PDF(Pubmed)
Abstract：
Data on the prevalence and etiology of infertility in Africa are limited. Secondary infertility is particularly common, defined as the inability of a woman to conceive for at least one year following a full-term pregnancy. We describe a prospective study conducted in Cameroon designed to test the hypothesis of an association between common treatable sexually transmitted infections (STI): Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), and Trichomonas vaginalis (TV) and secondary infertility in women.
In this case-control study, we enrolled women in Fako Division, Cameroon between November 2017 and December 2018 with secondary infertility (cases) or current pregnancy (controls). We conducted a baseline survey to collect sociodemographic, and sexual and medical history information. Nucleic acid amplification testing using Aptima (Hologic, San Diego, CA, US) was performed on endocervical swabs for CT, NG, MG, and TV. Multivariable logistic regression was used to assess the relationship between active STI and secondary infertility.
A total of 416 women were enrolled: 151 cases and 265 controls. Compared to controls, cases were older (median age 32 vs 27 years) and had more lifetime sexual partners (median 4 vs 3) (p<0.001). Cases were more likely to report dyspareunia, abnormal menses, prior miscarriage, and ectopic pregnancy (all p<0.05). STI positivity was not significantly different among cases and controls (2.7% vs 5.4% for CT, 1.3% vs 2.9% for NG, 6.0% vs 7.0% for MG, respectively), with the exception of TV which was more common in pregnant controls (0.7% vs 5%; p = 0.02).
Study findings did not support an association between active STI and secondary infertility in Cameroon. Given high rates of pre-existing tubal damage, routine STI screening and treatment in younger women may be more impactful than costly STI testing during infertility assessments.
In this case-control study, we enrolled women in Fako Division, Cameroon between November 2017 and December 2018 with secondary infertility (cases) or current pregnancy (controls). We conducted a baseline survey to collect sociodemographic, and sexual and medical history information. Nucleic acid amplification testing using Aptima (Hologic, San Diego, CA, US) was performed on endocervical swabs for CT, NG, MG, and TV. Multivariable logistic regression was used to assess the relationship between active STI and secondary infertility.
A total of 416 women were enrolled: 151 cases and 265 controls. Compared to controls, cases were older (median age 32 vs 27 years) and had more lifetime sexual partners (median 4 vs 3) (p<0.001). Cases were more likely to report dyspareunia, abnormal menses, prior miscarriage, and ectopic pregnancy (all p<0.05). STI positivity was not significantly different among cases and controls (2.7% vs 5.4% for CT, 1.3% vs 2.9% for NG, 6.0% vs 7.0% for MG, respectively), with the exception of TV which was more common in pregnant controls (0.7% vs 5%; p = 0.02).
Study findings did not support an association between active STI and secondary infertility in Cameroon. Given high rates of pre-existing tubal damage, routine STI screening and treatment in younger women may be more impactful than costly STI testing during infertility assessments.
摘要：
关于非洲不孕症患病率和病因的数据有限。继发性不孕尤其常见，定义为妇女在足月怀孕后至少一年不能怀孕。我们描述了在喀麦隆进行的一项前瞻性研究，旨在检验常见可治疗的性传播感染（STI）之间的关联假设：沙眼衣原体（CT），淋病奈瑟菌（NG），生殖支原体（MG），阴道毛滴虫（TV）和女性继发性不孕症。
在本病例对照研究中，我们在法科注册了女性，喀麦隆在2017年11月至2018年12月期间患有继发性不孕症（病例）或当前怀孕（对照）。我们进行了一项基线调查，以收集社会人口统计学，性和病史信息。使用Aptima（Hologic，圣地亚哥,CA,US）对宫颈拭子进行CT检查，NG,MG,和电视。多变量logistic回归分析活动性STI与继发性不孕症的关系。
共有416名女性入组：151例和265例对照。与对照组相比，病例年龄较大(中位年龄32岁vs27岁),终生性伴侣较多(中位年龄4岁vs3岁)(p<0.001).病例更有可能报告性交困难，月经异常,之前流产,和异位妊娠（均p<0.05）。STI阳性在病例和对照组之间没有显着差异（CT为2.7％vs5.4％，NG为1.3%vs2.9%，MG为6.0%vs7.0%，分别)，除了在怀孕对照组中更常见的TV（0.7％vs5％；p=0.02）。
研究结果不支持喀麦隆活动性STI与继发性不孕症之间的关联。鉴于先前存在的输卵管损伤率高，在不孕症评估期间,年轻女性的常规STI筛查和治疗可能比昂贵的STI检测更具影响力.
在本病例对照研究中，我们在法科注册了女性，喀麦隆在2017年11月至2018年12月期间患有继发性不孕症（病例）或当前怀孕（对照）。我们进行了一项基线调查，以收集社会人口统计学，性和病史信息。使用Aptima（Hologic，圣地亚哥,CA,US）对宫颈拭子进行CT检查，NG,MG,和电视。多变量logistic回归分析活动性STI与继发性不孕症的关系。
共有416名女性入组：151例和265例对照。与对照组相比，病例年龄较大(中位年龄32岁vs27岁),终生性伴侣较多(中位年龄4岁vs3岁)(p<0.001).病例更有可能报告性交困难，月经异常,之前流产,和异位妊娠（均p<0.05）。STI阳性在病例和对照组之间没有显着差异（CT为2.7％vs5.4％，NG为1.3%vs2.9%，MG为6.0%vs7.0%，分别)，除了在怀孕对照组中更常见的TV（0.7％vs5％；p=0.02）。
研究结果不支持喀麦隆活动性STI与继发性不孕症之间的关联。鉴于先前存在的输卵管损伤率高，在不孕症评估期间,年轻女性的常规STI筛查和治疗可能比昂贵的STI检测更具影响力.
