Background: Chlamydia trachomatis (Ct) infection is the most commonly reported infection in the United States, with rates 5.7 times higher among black vs white women. While Ct is associated with tubal factor infertility (TFI), the proportion of TFI attributable to Ct is unknown. We estimated Ct seroprevalence and population attributable fraction (PAF) of TFI due to Ct in infertile women, by race.
Methods: From October 2012 - June 2015, we enrolled and collected serum from 107 black women and 620 white women undergoing infertility evaluation in Birmingham, AL and Pittsburgh, PA. We categorized participants as TFI cases if they had fallopian tube occlusion and controls if they had bilateral tubal patency by hysterosalpingogram. We defined Ct seropositivity by Ct antibody detection by either the Medac Ct-IgG plus or a more sensitive Ct elementary body ELISA. We estimated Ct seropositivity and PAF with associated 95% confidence intervals (CIs).
Results: TFI was present in 47 (44%) black and 140 (23%) white study participants. Ct seropositivity was 83% (95% CI: 71%-95%) among 47 black cases, 80% (95% CI: 69%-91%) among 60 black controls, 37% (95% CI: 29%-46%) among 140 white cases, and 30% (95% CI: 25%-34%) among 480 white controls. Estimated PAF of TFI due to Ct was 15% (95% CI: -97% to 68%) for blacks and 11% (95% CI: -3% to 23%) for whites.
Conclusions: Ct seroprevalence was high in infertile women, particularly black women. Low PAF estimates suggest factors other than Ct play an important role in TFI. However, high background Ct seroprevalence associated with uncomplicated infections and case-misclassification due to presence of non-occlusive tubal damage among the controls may have attenuated the calculated PAF. Our findings support the need for continued Ct screening in women to prevent Ct-associated reproductive morbidity, and further study of the multifactorial causes of TFI.