Detection of chlamydia trachomat1s in pregnant women by polymerase chain reaction (PCR), cervical IGA antibodies and antigen analysis: relation to pregnancy outcome
Genome-Wide Association Study
Nucleic Acid Amplification Techniques
pbiectives: To compare the prevalence of cervical C. trachomatis in pregnant women as detected by PCR, IgA antibodies and and antigen detection and ascertain their relation to pregnancy outcome. Study Design: A total of 211 endocervical samples from 167 women were evaluated. For each sample aliquots were tested for £. trachomatis by PCR (Amplicor, Roche Diagnostics) and for IgA antibodies to C. trachomatis by a 6 minute assay (Chlamydia IgA Rapid SeroTest, Savyon Diagnostics). A third sample was analyzed by the hospital clinical laboratory for C trachomatis antigen (Chlamydiazyme, Abbott). Pregnancy outcomes were obtained. Laboratory results were not available to the clinician prior to delivery. Results: C_. trachomalis was detected by PCR in 27 (12.8%) samples from 23 (13.8%) women, antichlamydial IgA was present in 37 (17.5%) samples from 32 women (19.2%) while 24 (11.4%) samples from 20 (12.0%) women were positive for jhlamydial antigen. Antibody positive, PCR negative samples were rctcstcd by a second antibody test and a repeat PCR using samples spiked with C_. trachomatis. Compared to PCR. the IgA Rapid SeroTest had a sensitivity of 96.3% and a specificity of 93.5%; the antigen assay had a sensitivity relative to PCR of 74.1% and a specificity if 97.8%. The pregnancy outcomes were 86 (52.1%) patients with term labor (TL), 41 24.8%) with prctcrm labor (PTL) and 38 (23.0%) with premature rupture of membranes (PROM). The pregnancies of 11 (47.8%) of the 23 PCR positive women is opposed to 30 (21.1%) of 142 PCR negative women ended in PTL (P=0.009). Only hose women positive in the IgA or antigen assays who were also PCR positive had PTL. There was no relation between Chlamvdia detection by any assay and PROM. Conclusions: PCR-detectable C trachomatis in the endoccrvix of pregnant women orrelatcs with PTL. In settings where PCR is not available the IgA Rapid SeroTest. vhich can be performed in 6 minutes without any special equipment, is an accurate and icnsitive procedure for detection of cervical C_. trachomatis in pregnant women.