SEROLOGICAL AND CLINICAL CORRELATES OF GONORRHEA AND SYPHILIS IN FERTILE AND INFERTILE NIGERIAN WOMEN

Objective: To test the hypothesis that infertile Nigerian women have h igher serum levels of antibodies against Neisseria gonorrhoea and Trep onema pallidum compared with fertile controls. Design: The prevalence of serum antibodies against N gonorrhoea and T pallidum was compared i n fertile and infertile Nigerian women. Setting: Population based case -control study in Ile-Ife, southwestern Nigeria.Subjects: 60 women wit h infertility identified from a community based questionnaire survey o f 1075 women were compared with 53 age matched fertile controls.Method s: Sera of fertile and infertile women were tested for the presence of gonococcal antibodies with indirect agglutination test and syphilis a ntibodies using rapid reagin method. Main outcome measures: Prevalence of anti-gonococcal and anti-treponemal antibodies in cases and contro ls. Frequency of self reports of sexually transmitted infections (STIs ) in cases and controls. Results: In comparison with fertile women, in fertile women were more likely to report having had repeated lower abd ominal pains (p < 0.01), yellow vaginal discharge (p < 0.004), and whi tish vaginal discharge (p < 0.02). There was no significant difference between cases and controls in the proportions reporting previous STI diagnoses. However, two infertile women reported previous gonococcal i nfection compared with none in the fertile group. Sixteen of the infer tile women (26.7%) demonstrated anti-gonococcal antibodies in their se ra compared with only four of the 53 fertile controls (7.5%) (p < 0.02 ; OR 4.5). There was no significant difference between fertile and inf ertile women in the proportion showing serological reactivity to T pal lidum. Conclusion: Infertile women have a higher prevalence of anti-go nococcal antibodies compared with fertile controls. Infertile women ar e also more likely to report previous lower abdominal pains and vagina l discharge. These results provide credible evidence implicating STIs and N gonorrhoea in particular as important factors contributing to fe male infertility in this population. Public health measures are warran ted to address the high rate of STIs and N gonorrhoea in Nigeria.