男性沙眼衣原体感染及其与性伴侣妇科改变的关联

Guerra-Infante Fernando M, Tapia-Yáñez J Ramón, López-Hurtado Marcela, Flores-Medina Saúl, Díaz-García Francisco J

Departamento de Infectología del Instituto Nacional de Perinatología.

Rev Invest Clin. 2005 May-Jun;57(3):406-14.

OBJECTIVE

To determinate the frequency of Chlamydia trachomatis infection in male partners of infertile couples who attend to the infertility clinic at Instituto Nacional de Perinatología, as well as to compare the clinical data and lifestyle between C. trachomatis-infected and uninfected men to establish a possible association with gynecological damage in their sexual female partners.

METHODS

An open prospective study was performed in infertile couples, whose follow up was carried out at Instituto Nacional de Perinatología between June 2000 and April 2001. Urethral and cervical swabs were obtained from each couple and the specimens were subjected to a C. trachomatis-specific liquid-phase hybridization test (PACE-2) and routine microbiological analysis. Semen analysis were also included. A relative risk (RR) test was done to analyze variables and square chi test was used to analyze clinical and gynecological data from female partners and data from semen examination. Statistical differences were considered as significant when the p value was below 0.05.

RESULTS

C. trachomatis active infection was found in 14 out of 384 urethral swabs (3.6%). No significant alterations were observed in semen samples of C. trachomatis-infected men, as compared to non-infected individuals. Microbiological analyses of semen showed a significant isolation of Mycoplasma sp (RR = 5.87, IC95% 1.4-24.7). Eight out of fourteen female partners of C. trachomatis-infected men were also infected with C. trachomatis (RR = 10.57, IC95% 5.67-19.7), Candida albicans was other pathogen isolated from 8/14 of those women (RR = 1.89, IC95% 1.17-3.05). Gynecological and obstetrical associations found among female partners of C. trachomatis-infected men were as follows: tubal adhesions in 10/14 (RR = 1.54, IC95% 1.08-2.18), salpingitis in 2/14 (RR = 2.2), history of ectopic pregnancies in 11/14 (RR = 2.94, IC95% 1.01-8.53) and abnormal pregnancy loss in 9/14 (RR = 1.5).

CONCLUSION

A low prevalence of C. trachomatis infection was observed among male partners of infertile couples as compared with other reports, but this discrepancy could be attributable to the specimen collection and diagnostic assay used. Otherwise, this data suggests that a chronic pathogen's antigenic stimulation may result in an increased formation of tubal adhesions and/or in ectopic pregnancies among female partners of C. trachomatis-infected individuals. Thus, preventive and control measures must be introduced into men's healthcare services, through laboratory and clinical examination, since these subjects are the main reservoirs of C. trachomatis.

目的

确定在国立围产医学研究所不孕不育门诊就诊的不育夫妇男性伴侣中沙眼衣原体感染的频率，并比较沙眼衣原体感染和未感染男性的临床数据及生活方式，以确定其与性伴侣妇科损伤之间可能存在的关联。

方法

对不育夫妇进行一项开放性前瞻性研究，于2000年6月至2001年4月在国立围产医学研究所进行随访。从每对夫妇中获取尿道和宫颈拭子，并将标本进行沙眼衣原体特异性液相杂交试验（PACE-2）和常规微生物分析。还包括精液分析。采用相对危险度（RR）检验分析变量，用卡方检验分析女性伴侣的临床和妇科数据以及精液检查数据。当p值低于0.05时，统计学差异被视为具有显著性。

结果

在384份尿道拭子中，有14份（3.6%）发现沙眼衣原体活动性感染。与未感染个体相比，沙眼衣原体感染男性的精液样本未观察到明显改变。精液的微生物分析显示支原体属有显著分离（RR = 5.87，95%置信区间1.4 - 24.7）。沙眼衣原体感染男性的14名女性伴侣中有8名也感染了沙眼衣原体（RR = 10.57，95%置信区间5.67 - 19.7），白色念珠菌是从其中8/14的女性中分离出的另一种病原体（RR = 1.89，95%置信区间1.17 - 3.05）。沙眼衣原体感染男性的女性伴侣中发现的妇产科关联如下：10/14有输卵管粘连（RR = 1.54，95%置信区间1.08 - 2.18），2/14有输卵管炎（RR = 2.2），11/14有宫外孕病史（RR = 2.94，95%置信区间1.01 - 8.53），9/14有异常妊娠丢失（RR = 1.5）。

结论

与其他报告相比，不育夫妇男性伴侣中沙眼衣原体感染的患病率较低，但这种差异可能归因于所使用的标本采集和诊断检测方法。此外，这些数据表明，慢性病原体的抗原刺激可能导致沙眼衣原体感染个体的女性伴侣中输卵管粘连形成增加和/或宫外孕发生率增加。因此，必须通过实验室和临床检查将预防和控制措施引入男性医疗保健服务中，因为这些男性是沙眼衣原体的主要储存宿主。