Antibodies to Chlamydia trachomatis in acute salpingitis

Abstract

Recent isolation studies have shown Chlamydia trachomatis to be an important aetiological agent in acute salpingitis in women. The present serological study indicates that C. trachomatis is the probable aetiological agent in two-thirds of 143 women with pelvic inflammatory disease (PID). In general, high levels of chlamydial antibody were found in sera and fluids aspirated from the pouch of Douglas and such antibody titres were shown to correlate with the severity of clinically graded tubal inflammation.

PIP: A modified micro-immunofluorescence test was used to assess the level and prevalence of different immunoglobulin classes of type specific chlamydial antibodies in sera and in fluid aspirated from the pouch of Douglas in women with laparoscopically verified acute salpingitis, and the findings were related to the visual clinical grading of tubal inflammation. Laparoscopy was carried out on the day of admission for all patients admitted to the Department of Obstetrics and Gynecology of the University Hospital in Lund, Sweden, with the presumptive diagnosis of acute salpingitis. The study includes patients admitted between 1973-77. Serum samples were collected on the day of admission from 143 women with acute salpingitis, peritoneal fluid was collected during laparoscopy from the pouch of Douglas of 27 patients, and serum samples were collected from 19 women with no signs of genital infection who had also undergone laparoscopy. 88 of the 143 patients with acute salpingitis (62%) had chlamydial IgC antibody levels of 1/64 or greater in their sera. The geometric mean titre (GMT) of antibody in all 143 women was 1/51. The results indicated a correlation between the inflammatory grade of salpingitis, the percentage of women with high levels of IgG chlamydial antibody, and the GMT of their antibody. 73% of women with severe salpingitis had significant levels of antibody and also the highest GMT of chlamydia IgG antibody, 1/527, compared to 1/63 in women with mild and 1/189 in women with moderate salpingitis. Only 2 of the 19 women with no salpingitis had high levels of antibody. IgM chlamydial antibody was detected in only 33 of 142 women tested. Fluid aspirated from the pouch of Douglas in 27 women with acute salpingitis had high GMTs of both IgG and IgA chlamydial antibody, and again the GMTs and percentages of women with high levels of IgG antibody increased with increasing severity of tubal inflammation. In 83 of 88 women in whom IgG chlamydial antibody was demonstrated, the predominant type-specific antibody was of the paratrachoma (D-K) serotype, while in the remaining 5 patients it was of the C/J type. The study indicates that C. trachomatis is the probable etiological agent in as many as 66% of women with acute salpingitis.