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Vol. 11(2), pp. 116-121, 2021
Copyright ©2021, the copyright of this article is retained by the author(s)
Seroprevalence of Chlamydia trachomatis Antibodies and Associated Risk Factors Among HIV Positive Patients Seen in Enugu.
Amaewhule Mary Nnenda1, Bob-Manuel Mienye2, Lawson Stephenson Danagogo2
1 Department of Internal Medicine, Rivers State University Teaching Hospital.
2Department of Medical Microbiology and Parasitology, Rivers State University Teaching Hospital.
E-mail: mienye.bob-manuel@ ust.edu.ng
Chlamydia trachomatis is one of the 4 bacterial species in the genus Chlamydia family-Chlamydiaceae; phylum- Chlamydiae. It is a Gram-negative, obligate intracellular organism and the first chlamydial agent discovered in humans in 19071. Two biovars of C. Trachomatis are responsible for human infections-the trachoma biovar which causes localised infection on the epithelial surfaces of the conjunctiva and urogenital system and the lymphogranuloma venereum biovar responsible for genital ulceration and spread via lymphatic channels2. Serovars in both C. trachomatis biovars cause trachoma, sexually transmitted disease, some form of arthritis, neonatal inclusion conjunctivitis and pneumonia. Infection is primarily through penetrative sexual intercourse, however infection can be detected in the conjunctiva and nasopharynx without concomitant genital tract infection3.In females, C. trachomatis causes cervicitis and pelvic inflammatory disease which may lead to such complications as ectopic pregnancy and tubal factor infertility. Chlamydia trachomatis in the cervix can be transmitted to a neonate during passage through an infected birth canal resulting in neonatal pneumonia and conjunctivitis. In males, urogenital serovars cause non-gonococcal urethritis and epididymitis. Chlamydia trachomatis can also induce Reiter’s syndrome, proctitis, and conjunctivitis in both sexes4,5.
Over 127 million new cases of chlamydia infection were expected to have occurred in 2016 with females having a slightly higher prevalence than males6. A prevalence of 3.8% was reported in females in the African region, which is second only to the Americas7. Within Nigeria, a prevalence of 9.6% has been reported in Kano amongst patients attending infertility and sexually transmitted disease clinics8. Another study reported 30.2% among female undergraduates in Port Harcourt9. A seroprevalence study in Enugu, Nigeria reported 42.9% in 201110.Among HIV patients, a 29.4% prevalence rate has been reported in Abuja, Nigeria11 and 17.3% in Lagos12. Although the pathogenesis of C. trachomatis genital infection is still poorly understood, evidence indicates that active C. trachomatis infection is an important risk factor for HIV transmission and vice versa13,14.
However, it is often difficult to compare prevalence rates reported for C. trachomatis in various studies because of the wide variations in the sensitivities of the different methods used for its detection. Direct cytological testing by Giemsa stain of fixed smears is rapid and has a sensitivity of 90% for detection of Chlamydial conjunctivitis in neonates but is not sensitive enough for diagnosing genital infections or conjunctivitis in adults15. Culture for years was considered as the most sensitive test for detecting C. trachomatis and is the only diagnostic procedure that confirms the presence of viable organisms15,16. It is 100 per cent specific but is less sensitive when compared to nucleic acid amplification tests15. Serology tests such as complement fixation (CF), microimmunoflorescent (MIF) and tests based on enzyme immunoassays (EIA) are used mainly for neonates, patients with tubal factor infertility and occasionally for LGV infections when bubo aspirates are not available15. A major disadvantage of these tests is that they also detect antibodies to other chlamydial species and not just C. trachomatis in addition, antibody response to previous Chlamydial infections may not even have been elicited at all16.Antigen detection tests include the Direct Fluorescent Antibody (DFA) tests and the Enzyme Immunoassays (EIA) tests that use monoclonal or polyclonal antibodies to detect chlamydial lipopolysaccharide (LPS) or the major outer membrane protein (MOMP). The DFA tests are however no longer recommended for testing genital specimens due to variations in their sensitivity16. Currently, the most sensitive tests for detecting C. trachomatis are the Nucleic Acid Amplification Tests (NAATs)16,17. Another advantage of these NAATs is their non-reliance on viable organisms, so samples collected in the field and transported to a laboratory can still be tested.
In view of the of the rising prevalence rates of C. trachomatis infection worldwide, the importance of early diagnosis and treatment in the control of the HIV/AIDS epidemic cannot be overemphasised. C. trachomatis disease of the genital tract is often asymptomatic, especially in women. This contributes to the high rate of spread of the disease as well as HIV by carriers if co-infected by HIV. The aim of this study was to determine the prevalence of and risk factors for C. trachomatis antibodies as an indicator of Chlamydia sp seroprevalence among HIV patients.
The study population consisted of people living with HIV attending the HIV clinic of the University of Nigeria Teaching Hospital, Enugu.
A minimum sample size of 122 was calculated using Cochran formula based on a prevalence of 17%12. The sample size was however increased to 150 to allow for attrition. All patients who had HIV and gave their consent were included in the study.
