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Human Reproduction Update Advance Access published online on July 10, 2006
Human Reproduction Update, doi:10.1093/humupd/dml030
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received March 31, 2006
Revised June 6, 2006
Accepted June 8, 2006

Article

Chlamydia trachomatis-associated tubal factor subfertility: immunogenetic aspects and serological screening

J.E. den Hartog 1 *, S.A. Morré 2, and J.A. Land 1

1 Research Institute Growth and Development (GROW) and Department of Obstetrics and Gynaecology, Academic Hospital Maastricht, Maastricht
2 Laboratory of Immunogenetics, Section Immunogenetics of Infectious Diseases, Department of Pathology and Department of Internal Medicine, Section Infectious Diseases, VU University Medical Centre, Amsterdam, the Netherlands

* To whom correspondence should be addressed.
J.E. den Hartog, E-mail: je_denhartog{at}hotmail.com


  Abstract

Chlamydia (C.) trachomatis female genital tract infections usually remain asymptomatic and untreated. Therefore, an adequate immune response, rather than antibiotic treatment, is essential to clear the pathogen. Most women will effectively clear C. trachomatis infections, but some will have persistent C. trachomatis infections, which may ascend to the upper genital tract and increase the risk of tubal factor subfertility. Pattern recognition receptors (PRRs) of the toll-like receptor (TLR) and nucleotide-binding oligomerization domain (NOD) families recognize C. trachomatis and initiate the immune response. Host immune factors are determinants of the course of C. trachomatis infections. Genetic variations in TLR and NOD genes may affect receptor function, leading to inadequate recognition of C. trachomatis, an inadequate immune response, and consequently an increased risk of persistence and late sequelae. For the risk assessment of tubal pathology in subfertile women, C. trachomatis immunoglobulin (Ig) G antibody testing (CAT) in serum is widely used. A positive CAT is indicative of a previous infection but not of a persistent infection. Measuring serological markers of persistence, of which C-reactive protein (CRP) seems promising, in CAT-positive women may identify a subgroup of subfertile women with persistent C. trachomatis infections and the highest risk of tubal pathology.

Keywords: Chlamydia trachomatis/immunogenetics/serological markers/tubal factor subfertility.
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J.E. den Hartog, C.M.J.G. Lardenoije, J.L. Severens, J.A. Land, J.L.H. Evers, and A.G.H. Kessels
Screening strategies for tubal factor subfertility
Hum. Reprod., August 1, 2008; 23(8): 1840 - 1848.
[Abstract] [Full Text] [PDF]


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