RESEARCH PAPER
The role of serological testing for Chlamydia trachomatis in differential diagnosis of pelvic pain
 
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1
Frauenklinik Asklepios Klinkum Uckermark, Schwedt, Germany
 
2
Departament of Gynecology and Urogynecology, Pomeranian Medical University, Szczecin, Poland
 
3
Primary Healthcare Center, Pomeranian Medical University, Szczecin, Poland
 
4
Clinic of Plastic, Endocrine and General Surgery, Pomeranian Medical University, Szczecin, Poland
 
 
Ann Agric Environ Med. 2016;23(3):506-510
 
KEYWORDS
ABSTRACT
Introduction:
Pelvic pain is typically associated with pelvic inflammatory disease (PID). The most common cause of PID is Chlamydia trachomatis. The aim of this study was to verify the role of serological testing for Chlamydia trachomatis in patients with suspected PID.

Material and Methods:
The retrospective study included 185 patients with pelvic pain hospitalized at the Department of Obstetrics and Gynecology in 2003 and 2004. Titers of anti-Chlamydia trachomatis IgG and IgA were measured by means ELISA immunoassays. Erythrocyte sedimentation rate (ESR), serum concentration of C-reactive protein (CRP) and leukocyte count (WBC) were also determined. Final diagnosis was established on the basis of laparoscopic examination.

Results:
The presence of anti-Chlamydia trachomatis antibodies correlated significantly with abnormal values of ESR, WBC and CRP. The most common laparoscopic pathology were pelvic adhesions, typically found in women with elevated titers of anti-Chlamydia trachomatis IgG.

Conclusions:
Serological examination for Chlamydia trachomatis is helpful in evaluation of patients with suspected PID. Elevated titers of anti-Chlamydia trachomatis antibodies are frequently associated with laparoscopic evidence of pelvic adhesions and inflammation.

 
REFERENCES (40)
1.
Won HR, Abbott J. Optimal management of chronic cyclical pelvic pain: An evidence-based and pragmatic approach. Int J Womens Health. 2010; 2: 263–277.
 
2.
Malhotra M, Sood S, Mukherjee A, Muralidhar S, Bala M. Genital chlamydia trachomatis: An update. Indian J Med Res. 2013; 138(3): 303–316.
 
3.
Papp J, Schachter J, Gaydos C, Van Der Pol B. Recommendations for the laboratory-based detection of chlamydia trachomatis and neisseria gonorrhoeae--2014. MMWR Recomm Rep. 2014; 63(RR-02): 1–19.
 
4.
WHO. Global prevalence and incidence of selected curable sexually transmitted diseases: Overview and estimates. Geneva, World Health Organization, 2011.
 
5.
Ceovic R, Gulin SJ. Lymphogranuloma venereum: Diagnostic and treatment challenges. Infect Drug Resist. 2015; 8: 39–47.
 
6.
Price MJ, Ades AE, De Angelis D, Welton NJ, Macleod J, Soldan K, et al. Risk of pelvic inflammatory disease following chlamydia trachomatis infection: Analysis of prospective studies with a multistate model. Am J Epidemiol. 2013; 178(3): 484–492.
 
7.
Marrazzo JM, Cates W. Interventions to prevent sexually transmitted infections, including hiv infection. Clin Infect Dis. 2011; 53(3).
 
8.
Rours GI, Duijts L, Moll HA, Arends LR, de Groot R, Jaddoe VW, et al. Chlamydia trachomatis infection during pregnancy associated with preterm delivery: A population-based prospective cohort study. Eur J Epidemiol. 2011; 26(6): 493–502.
 
9.
Banz C, Diedrich K, Hornung D. Antiflammatorische therapie bei endometriose. Gynäkologische Endokrinologie. 2004; 4: 223–225.
 
10.
Jang HY, Burbelo PD, Chae YS, Kim T, Cho Y, Park HT. Nontuberculous mycobacterial infection in a clinical presentation of fitz-hugh-curtis syndrome: A case report with multigene diagnostic approach. BMC Womens Health. 2014; 14(95): 1472–6874.
 
11.
Lehtinen M, Ault KA, Lyytikainen E, Dillner J, Garland SM, Ferris DG, et al. Chlamydia trachomatis infection and risk of cervical intraepithelial neoplasia. Sex Transm Infect. 2011; 87(5): 372–376.
 
12.
Carter JD, Gerard HC, Whittum-Hudson JA, Hudson AP. Combination antibiotics for the treatment of chlamydia-induced reactive arthritis: Is a cure in sight? Int J Clin Rheumtol. 2011; 6(3): 333–345.
 
13.
Bremer V. Sexuell übertragene erkrankungen in deutschland – stille epidemie. Deutsches Arzteblatt. 2005; 102: 2020–2023.
 
14.
Bremer V, Hoffman A, Hamouda O. Epidemiologie der chlamydia trachomatis infektionen. Der Hautarzt. 2007; 58: 18–23.
 
15.
Ngeow YF. Limitations of serodiagnosis in chlamydial genital tract infections. Ann Acad Med Singapore. 1996; 25(2): 300–304.
 
16.
Rabenau HF, Kohler E, Peters M, Doerr HW, Weber B. Low correlation of serology with detection of chlamydia trachomatis by ligase chain reaction and antigen eia. Infection. 2000; 28(2): 97–102.
 
17.
Morre SA, Munk C, Persson K, Kruger-Kjaer S, van Dijk R, Meijer CJ, et al. Comparison of three commercially available peptide-based immunoglobulin g (igg) and iga assays to microimmunofluorescence assay for detection of chlamydia trachomatis antibodies. J Clin Microbiol. 2002; 40(2): 584–587.
 
