Urogenital Chlamydia trachomatis in Gabon: an unrecognised epidemic

Abstract

Samples from 218 men with urethritis, 517 women with pelvic pain or pelvic pain and vaginal discharge, 218 women consulting for infertility, and 598 postpartal women were screened for Chlamydia trachomatis by culture and direct immunofluorescence. Chlamydiae were detected in 18% (39/218) of the men, 18% (45/252) of women with vaginal discharge, 14% (38/265) of those with pelvic pain, 10% (21/218) of infertile, and 10% (59/598) of postpartal women. A chlamydial prevalence of 18% (41) was observed in 229 postpartal women aged under 21, whereas only 5% (10) of 360 postpartal women over 21 had C trachomatis. In the other clinical groups, an age related decrease in prevalence was noted in women over 25. The direct immunofluorescence test correlated well with culture. The small difference in isolation between symptomatic and postpartal women indicates that women in this population do not seek medical attention for chlamydial infections and expose themselves to chlamydial salpingitis and infertility.

PIP: Health workers took urethral samplers from 218 men with urethritis and 1850 women to screen for Chlamydia trachomatis using culture and immunofluorescence. All the men and women presented themselves at the Hospital Provincial de Franceville in semirural Gabon. 18% of men, 18% of women with vaginal discharge, 14% of women with pelvic pain, 10% of infertile women, and 10% of postpartum women tested positive for C. trachomatis infection. Postpartum women less than 21 years old had a significantly higher chlamydial prevalence than did older postpartum women (18 vs. 5%; p .05). Chlamydial prevalence among 21-25 year old postpartum women was significantly lower than among same age women presenting with other conditions (5% vs. 15% for infertile women, 21% for women with pelvic pain, and 2% for women with vaginal discharge; p .01). Except for postpartum women, older than 25 chlamydia prevalence decreased after age 25. The sensitivity of immunofluorescence ranged from 77% for infertile women to 93% for postpartum women. Its specificity ranged from 97% for women with discharge or pelvic pain to 100% for men. Thus, the direct immunofluorescence test corresponded well with culture. The isolation rates for asymptomatic women neared those of symptomatic women, indicating that most women with C. trachomatis infections have no or very mild symptoms and do no seek medical attention. This most likely jeopardizes their fertility.