THE ROLE OF CHLAMYDIA-TRACHOMATIS AND NEISSERIA-GONORRHOEAE IN THE ETIOLOGY OF ECTOPIC PREGNANCY IN GABON

Objective-To study the association between ectopic pregnancy and Chlamydia trachomatis and Neisseria gonorrhoeae. Design-A prospective observational study with two comparison groups. Setting-A general hospital in Franceville, Gabon. Subjects-Forty-five women with ectopic pregnancies and two comparison groups each of 45 women, one at 5 to 12 and the other at 32 to 41 weeks gestation. Main outcome measures-Serum levels of IgG and IgA antibodies to C. trachomatis (L1 and rMOMP) and N. gonorrhoeae (pili) in all the women. In the women with ectopic pregnancy peritoneal adhesions were scored and in 40 women samples of tube were cultured for organisms being studied. Results-IgG and IgA antibodies to C. trachomatis (L1) were detected in 84% of the ectopic group and 53 and 39% of the comparison groups (P < 0.0001). IgG and IgA antibodies to N. gonorrhoeae occurred in 49, 28 and 18% and 49, 28 and 26% of the groups but the differences were not statistically significant. Adhesions were positively associated with the antibodies. C. trachomatis was cultured from the tubes of 71% of the women with ectopic pregnancy. Conclusions-Infection with chlamydia, and probably with N. gonorrhoeae, is an important factor in the causation of ectopic pregnancy in Gabon.