18.
Bulhak-Koziol V, Zdrodowska-Stefanow B, Ostaszewska-Puchalska I, Mackowiak-Matejczyk B, Pietrewicz TM, Wilkowska-Trojniel M. Prevalence of chlamydia trachomatis infection in women with cervical lesions. Adv Med Sci. 2007; 52: 179–181.
 
19.
Soper DE. Diagnosis and laparoscopic grading of acute salpingitis. Am J Obstet Gynecol. 1991; 164(5 Pt 2): 1370–1376.
 
20.
Henry-Suchet J, Tesquier L. Role of laparoscopy in the management of pelvic adhesions and pelvic sepsis. Baillieres Clin Obstet Gynaecol. 1994; 8(4): 759–772.
 
21.
Eschenbach DA, Wolner-Hanssen P, Hawes SE, Pavletic A, Paavonen J, Holmes KK. Acute pelvic inflammatory disease: Associations of clinical and laboratory findings with laparoscopic findings. Obstet Gynecol. 1997; 89(2): 184–192.
 
22.
Maggio AQ, Reece-Smith AM, Tang TY, Sadat U, Walsh SR. Early laparoscopy versus active observation in acute abdominal pain: Systematic review and meta-analysis. Int J Surg. 2008; 6(5): 400–403.
 
23.
Miettinen AK, Heinonen PK, Laippala P, Paavonen J. Test performance of erythrocyte sedimentation rate and c-reactive protein in assessing the severity of acute pelvic inflammatory disease. Am J Obstet Gynecol. 1993; 169(5): 1143–1149.
 
24.
Nelson DB, Ness RB, Peipert JF, Soper DE, Amortegui AJ, Gluck J, et al. Factors predicting upper genital tract inflammation among women with lower genital tract infection. J Womens Health. 1998; 7(8): 1033–1040.
 
25.
Hall MN, Leach L, Beck E. Clinical inquiries. Which blood tests are most helpful in evaluating pelvic inflammatory disease? J Fam Pract. 2004; 53(4): 330–331.
 
26.
Peipert JF, Boardman L, Hogan JW, Sung J, Mayer KH. Laboratory evaluation of acute upper genital tract infection. Obstet Gynecol. 1996; 87(5 Pt 1): 730–736.
 
27.
Bevan CD, Johal BJ, Mumtaz G, Ridgway GL, Siddle NC. Clinical, laparoscopic and microbiological findings in acute salpingitis: Report on a united kingdom cohort. Br J Obstet Gynaecol. 1995; 102(5): 407–414.
 
28.
Tikkanen M, Surcel HM, Bloigu A, Nuutila M, Hiilesmaa V, Ylikorkala O, et al. Prediction of placental abruption by testing for c-reactive protein and chlamydial antibody levels in early pregnancy. Bjog. 2008; 115(4): 486–491.
 
29.
Karinen L, Pouta A, Bloigu A, Koskela P, Paldanius M, Leinonen M, et al. Serum c-reactive protein and chlamydia trachomatis antibodies in preterm delivery. Obstet Gynecol. 2005; 106(1): 73–80.
 
30.
Debattista J, Gazzard CM, Wood RN, Allan JA, Allan JM, Scarman A, et al. Interaction of microbiology and pathology in women undergoing investigations for infertility. Infect Dis Obstet Gynecol. 2004; 12(3–4): 135–145.
 
31.
Ng EH, Tang OS, Ho PC. Measurement of serum ca-125 concentrations does not improve the value of chlamydia trachomatis antibody in predicting tubal pathology at laparoscopy. Hum Reprod. 2001; 16(4): 775–779.
 
32.
Petersen EE, Clad A, Pichlmeier U, Bottcher M. The extended chlamydia trachomatis diagnosis in patients with pelvic inflammatory disease--a better approach for the diagnosis of upper genital tract infections. Clin Lab. 2003; 49(5–6): 277–281.
 
33.
Dabekausen YA, Evers JL, Land JA, Stals FS. Chlamydia trachomatis antibody testing is more accurate than hysterosalpingography in predicting tubal factor infertility. Fertil Steril. 1994; 61(5): 833–837.
 
34.
Crha I, Pospisil L, Stroblova H, Ventruba P, Zakova J, Huser M. [antibodies against the chlamydial heat shock protein in women with periadnexal adhesions]. Ceska Gynekol. 2006; 71(2): 127–131.
 
35.
Simms I, Eastick K, Mallinson H, Thomas K, Gokhale R, Hay P, et al. Associations between mycoplasma genitalium, chlamydia trachomatis, and pelvic inflammatory disease. Sex Transm Infect. 2003; 79(2): 154–156.
 
36.
Vidhani S, Mehta S, Bhalla P, Bhalla R, Sharma VK, Batra S. Seroprevalence of chalmydia trachomatis infection amongst patients with pelvic inflammatory diseases and infertility. J Commun Dis. 2005; 37(3): 233–238.
 
37.
Puolakkainen M, Vesterinen E, Purola E, Saikku P, Paavonen J. Persistence of chlamydial antibodies after pelvic inflammatory disease. J Clin Microbiol. 1986; 23(5): 924–928.
 
38.
Kligman I, Grifo JA, Witkin SS. Expression of the 60 kda heat shock protein in peritoneal fluids from women with endometriosis: Implications for endometriosis-associated infertility. Hum Reprod. 1996; 11(12): 2736–2738.
 
39.
Heinonen PK, Leinonen M. Fecundity and morbidity following acute pelvic inflammatory disease treated with doxycycline and metronidazole. Arch Gynecol Obstet. 2003; 268(4): 284–288.
 
40.
Sharma K, Aggarwal A, Arora U. Seroprevalence of chlamydia trachomatis in women with bad obstetric history and infertility. Indian J Med Sci. 2002; 56(5): 216–217.
 
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ISSN:1232-1966
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