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P257 Association of Chlamydia trachomatis infection with female infertility
Saturday, June 20, 2009 P255 Pregnancy & Neonatal outcomes of women with reactive syphilis serology in Alberta, 2002 2006 S. Caddy1 *, B. Lee2 , K. Sutherland3 , J. Robinson1 , S. Plitt4 , A. Singh1 . of Alberta, Edmonton, Canada, 2 Provincial Public Health Laboratory, Edmonton, Canada, 3 Alberta Health and Wellness, Edmonton, Canada, 4 Public Health Agency of Canada, Edmonton, Canada 1 University
Objectives: The objectives of this study were to describe the maternal characteristics, maternal diagnosis, pregnancy and neonatal outcomes of pregnant women with reactive syphilis serology (RSS) in Alberta, Canada between 2002 and 2006. Methods: Alberta’s prenatal screening program routinely screens all pregnant women accessing prenatal care; other syphilis testing is performed as clinically indicated. All reactive syphilis tests are reported to provincial STD Services (Alberta Health and Wellness [AHW]). The clinical staging of the mothers and infants was determined by the medical consultant (AES) using provincial surveillance criteria. Inclusion criteria included all pregnant women with RSS between Jan 1, 2002 and Dec 31, 2006. A retrospective review of AHW records and other health and laboratory records was performed. Results: There were 77 pregnancies in 62 women resulting in 1 stillborn, 1 abortion, 1 ectopic pregnancy and 79 live births (includes 5 sets of twins). Of 77 pregnancies: 30 were in women treated for syphilis prior to that pregnancy, 20 infectious syphilis (10 primary, 4 secondary, 6 early latent), 25 late latent syphilis, 1 symptomatic neurosyphilis and 1 unknown stage. There were 7 cases of congenital syphilis born to mothers with syphilis (4 primary, 2 secondary and 1 unknown stage) during this time period. Median gestational age at delivery was 33 weeks (range 23 to 36 weeks). 1 infant had impaired vision (IV), 1 microcephaly (MC) and seizures, 1 MC and IV and 4 cases had no sequelae. In 4 of the congenital cases, the woman did not access prenatal care. Of the 3 tested during pregnancy, one was never located (infant found after adoption), one was located at delivery and in one, the initial test results were consistent with a false positive reaction. In 2006, 3 more babies meeting surveillance criteria for congenital syphilis were born but were not included as their mothers were not diagnosed as cases until 2007. Conclusions: All congenital syphilis cases were born to mothers with infectious syphilis with no reported cases in late latent or previously treated cases. The majority of congenital syphilis cases were born to women with poor or no prenatal care. Initiatives to reach these high risk women are needed. P256 Women in the Shadows (WIS): Impact of a peer-based outreach programme in reaching street-involved pregnant women during a heterosexual syphilis outbreak in Alberta, Canada A. Singh1 *, M. Taylor2 , A. Krasowski2 , K. Turner2 , L. McDermott2 , R. Ahmad2 , P. Conroy3 , T. Guenette4 , S. Plitt5 . 1 University of Alberta, Edmonton, Canada, 2 Streetworks, Edmonton, Canada, 3 Alberta Health Services-Edmonton STD Centre, Edmonton, Canada, 4 Alberta Health Services Edmonton STD Centre, Edmonton, Canada, 5 Public Health Agency of Canada, Edmonton, Canada Objectives: In the context of a heterosexual outbreak of syphilis with resurgence in congenital syphilis cases born mainly to street involved pregnant women, this pilot program was developed to determine the feasibility and utility of using community helpers to reach street involved pregnant women and the impact on testing for sexually transmitted infections (STI). Methods: A WIS team (2 peer workers, a registered nurse, and family physician) plus the outreach team of the Edmonton STD clinic recruited street involved women who were pregnant or believed they might be pregnant. WIS, STD clinic and electronic health records were reviewed to collect information on patient demographics, risk factors for STI, referral to services, prenatal STI testing, birth outcome and infant status at birth. Simple descriptive analyses were performed.
