Performance of five serological chlamydia antibody tests in subfertile women.
BACKGROUND
Micro-immunofluorescence (MIF) is widely used for chlamydia antibody testing (CAT). Recently a species-specific MIF and three enzyme-linked immunosorbent assay (ELISA) tests have been introduced. We compared five commercially available CAT tests, using laparoscopy as a reference, and evaluated whether combinations of tests could improve the predictive value of CAT.


METHODS
In a consecutive cohort of 315 subfertile women, results of the five CAT tests were correlated to findings at laparoscopy. Likelihood and odds ratios (OR) were calculated for single tests and for combinations of tests.


RESULTS
Of the tests evaluated, MIF Labsystems had the best diagnostic performance (OR 15.7), while pELISA Medac (OR 8.2) was the best of the three ELISA tests. Stepwise logistic regression analysis showed that performance of MIF Labsystems could not be improved by adding a second test. Significant cross-reactivity with C. pneumoniae antibodies was found in all tests evaluated, except in pELISA Medac.


CONCLUSIONS
In screening for tubal factor subfertility, MIF Labsystems was superior to the ELISA tests evaluated, and combining two CAT tests did not improve its predictive value. Economic analysis will show whether serial testing by pELISA Medac, and retesting positive samples by MIF Labsystems, is most cost-effective. In CAT, cross-reactivity with C. pneumoniae antibodies is still a major concern.
Land
J A
JA
Department of Obstetrics and Gynaecology, Academisch Ziekenhuis Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. jlan@sgyn.azm.nl
Gijsen
A P
AP
Kessels
A G H
AG
Slobbe
M E P
ME
Bruggeman
C A
CA
D000907:Antibodies, Bacterial / Q000097:blood*; D000918:Antibody Specificity; D002690:Chlamydia Infections / Q000175:diagnosis*; D002692:Chlamydia trachomatis / Q000276:immunology*; D016993:Chlamydophila pneumoniae / Q000276:immunology; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005455:Fluorescent Antibody Technique; D006801:Humans; D007247:Infertility, Female / Q000382:microbiology*; D010535:Laparoscopy; D016015:Logistic Models; D016017:Odds Ratio; D011933:Reagent Kits, Diagnostic / Q000191:economics; D012680:Sensitivity and Specificity
D000907:Antibodies, Bacterial; D011933:Reagent Kits, Diagnostic