Serological and clinical correlates of gonorrhoea and syphilis in fertile and infertile Nigerian women.

OBJECTIVE: To test the hypothesis that infertile Nigerian women have higher serum levels of antibodies against Neisseria gonorrhoea and Treponema pallidum compared with fertile controls. DESIGN: The prevalence of serum antibodies against N gonorrhoea and T pallidum was compared in fertile and infertile Nigerian women. SETTING: Population based case-control study in Ile-Ife, southwestern Nigeria. SUBJECTS: 60 women with infertility identified from a community based questionnaire survey of 1075 women were compared with 53 age matched fertile controls. METHODS: Sera of fertile and infertile women were tested for the presence of gonococcal antibodies with indirect agglutination test and syphilis antibodies using rapid reagin method. MAIN OUTCOME MEASURES: Prevalence of anti-gonococcal and anti-treponemal antibodies in cases and controls. Frequency of self reports of sexually transmitted infections (STIs) in cases and controls. RESULTS: In comparison with fertile women, infertile women were more likely to report having had repeated lower abdominal pains (p < 0.01), yellow vaginal discharge (p < 0.004), and whitish vaginal discharge (p < 0.02). There was no significant difference between cases and controls in the proportions reporting previous STI diagnoses. However, two infertile women reported previous gonococcal infection compared with none in the fertile group. Sixteen of the infertile women (26.7%) demonstrated anti-gonococcal antibodies in their sera compared with only four of the 53 fertile controls (7.5%) (p < 0.02; OR 4.5). There was no significant difference between fertile and infertile women in the proportion showing serological reactivity to T pallidum. CONCLUSION: Infertile women have a higher prevalence of anti-gonococcal antibodies compared with fertile controls. Infertile women are also more likely to report previous lower abdominal pains and vaginal discharge. These results provide credible evidence implicating STIs and N gonorrhoea in particular as important factors contributing to female infertility in this population. Public health measures are warranted to address the high rate of STIs and N gonorrhoea in Nigeria.