RESUMEN
BACKGROUND: The Chlamydia IgG antibody test (CAT) shows considerable variations in reported estimates of test accuracy, partly because of the use of different assays and cut-off values. The aim of this study was to reassess the accuracy of CAT in diagnosing tubal pathology by individual patient data (IPD) meta-analysis for three different CAT assays. METHODS: We approached authors of primary studies that used micro-immunofluorescence tests (MIF), immunofluorescence tests (IF) or enzyme-linked immunosorbent assay tests (ELISA). Using the obtained IPD, we performed pooled receiver operator characteristics analysis and logistic regression analysis with a random effects model to compare the three assays. Tubal pathology was defined as either any tubal obstruction or bilateral tubal obstruction. RESULTS: We acquired data of 14 primary studies containing data of 6191 women, of which data of 3453 women were available for analysis. The areas under the curve for ELISA, IF and MIF were 0.64, 0.65 and 0.75, respectively (P-value < 0.001) for any tubal pathology and 0.66, 0.66 and 0.77, respectively (P-value = 0.01) for bilateral tubal pathology. CONCLUSIONS: In Chlamydia antibody testing, MIF is superior in the assessment of tubal pathology. In the initial screen for tubal pathology MIF should therefore be the test of first choice.
Asunto(s)
Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis/inmunología , Enfermedades de las Trompas Uterinas/diagnóstico , Ensayo de Inmunoadsorción Enzimática , Enfermedades de las Trompas Uterinas/microbiología , Femenino , Técnica del Anticuerpo Fluorescente , Humanos , Inmunoglobulina G/análisis , Proyectos de Investigación , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To evaluate serum chlamydia antibody titers (CATs) in tubal occlusion or previous ectopic pregnancy and the associated risk factors. METHODS: The study population consisted of 55 women wih tubal damage and 55 parous women. CAT was measured using the whole-cell inclusion immunofluorescence test and cervical chlamydial DNA detected by PCR. Odds ratios were calculated to assess variables associated with C. trachomatis infection. RESULTS: The prevalence of chlamydial antibodies and antibody titers in women with tubal occlusion or previous ectopic pregnancy was significantly higher (P < .01) than in parous women. Stepwise logistic regression analysis showed that chlamydia IgG antibodies were associated with tubal damage and with a larger number of lifetime sexual partners. CONCLUSIONS: Chlamydia antibody titers were associated with tubal occlusion, prior ectopic pregnancy, and with sexual behavior, suggesting that a chlamydia infection was the major contributor to the tubal damage in these women.
Asunto(s)
Anticuerpos Antibacterianos/sangre , Infecciones por Chlamydia/complicaciones , Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis/inmunología , Enfermedades de las Trompas Uterinas/microbiología , Embarazo Ectópico/microbiología , Adolescente , Adulto , Brasil/epidemiología , Infecciones por Chlamydia/inmunología , Infecciones por Chlamydia/microbiología , Enfermedades de las Trompas Uterinas/epidemiología , Enfermedades de las Trompas Uterinas/inmunología , Trompas Uterinas/patología , Femenino , Humanos , Inmunoglobulina G/sangre , Modelos Logísticos , Embarazo , Embarazo Ectópico/epidemiología , Embarazo Ectópico/inmunología , Prevalencia , Factores de Riesgo , Conducta SexualRESUMEN
In order to determine the prevalence and risk factors for Chlamydia trachomatis infection in adolescent females and young women in central Brazil, 296 subjects attending two public health services were evaluated. The overall prevalence of C. trachomatis infection, as determined using polymerase chain reaction, was 19.6% (95% confidence interval [CI], 15.3-24.7). In multivariate analysis, young age (odds ratio [OR]adjusted 2.32, 95%CI 1.1-4.8, p<0.05) and having 2-3 (ORadjusted 3.41, 95%CI 1.6-6.3, p<0.05) or >or=4 sexual partners in life (ORadjusted 3.10, 95%CI 1.1-6.3, p<0.05) were factors significantly associated with chlamydial infection. In conclusion, the prevalence of C. trachomatis infection was high in the studied population and risk factors were related to age and sexual behavior.