The role of Chlamydia trachomatis and Neisseria gonorrhoeae in the aetiology of ectopic pregnancy in Gabon

Abstract

Objective: To study the association between ectopic pregnancy and Chlamydia trachomatis and Neisseria gonorrhoeae.

Design: A prospective observational study with two comparison groups.

Setting: A general hospital in Franceville, Gabon.

Subjects: Forty-five women with ectopic pregnancies and two comparison groups each of 45 women, one at 5 to 12 and the other at 32 to 41 weeks gestation.

Main outcome measures: Serum levels of IgG and IgA antibodies to C. trachomatis (L1 and rMOMP) and N. gonorrhoeae (pili) in all the women. In the women with ectopic pregnancy peritoneal adhesions were scored and in 40 women samples of tube were cultured for organisms being studied.

Results: IgG and IgA antibodies to C. trachomatis (L1) were detected in 84% of the ectopic group and 53 and 39% of the comparison groups (P less than 0.0001). IgG and IgA antibodies to N. gonorrhoeae occurred in 49, 28 and 18% and 49, 28 and 26% of the groups but the differences were not statistically significant. Adhesions were positively associated with the antibodies. C. trachomatis was cultured from the tubes of 71% of the women with ectopic pregnancy.

Conclusions: Infection with chlamydia, and probably with N. gonorrhoeae, is an important factor in the causation of ectopic pregnancy in Gabon.

PIP: A general hospital in Franceville, Gabon was the site for this prospective, observational study with 2 comparison groups which studied the association between ectopic pregnancy and Chlamydia trachomatous and Neisseria gonorrhoea. 45 women with ectopic pregnancies and 2 comparison groups, each with 45 women, were part of the study, 1 group from 5-12 weeks and the other at 32-41 weeks gestation. Serum levels of IgG and IgA antibodies to C. trachomatous (L1 and rMOMP) and gonorrhoea (pili) in all of the women were measured. In women with ectopic pregnancy, peritoneal adhesions were scored and in 40 women, samples of tube were cultured for organisms under study. IgG and IgA antibodies to C. trachomatous (L1) were detected in 84% of the ectopic group and 53% and 39% of the comparison groups (p0.001). IgG and IgA antibodies to N. gonorrhoea occurred in 49, 28, and 18%, and 49, 28, and 26% for the groups but the differences were not statistically significant. Adhesions were positively associated with the antibodies. C. trachomatous was cultured from the tubes of 71% of the women with ectopic pregnancies. It was concluded that infection with chlamydia, and probably with N. gonorrhoea, is an important factor in the causation of ectopic pregnancy in Gabon.