POSTTHERAPEUTIC EVOLUTION OF SERUM CHLAMYDIAL ANTIBODY-TITERS IN WOMEN WITH ACUTE SALPINGITIS AND TUBAL INFERTILITY

Objective: To determine if serologic data and, more particularly, anti chlamydial immunoglobulin (Ig) M can be used for diagnosis of current chlamydial intrapelvic gynecologic infection. Design: Forty-two women with acute salpingitis (group A), 131 women with tubal factor infertil ity (group B), and 98 pregnant women (control group C) were studied. S etting: Hopital Jean Rostand, Sevres (patients), Laboratories Magenta and Eylau, Paris (serology), Institut Pasteur, Paris (cultures). Inter ventions: Study groups: endocervical/urethral swabs, pelvic samples; s erologic study before and after treatment. Control group: Serologic st udy. Main Outcome Measures: Serum samples were collected from each pat ient initially and 6 to 9 weeks later; additionally, two to five seque ntial sera were obtained from 22 (group A) and 25 (group B) patients w ith positive cultures, evolutive serology, or positive antichlamydial IgM. Sera were tested for antichlamydial IgG by a microimmunofluoresce nce assay using Chlamydia trachomatis elementary bodies and for IgA an d IgM by whole inclusion-fluorescent assay. Results: Before treatment, there was a correlation between the presence of antichlamydial IgM an d positive cervical and/or intrapelvic chlamydia cultures. After treat ment, antichlamydial IgM, when initially positive, rapidly disappeared in most subjects; its persistence after 4 months was significantly as sociated with tubal sequelae in group A patients and persistence of po sitive intrapelvic chlamydial cultures in group B women. Conclusion: S erologic analysis of women with acute salpingitis or tubal infertility , including antichlamydial IgM, may aid both in the before treatment d iagnosis of chlamydial infection and in the follow-up evaluation.