Details:

Alternative Title:
Am J Obstet Gynecol
Publisher's site:
http://dx.doi.org/10.1016/j.ajog.2017.05.026
Personal Author:
GORWITZ, Rachel J. ; WIESENFELD, Harold C. ; CHEN, Pai Lien ; HAMMOND, Karen R. ; SEREDAY, Karen A. ; ... More +
GORWITZ, Rachel J. ; WIESENFELD, Harold C. ; CHEN, Pai Lien ; HAMMOND, Karen R. ; SEREDAY, Karen A. ; HAGGERTY, Catherine L. ; JOHNSON, Robert E. ; PAPP, John R. ; KISSIN, Dmitry M. ; HENNING, Tara C. ; HOOK, Edward W. ; STEINKAMPF, Michael P. ; MARKOWITZ, Lauri E. ; GEISLER, William M. Less -
Description:
Background

Chlamydia trachomatis infection is highly prevalent among young women in the United States. Prevention of long-term sequelae of infection, including tubal factor infertility, is a primary goal of chlamydia screening and treatment activities. However, the population attributable fraction of tubal factor infertility associated with chlamydia is unclear, and optimal measures for assessing tubal factor infertility and prior chlamydia in epidemiologic studies have not been established. Black women have increased rates of chlamydia and tubal factor infertility compared to white women, but have been underrepresented in prior studies of the association of chlamydia and tubal factor infertility.

Objectives

To estimate the population attributable fraction of tubal factor infertility associated with Chlamydia trachomatis infection by race (black, non-black), and assess how different definitions of C. trachomatis seropositivity and tubal factor infertility affect population attributable fraction estimates.

Study Design

We conducted a case-control study, enrolling infertile women attending infertility practices in Birmingham, AL and Pittsburgh, PA during October 2012–June 2015. Tubal factor infertility case status was primarily defined by unilateral or bilateral fallopian tube occlusion (cases) or bilateral fallopian tube patency (controls) on hysterosalpingogram. Alternate tubal factor infertility definitions incorporated history suggestive of tubal damage or were based on laparoscopic evidence of tubal damage. We aimed to enroll all eligible women, with an expected ratio of one and three controls per case for black and non-black women, respectively. We assessed C. trachomatis seropositivity with a commercial assay and a more sensitive research assay; our primary measure of seropositivity was defined as positivity on either assay. We estimated C. trachomatis seropositivity and calculated C. trachomatis-TFI odds ratios and population attributable fraction, stratified by race.

Results

We enrolled 107 black women (47 cases, 60 controls) and 620 non-black women (140 cases, 480 controls). C. trachomatis seropositivity by either assay was 81% (95% confidence interval 73%, 89%) among black and 31% (95% confidence interval 28%, 35%) among non-black participants (P<0.001). Using the primary C. trachomatis seropositivity and tubal factor infertility definitions, no significant association was detected between chlamydia and tubal factor infertility among blacks (odds ratio 1.22, 95% confidence interval 0.45, 3.28) or non-blacks (odds ratio 1.41, 95% confidence interval 0.95, 2.09), and the estimated population attributable fraction was 15% (95% confidence interval −97%, 68%) among blacks and 11% (95% confidence interval −3%, 23%) among non-blacks. Use of alternate serologic measures and tubal factor infertility definitions impacted the magnitude of the chlamydia-tubal factor infertility association, and resulted in a significant association among non-blacks.

Conclusions

Low population attributable fraction estimates suggest factors in addition to chlamydia contribute to tubal factor infertility in the study population. However, high background C. trachomatis seropositivity among controls, most striking among black participants, could have obscured an association with tubal factor infertility and resulted in a population attributable fraction that underestimates the true etiologic role of chlamydia. Choice of chlamydia and tubal factor infertility definitions also impacts odds ratio and population attributable fraction estimates.


Subject:
[+]
Adult
Blacks
Case-Control Studies
Chlamydia Infections
Fallopian Tube Diseases
Female
Humans
Infertility, Female
Seroepidemiologic Studies
Whites
Young Adult

Source:
Am J Obstet Gynecol. 217(3):336.e1-336.e16.
Pubmed ID:
28532600
Pubmed Central ID:
PMC5600165
Document Type:
Journal Article
Funding:
U48 DP001915/DP/NCCDPHP CDC HHS/United States ; HHSN272201300012I/AI/NIAID NIH HHS/United States ; U48 DP001918/DP/NCCDPHP CDC HHS/United States ; HHSN272201300012C/AI/NIAID NIH HHS/United States ; CC999999/Intramural CDC HHS/United States
U48 DP001915/DP/NCCDPHP CDC HHS/United States ; HHSN272201300012I/AI/NIAID NIH HHS/United States ; U48 DP001918/DP/NCCDPHP CDC HHS/United States ; HHSN272201300012C/AI/NIAID NIH HHS/United States ; CC999999/Intramural CDC HHS/United States Less -
Place as Subject:
Alabama
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:816c63593066407b8e7f010eaaa506826ad9d9108131b21acd2f79250b77e11a
File Type:

Supporting Files

• 	NIHMS892243-supplement-supplement_1.pdf	pdf
  	nihms892243.nxml	xml
  	nihms892243f1.gif	gif
  	nihms892243f1.jpg	jpeg

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