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  • Title: The prevalence, risks, and management of Chlamydia trachomatis infections in fertile and infertile patients from the high socioeconomic bracket of the South African population.
    Author: Wessels PH, Viljoen GJ, Marais NF, de Beer JA, Smith M, Gericke A.
    Journal: Fertil Steril; 1991 Sep; 56(3):485-8. PubMed ID: 1894026.
    Abstract:
    OBJECTIVE: The main objective of the study was to evaluate the prevalence of Chlamydia trachomatis endocervicitis in an infertile population. DESIGN: Forty consecutive patients were enrolled in the study group and 41 in the control group. SETTING: The study was undertaken in the Department of Obstetrics and Gynaecology of the University of the Orange Free State, Bloemfontein, Republic of South Africa. PATIENTS: Infertile white females, visiting an infertility clinic in an academic hospital and fertile white female patients visiting an antenatal clinic. INTERVENTIONS: Endocervical swabs were taken, and monoclonal direct immunofluorescence for C. Trachomatis were done on each. MAIN OUTCOME MEASURES: A difference was expected between the prevalence of C. trachomatis infection in the fertile and infertile population. RESULTS: In the study group, 14(35.9%) positive, 25(64.1%) negative, and 1 fallout were obtained. In the control group, 3 patients (7.32%) tested positive. CONCLUSION: Although no correlation was found between C. trachomatis infection of the female genital tract and the clinical history, it showed a significant correlation with infertility. This justifies routine screening tests and antibiotic treatment of positive infertile couples. Analysis of cost-effectiveness showed that empirical treatment of new infertile couples is justified in some populations. Health workers at the Department of Obstetrics and Gynecology of the University of the Orange Free State in Bloemfontein, South Africa enrolled 40 consecutive infertile white couples 41 consecutive pregnant white females into a case control study to determine the prevalence of Chlamydia trachomatis infections in an infertile population. Both groups were from the middle to upper socioeconomic class. Laboratory personnel used the monoclonal direct immunofluorescence test to each cervical cytology smear. They had to repeat the test on 5% of the smears. Prevalence of C. trachomatis in the study group stood much higher than it did in the control group (35.9% vs. 7.3%; p.002). No association existed between clinical history and presence of C. trachomatis in the fertile group. 19.5% of the fertile patients had taken antibiotics during the 3 months prior to the study. None reported earlier episodes of salpingitis and/or pelvic inflammatory disease. The researchers proposed a possible reason for the very high rate of C. trachomatis in infertile patients. Perhaps the infertile clinic only examined unresolved infertile cases who may have had an exceptionally high rate of C. trachomatis. The infertility clinic chose to treat all new couples with lymecycline because studies showed that it is always effective against C. trachomatis. Indeed this treatment proved to be the most beneficial at the lowest cost.
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