title: Human and Pathogen Factors Associated with Chlamydia trachomatis-Related Infertility in Women.
abstract: Chlamydia trachomatis is the most common bacterial sexually transmitted pathogen worldwide. Infection can result in serious reproductive pathologies, including pelvic inflammatory disease, ectopic pregnancy, and infertility, in women. However, the processes that result in these reproductive pathologies have not been well defined. Here we review the evidence for the human disease burden of these chlamydial reproductive pathologies. We then review human-based evidence that links Chlamydia with reproductive pathologies in women. We present data supporting the idea that host, immunological, epidemiological, and pathogen factors may all contribute to the development of infertility. Specifically, we review the existing evidence that host and pathogen genotypes, host hormone status, age of sexual debut, sexual behavior, coinfections, and repeat infections are all likely to be contributory factors in development of infertility. Pathogen factors such as infectious burden, treatment failure, and tissue tropisms or ascension capacity are also potential contributory factors. We present four possible processes of pathology development and how these processes are supported by the published data. We highlight the limitations of the evidence and propose future studies that could improve our understanding of how chlamydial infertility in women occurs and possible future interventions to reduce this disease burden.
authors: Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia.
authors: S
authors: S
authors: Menon
authors: Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, QLD, Australia.
authors: P
authors: P
authors: Timms
authors: Wesley and St. Andrews Research Institute, The Wesley Hospital, Auchenflower, QLD, Australia UC Health Clinical School, The Wesley Hospital, Auchenflower, QLD, Australia.
authors: J A
authors: JA
authors: Allan
authors: Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia.
authors: K
authors: K
authors: Alexander
authors: MIMR-PH Institute of Medical Research, Monash, VIC, Australia.
authors: L
authors: L
authors: Rombauts
authors: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom Bristol Sexual Health Centre, University Hospital Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors: P
authors: P
authors: Horner
authors: WESTMED Reproductive Services, New York, New York, USA Icahn School of Medicine at Mt. Sinai Hospital, New York, New York, USA.
authors: M
authors: M
authors: Keltz
authors: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton South, VIC, Australia.
authors: J
authors: J
authors: Hocking
authors: Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia w.huston@qut.edu.au.
authors: W M
authors: http://orcid.org/0000-0002-0879-1287
authors: WM
authors: Huston
mesh_terms: D002690:Chlamydia Infections / Q000150:complications* / Q000276:immunology; D002692:Chlamydia trachomatis / Q000276:immunology / Q000502:physiology*; D005260:Female; D006801:Humans; D007246:Infertility / Q000209:etiology*; D011247:Pregnancy; D012307:Risk Factors