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. 2022 Aug 1;49(8):527-533.
doi: 10.1097/OLQ.0000000000001434. Epub 2021 Mar 31.

Chlamydial Pgp3 Seropositivity and Population-Attributable Fraction Among Women With Tubal Factor Infertility

Gloria E Anyalechi  1 , Jaeyoung Hong  1 , Robert D Kirkcaldy  1 , Harold C Wiesenfeld  2 , Paddy Horner  3 , Gillian S Wills  4 , Myra O McClure  4 , Karen R Hammond  5 , Catherine L Haggerty  6 , Dmitry M Kissin  7 , Edward W Hook 3rd  8 , Michael P Steinkampf  5 , Kyle Bernstein  1 , William M Geisler  8
Affiliations

Chlamydial Pgp3 Seropositivity and Population-Attributable Fraction Among Women With Tubal Factor Infertility

Gloria E Anyalechi et al. Sex Transm Dis. .

Abstract

Background: Chlamydial infection is associated with tubal factor infertility (TFI); however, assessment of prior chlamydial infection and TFI is imperfect. We previously evaluated a combination of serological assays for association with TFI. We now describe the chlamydial contribution to TFI using a newer Chlamydia trachomatis Pgp3-enhanced serological (Pgp3) assay.

Methods: In our case-control study of women 19 to 42 years old with hysterosalpingogram-diagnosed TFI (cases) and non-TFI (controls) in 2 US infertility clinics, we assessed possible associations and effect modifiers between Pgp3 seropositivity and TFI using adjusted odds ratios with 95% confidence intervals (CIs) stratified by race. We then estimated the adjusted chlamydia population-attributable fraction with 95% CI of TFI.

Results: All Black (n = 107) and 618 of 620 non-Black women had Pgp3 results. Pgp3 seropositivity was 25.9% (95% CI, 19.3%-33.8%) for non-Black cases, 15.2% (95% CI, 12.3%-18.7%) for non-Black controls, 66.0% (95% CI, 51.7%-77.8%) for Black cases, and 71.7% (95% CI, 59.2%-81.5%) for Black controls. Among 476 non-Black women without endometriosis (n = 476), Pgp3 was associated with TFI (adjusted odds ratio, 2.6 [95% CI, 1.5-4.4]), adjusting for clinic, age, and income; chlamydia TFI-adjusted population-attributable fraction was 19.8% (95% CI, 7.7%-32.2%) in these women. Pgp3 positivity was not associated with TFI among non-Black women with endometriosis or among Black women (regardless of endometriosis).

Conclusions: Among non-Black infertile women without endometriosis in these clinics, 20% of TFI was attributed to chlamydia. Better biomarkers are needed to estimate chlamydia TFI PAF, especially in Black women.

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Conflict of interest statement

Conflict of Interest and Sources of Funding: The authors have no conflict of interest. This study was supported by Centers for Disease Control and Prevention, Prevention Research Centers grants (5U48DP001915 and 5U48DP001918) and National Institutes of Health, Sexually Transmitted Infections Clinical Trials group (contract HHSN27220130012I).

Figures

Figure 1:
Figure 1:. Chlamydia seropositivity among women overall, all women with any history of chlamydia, and women with any history of pelvic inflammatory disease by race and tubal factor infertility status, N=725 women
PID: pelvic inflammatory disease. Sample sizes: Black women with tubal factor infertility (TFI): All women: N=43; history of chlamydia: N=17; history of pelvic inflammatory disease N=9 Black women with non-TFI infertility: All women: N=36; History of chlamydia: N=17; History of pelvic inflammatory disease N=5 Non-black women with TFI: All women: N=36; History of chlamydia: N=12; History of pelvic inflammatory disease N=5 Non-black women non-TFI infertility: All women: N=73; History of chlamydia: N=27; History of pelvic inflammatory disease N=9 Note: Categories of women with history of chlamydia and history of pelvic inflammatory disease are not mutually exclusive
Figure 2:
Figure 2:. Population attributable fraction (PAF) and adjusted population attributable fraction (aPAF) of chlamydia in TFI for non-black women using Pgp3 serology, N=725 women overall
PAF: population attributable fraction Total sample size for unadjusted analysis of non-black women with endometriosis: n=113 women; sample size for adjusted analysis of non-black women with no endometriosis: n=476 women
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