadden A, McManus S, Wellings K, et al. Sexual behavior in Britain: reported sexually transmitted infections and prevalence of genital Chlamydia Trachomatis infections. Lancet. 2001;358;1851-4.

Peipert JF. Clinical practice. Genital chlamydia infections. N Engl J Med. 2003;349:2424-30.

Den Harloq JE, Morre SA, Land JA. Chlamydia Trachomatis associated tubal factor subfertility: immunogenetic aspects and serological screening. Hum Reprod Update. 2006;12(6):719-30.

World Health organization (2002). Global prevalence and incidence of selected curable sexually transmitted infections. Available at http:/ Global Report, 2001.

denHartog JE, Land JA, Stassen FR, Kessels AG, Bruggeman CA. Serological markers of persistent Chlamydia Trachomatis infections in women with tubal factor subfertility. Hum Reprod. 2005;20:986-90.

Shibahara H, Takamizawa S, Hirano Y, Ayustawati Takei Y, Fujiwara H, Tamada S, et al. Relationship between Chlamydia Trachomatis antibody titers and tubal pathology assessed using transvaginal hydro laparoscopy in infertile women. Am J Reprodimmunol. 2003;50:7-12.

Jeremiah I, Okike O, Akani C. The prevalence of serum immunoglobin G antibody to Chlamydia Trachomatis in sub fertile women presenting at the university of port Harcourt teaching hospital, Nigeria. Int J Biomed Sci. 2011;7(2):120-4.

Okonofua F. Infertility and women’s reproductive health in Africa (editorial). Afr J Reprod Health. 1999;3(1):7-9.

Snick HK, Snick TS, Evers JLA, Collins JA. The spontaneous pregnancy prognosis in untreated sub fertile couples: The Walcheren primary care study. Hum Reprod. 1997;12:1582-8.

Howkins J, Barne G. The pathology of conception. In: Padubiri VA, Shilfish ND, eds. Shaw’s textbook of Gynaecology. 2002:194-216.

Okonofua FE. Infertility in Subsaharan Africa. In: Okonofua FE, Odunsi K, Eds. Contemporary Obstetrics and Gynaecology for Developing countries, women Health and Action Research Centre. 2003:128-155.

Otubu JAM. Infertility. In: Agboola A, Ed. Textbook of Obstetrics and Gynaecology for medical students, Second edition, Heinemann Educational Books (Nigeria) plc. 2006:128-138.

Paavonen J. Pelvic Inflammatory disease. Sex transmitted Dis. 1998;16:747-55.

Westron I, Mardh PA. Acute pelvic inflammatory disease. In: Holmes KK, Mardh PA, Sparkling PF, Wiesner PJ, eds. Sexually transmitted disease. New York: Mc Graw- Hill. 1990:593-615.

Wolner-hanses P, Kiriate NB, Holmes KK. A typical pelvic inflammatory disease: Sub acute, chronic or sub clinical upper genital tract infection in women. In: Holmes KK, Mardh PA, Sparkling PF, Wiesner PJ, eds. Sexually transmitted disease New York: mc Graw Hill. 1990:615-621.

Moore DE, Cate W. Sexually transmitted disease and infertility. In: Holmes KK, Mardh PA, Sparkling PF, Wiesner PJ, eds. Sexually Transmitted disease. New York: mc Graw-Hill. 1990:763-771.

Hughes HD, Schlaff WD, Smith DC, Alvers RS. The use of Chlamydia Trachomatis 1gG Titers versus patients’ history in directing clinical care. Fertil Steril. 2002;73(1):198.

Logan S, Gazvani R, McKenzie H, Templeton A, Bhattacharya S. Can history, ultrasound scan and Eliza Chlamydia Antibodies Alone or in combination predict Tubal factor infertility in Sub fertile women? Hum Reprod. 2003;18:2300-56.

US Preventive Services task force. Screening for Chlamydia infection: Recommendations and rationale. Am J Prev Med. 2001;20:90-4.

Malik A, Jain S, Hakim S, Shukla I, Rizvi M. Chlamydia Trachomatis and infertility. Indian J Med Res. 2006;23:770-5.

Ben WJ, John AC, Fuko VDV, Patrick MM. Cost effectiveness analysis of HSG, laparoscopy and chlamydia antibody test (CAT) is sub fertile couples. Fertil Steril. 2001;75(3):571-80.

Thomas K, Conghilin L, Mannion PT, Haddad NG. The value of Chlamydia Trachomatis antibody testing as part of routine investigations. Human Reprod. 2000;15(5):1079-52.

Mouton JW, Peeters MF, Van Ryssort-Vos JH, Verkwyen RP. Tubal factor pathology caused by Chlamydia Trachomatis: the role of serology. Int J STD AIDS. 2002;13(2):26-9.

Fawole OI, Okesola AV, Fawole AO. Genital ulcers disease among sexually transmitted clinic attendees in Ibadan, Nigeria. Afr J Med Sci. 2000;29(1):17-22.

McGregor JA. Chlamydia infection in women. In: Pastorek JG, Ed. Obstetrics and Gynaecology Clinic of North America. Saunders pub. 1989;565-592.

Scholes D, Stergachis A, Heidrich FE, Andrillia H, Holmes KK, Slamm WE. Prevention of pelvic inflammatory disease by Screening for cervical chlamydia infections. New Engl J Med. 1996;334(21):1362-6.

Azenabor AA, Eghafona NO. Association of Chlamydia Trachomatis antibody with genital contact disease in women in Benin city, Nigeria. Trop Med Int Health. 1997;2(4):389-92.

ImmunocombR Chlamydia Trachomatis 1gG, Orgenics code: 50410002 version: 410/E8 format 3X12 tests. Orgenics, New Jersey 1999.

Azenabor AA, Eghafona NO. Association of Chlamydia Trachomatis antibody with genital contact disease in women in Benin city, Nigeria. Trop Med Int Health. 1997;2(4):389-92.

Ainbinder SW, Ramin SM. Sexually transmitted Diseases and pelvic infections. In: Decherney AH, Nathan L, eds. Current Obstetrics and Gynaecology Diagnosis and Treatment, 9th ed. McGraw-Hills. 2003:716-729.

Todd Cs, Hause C, Stoner BP. Emergency department Screening for asymptomatic Sexually transmitted infections. Am J Public Health. 2001;91(3):461-4.

Buve A, Weiss HA, Laga. The epidemiology of gonorrhoea, chlamydia infection and syphilis in four African cities. AIDS. 2001;15 (4):579-88.