Association between Chlamydia trachomatis, Neisseria gonorrhea, Mycoplasma genitalium, and Trichomonas vaginalis and Secondary Infertility in Cameroon: A case-control study

• Published in: PloS one Vol. 17; no. 2; p. e0263186
• Main Authors: Mbah, Clarisse Engowei, Jasani, Amy, Aaron, Kristal J, Akoachere, Jane-Francis, Tita, Alan T N, Geisler, William M, Van Der Pol, Barbara, Dionne-Odom, Jodie, Ngeudia, Jules Clement Assob
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 04-02-2022; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Cameroon; Case-Control Studies; Chlamydia; Chlamydia Infections - complications; Chlamydia trachomatis; Complications and side effects; Distribution; Ectopic pregnancy; Etiology; Female; Fertility; Gonorrhea; Gonorrhea - complications; Gynecology; Herbal medicine; Humans; Infections; Infectious diseases; Infertility; Infertility, Female - complications; Laboratories; Medical research; Medicine; Medicine and Health Sciences; Middle Aged; Mycoplasma genitalium; Mycoplasma Infections - complications; Neisseria gonorrhoeae; Nucleic acids; Parasitic diseases; Parasitology; Pelvic inflammatory disease; People and Places; Pregnancy; Prevalence; Prospective Studies; Reproductive technologies; Research and Analysis Methods; Risk factors; Sexual behavior; Sexual partners; Sexually transmitted diseases; Sociodemographics; STD; Trichomonas Infections - complications; Trichomonas vaginalis; Womens health; Young Adult; Cameroon; United States > US; Yaounde Cameroon
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0263186

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.