Prevalence of Seven Sexually Transmitted Organisms by Multiplex Real-Time PCR in Fallopian Tube Specimens Collected from Saudi Women With & Without Ectopic Pregnancy

BACKGROUND:

Ectopic pregnancy (EP) is associated with maternal morbidity and occasionally mortality during the first trimester. A history of sexually transmitted infection (STI) and pelvic inflammatory disease have been implicated as major risk factors for EP. Our aim was to measure the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae, Mycoplasma genitalium (MG), Ureaplasma parvum/urealyticum, Gardnerella vaginalis, Trichomonas vaginalis and herpes simplex virus (HSV)-1&2 in Fallopian tubes collected from EP and the results were compared with those obtained from total abdominal hysterectomy (TAH) and tubal ligation.

METHODS:

This was a prospective case-control study and tubal samples were collected from 135 Saudi women recruited from 3 centres in the Western region as follow: 84 EPs, 20 TAH and 31 tubal ligations. Multiplex TaqMan PCR was performed using an IVD CE kit for the simultaneous detection of candidate pathogens following DNA extraction.

RESULTS:

Infections were detected in 31.8 % of the 135 participants either as single (11.1 %) or co-infections (20.7 %) and the frequencies were significantly higher in EP (42.85 %) compared with control (13.72 %). The rates of CT (27.4 %; P = 0.001); MG (20.2 %; P = 0.009) and HSV-1/2 (21.4 %; P = 0.01) were significantly higher in EP. No significant difference between the study groups was observed for the other pathogens (P > 0.05). Binary logistic regression also showed that infection with ≥ 2 pathogens (OR 4.9; 95 % CI: 2.2 - 11.6; P = 0.006), CT (OR 3.07; 95 % CI: 1.3 - 12.3; P = 0.002), MG (OR 2.3; 95 % CI: 1.1 - 8.6; P = 0.03) and HSV-1/2 (OR 1.7; 95 % CI: 0.75 - 5.7; P = 0.004) were associated with a significantly higher risk of developing EP.

CONCLUSIONS:

STIs are frequent in the upper genital tract of Saudi women during the reproductive age and, CT, MG and HSV-1/2 were more prevalent in EP. The observed high rates of co-infection advocate the necessity of establishing national guidelines and/or screening program utilising multiplex PCR approach for the detection of common STIs among high risk groups in the kingdom. Further studies are needed to measure the adverse reproductive outcomes associated with STIs in Saudi Arabia.

Table 1

Principle inclusion and exclusion criteria for the study groups

Control group		Case group
Inclusion criteria	Exclusion criteria	Inclusion criteria	Exclusion criteria
Saudi	Non-Saudi	Saudi	Non-Saudi
Patient age ≥ 18 and ≤ 42 years.	Patient age < 18 or > 42 years.	Patient age ≥ 18 and < 40 years.	Patient age < 18 or > 40 years.
Cyclic women with a history of previous intrauterine pregnancy and no history of hydrosalpinx or ectopic pregnancy	Women with abnormal menstrual cycle, history of infertility treatment, history of PID, endometriosis and previous ectopic pregnancy.	Ectopic pregnancy following spontaneous conception	Ectopic pregnancy following assisted conception, using IUD, History/symptoms of urogenital infection (e.g. vaginal discharge, dysuria, PID, etc.)
Clinical decision to undertake total abdominal hysterectomy (TAH) for benign disease not affecting the Fallopian tubes and endometrium	Vaginal or subtotal hysterectomy	Singleton pregnancy	Multiple/heterotopic pregnancy
Clinical decision to undertake tubal ligation for sterilisation	Use of IUD ≤ 1 year prior to operation	Clinical determination that the patient is haemodynamically stable	Symptoms and signs of hypovolemia

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By:   Ashshi AM1, Batwa SA2, Kutbi SY3, Malibary FA4, Batwa M5, Refaat B6.

• 1Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, Makkah, PO Box 7607, KSA. aashshi@yhaoo.com.
• 2Obstertics and Gynaecology Department, Maternity and Children Hospital, Al-Aziziyah, Jeddah, KSA. sarahbatwa@hotmail.com.
• 3Obstertics and Gynaecology Department, Maternity and Children Hospital, Al-Aziziyah, Jeddah, KSA. seham.alkutbi@yahoo.com.
• 4Obstertics and Gynaecology Department, Maternity and Children Hospital, Al-Aziziyah, Jeddah, KSA. fzmilly12345@gmail.com.
• 5Al-Thager General Hospital, Jeddah, KSA. mbatwa@hotmail.com.
• 6Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, Makkah, PO Box 7607, KSA. bassem.refaat@yahoo.co.uk. 

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