Ethical approval for this study was obtained from the ethical board of the University of Nigeria Teaching Hospital, Enugu.
Pre-tested interviewer-administered PROFORMA data collection sheets were used to obtain the biodata of the participants as well as history of any previous sexually transmitted infection (STI), HIV and Chlamydia risk factors such as multiple sexual partners, unprotected sexual intercourse, history of blood transfusion, use of sharp objects, etc.
Specimen collection and Analysis
Three millilitres of venous blood samples was then obtained from each participant by venepuncture and the sera separated and stored at -20ºC. The IgG and IgM in the sera were detected by ELISA (Diagnostic Automation, Inc).Analysis of serum samples were performed according to the manufacturers instuctions18,19.
The data was analysed using the statistical programme for social science (SPSS) version 25. Mean, standard deviation and range were calculated for quantitative data. Qualitative and categorical data were compared using Chi square tests. The risk of Chlamydia infection was determined by binomial logistic regression. All analysis was done at a 95% confidence interval and a p-value less than 0.05 was considered significant.
Table 1 shows the demographic distribution of the study participants. The mean duration of HIV infection for the cases was 3.92 years (SD±2.34, range=0.5-12 years).One hundred of the cases (66.67%) of the cases were females while 50 (33.33%) were males. Male to female ratio=1:2. The ages of the study participants ranged from 16-60years with a mean age of 35.9 (SD ± 9.22).Ninety-three (61.3%) were married, 38(25.3%) single, 18 (12.0%) widowed and only 1(0.75%) were divorced.
Table1: Demographic Distribution of Study Participants
Figure 1 shows that 91 (60.7%) of the participants were had Chlamydia antibodies and 59 (39.3%) did not have antibodies.
Table 2 shows the distribution of the C. trachomatis antibodies among the study participants found to have C. trachomatis antibodies. The IgM prevalence was 51.6% (47/91), followed by the IgG prevalence of 35.2% (32/91) and a 13.2% (12/91) prevalence of the IgM and IgG combination among the 91 participants with C. trachomatis antibodies.
Table 2: Serology of C. trachomatis antibodies in study participants
Table 3 shows the distribution of the risk factors for Chlamydia infection among the study participants. There was a significant association of indiscriminate use of parenteral drugs, history of blood transfusion, use of sharp unsterilised objects and irregular or non-usage of condoms with the occurrence of Chlamydia antibody seroprevalence. Logistic regression showed that the risk of chlamydia infection was increased with the history of STD (OR = 1.4, (0.7 – 2.7)), history of multiple sexual partners (OR = 1.9, (0.9 – 3.7)), those currently sexually active (OR = 1.5, (0.7 – 3.1)), the use of unsterilized objects (OR = 4.9, (2.3 – 10.4)) and the irregular or non-usage of condoms (OR = 10.2 (4.6 – 22.7)).
Table 3: Distribution of Risk Factors for Chlamydia Seroprevalence in Subjects
*Statistically significant (p<0.05), R: Risk is increased when O.R> 1.0
Chlamydia trachomatis is a common STD worldwide and its role in the transmission and acquisition of HIV cannot be overemphasised. It is usually under-diagnosed which is due to its asymptomatic presentation in majority of cases.11,13 Several studies performed in the past have demonstrated an association between the presence of an STD (especially if untreated) and the predisposition to acquire and transmit HIV infection.6–9,16 The C. trachomatis seroprevalence rate of 60.7% obtained in HIV infected persons in this study when compared to previous studies is higher than that obtained in some other studies.2,6,9,11
The distribution of the C. trachomatis antibodies among the 91 study participants found to have C. trachomatis antibodies showed that IgM prevalence was 51.6% (47/91), followed by the IgG prevalence of 35.2% (32/91) and a 13.2% (12/91) prevalence of the IgM and IgG combination among the 91 participants with C. trachomatis antibodies.Although several studies have demonstrated an increased prevalence of C. trachomatis infection among HIV seropositive patients.20–22In the current study, there was a relatively high prevalence of IgG antibodies which is indicative of past infection. The higher seroprevalence rate of C. trachomatis IgM in the HIV positive cases is an indication of a recent or current infection of Chlamydia trachomatis. Similarly, the relatively high prevalence of IgG may be attributed to the fact that it persists in the blood long after the infection has been cleared and therefore may not reflect the actual number of cases currently infected.21,23,24
Logistic regression showed that the risk of chlamydia infection was increased with the history of STD, history of multiple sexual partners, those currently sexually active, the use of unsterilized objects, and the irregular or non-usage of condoms. These are consistent with the findings of epidemiological studies which have consistently detected the main risk factors for C. trachomatis infection as frequent multiple sexual relationships and failure to use or erratic use of condoms.20–22,25
A relatively high seroprevalence of C. trachomatis antibodies was observed among people living with HIV. Although these may not all represent active C. trachomatis infection, it can be inferred that a high percentage of the population have been exposed to the infection and may have been recently infected as well. This has implications for continued transmission of this STI in Nigeria.
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