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Results: This pilot is still ongoing with a target completion date of March 30, 2009. Preliminary information as of Jan 26, 2009 shows that 42 street-involved women have accessed this program. 73.5% were aboriginal, 89.7% reported no fixed address and the median age was 26 years (range: 13 39 years). In total, 34 (81.0%) were pregnant. STI testing was performed by the WIS team, STD Outreach team and other clinicians. Overall, 28 pregnant women were screened for syphilis with 5 (17.8%) having a reactive syphilis EIA; of these two were newly identified infectious cases of syphilis. One mother delivered an infant with congenital syphilis and the other was treated in the 2nd trimester and is yet to deliver. All pregnant women tested for HIV (n = 27) were negative; one previously HIV positive woman was not retested. Of 31 women tested for gonorrhoea, 4 (12.9%) were positive. Of 29 tested for chlamydia, 5 (17.2%) were positive. Surveillance data for the geographical region and time period served by the pilot will be reviewed to determine cases of pregnant women with infectious syphilis not reached by this pilot program and possible reasons for this. Additional outcome measures such as number of contacts with the WIS team and referral to services will also be reported. Conclusions With an initial target of 15 women during the first year of the program, this pilot program has already reached and provided expanded services and support to 42 street involved pregnant women. P257 Association of Chlamydia trachomatis infection with female infertility A. Malik1 , M. Rizvi1 *, S. Jain1 , I. Shukla1 , S. Hakim1 . 1 Aligarh Muslim University, Aligarh, India Objectives: Chlamydia trachomatis an important sexually transmitted pathogen is being implicated as an aetiological agent in female infertility. The present study was conducted to assess the prevalence of C. trachomatis in infertile women in North India and to assess the diagnostic value of cell culture, antigen and antibody in its detection. Methods: Women of primary and secondary infertility (n = 110) and 30 healthy term pregnant women as control group were enrolled in the study. Detailed clinical history of each patient was noted. Endocervical swabs were collected for culture of C. trachomatis on cycloheximide treated McCoy cell line and for antigen detection by ELISA. Serum samples were collected for antibody detection by ELISA. Results: C. trachomatis was detected in 29 (26.3%) females by cell culture while 20 (18.8%) patients infected with C. trachomatis were identified by antigen detection. IgG antibody to C. trachomatis was detected in 41 (37.2%) cases suffering from Chlamydia infection. One control was positive for Chlamydia by both cell culture and antigen detection. P < 0.01. Two healthy controls were antibody positive P < 0.01. Overall Chlamydial positivity was found in 51 (46.3%) women. 21 (41.2%) women with Chlamydia infection had primary infertility while majority 30 (58.8%) had secondary infertility. Majority of infected women were asymptomatic 37 (72.5%). Conclusions: A significantly high rate of C. trachomatis infection was seen in cases of both primary and secondary infertility. IgG antibody was detected in maximum cases followed by cell culture and antigen detection. The presence of current infection by Chlamydia trachomatis points to recurrent nature of infection over a period of time which leads to infertility. P258 APTIMA Combo 2® testing detects additional cases of N. gonorrhoeae in community settings J. Kapala1 *, K. Biers1 , M. Cox1 , M. Kamionka1 , J. Sumner1 , D. Jang2 , M. Chernesky2 . 1 Gamma-Dynacare Medical Laboratories, Brampton, Canada, 2 McMaster University/St. Joseph’s Healthcare, Hamilton, Canada Objective: Lower genital tract infections with Neisseria gonorrhoeae [GC] may be asymptomatic and accompanied with Chlamydia trachomatis [CT]. Attempts to culture GC from clinical samples can be unsuccessful. A commercial transcription mediated amplification
Objectives: The objectives of this study were to describe the maternal characteristics, maternal diagnosis, pregnancy and neonatal outcomes of pregnant women with reactive syphilis serology (RSS) in Alberta, Canada between 2002 and 2006. Methods: Alberta’s prenatal screening program routinely screens all pregnant women accessing prenatal care; other syphilis testing is performed as clinically indicated. All reactive syphilis tests are reported to provincial STD Services (Alberta Health and Wellness [AHW]). The clinical staging of the mothers and infants was determined by the medical consultant (AES) using provincial surveillance criteria. Inclusion criteria included all pregnant women with RSS between Jan 1, 2002 and Dec 31, 2006. A retrospective review of AHW records and other health and laboratory records was performed. Results: There were 77 pregnancies in 62 women resulting in 1 stillborn, 1 abortion, 1 ectopic pregnancy and 79 live births (includes 5 sets of twins). Of 77 pregnancies: 30 were in women treated for syphilis prior to that pregnancy, 20 infectious syphilis (10 primary, 4 secondary, 6 early latent), 25 late latent syphilis, 1 symptomatic neurosyphilis and 1 unknown stage. There were 7 cases of congenital syphilis born to mothers with syphilis (4 primary, 2 secondary and 1 unknown stage) during this time period. Median gestational age at delivery was 33 weeks (range 23 to 36 weeks). 1 infant had impaired vision (IV), 1 microcephaly (MC) and seizures, 1 MC and IV and 4 cases had no sequelae. In 4 of the congenital cases, the woman did not access prenatal care. Of the 3 tested during pregnancy, one was never located (infant found after adoption), one was located at delivery and in one, the initial test results were consistent with a false positive reaction. In 2006, 3 more babies meeting surveillance criteria for congenital syphilis were born but were not included as their mothers were not diagnosed as cases until 2007. Conclusions: All congenital syphilis cases were born to mothers with infectious syphilis with no reported cases in late latent or previously treated cases. The majority of congenital syphilis cases were born to women with poor or no prenatal care. Initiatives to reach these high risk women are needed. P256 Women in the Shadows (WIS): Impact of a peer-based outreach programme in reaching street-involved pregnant women during a heterosexual syphilis outbreak in Alberta, Canada A. Singh1 *, M. Taylor2 , A. Krasowski2 , K. Turner2 , L. McDermott2 , R. Ahmad2 , P. Conroy3 , T. Guenette4 , S. Plitt5 . 1 University of Alberta, Edmonton, Canada, 2 Streetworks, Edmonton, Canada, 3 Alberta Health Services-Edmonton STD Centre, Edmonton, Canada, 4 Alberta Health Services Edmonton STD Centre, Edmonton, Canada, 5 Public Health Agency of Canada, Edmonton, Canada Objectives: In the context of a heterosexual outbreak of syphilis with resurgence in congenital syphilis cases born mainly to street involved pregnant women, this pilot program was developed to determine the feasibility and utility of using community helpers to reach street involved pregnant women and the impact on testing for sexually transmitted infections (STI). Methods: A WIS team (2 peer workers, a registered nurse, and family physician) plus the outreach team of the Edmonton STD clinic recruited street involved women who were pregnant or believed they might be pregnant. WIS, STD clinic and electronic health records were reviewed to collect information on patient demographics, risk factors for STI, referral to services, prenatal STI testing, birth outcome and infant status at birth. Simple descriptive analyses were performed.
S107
Results: This pilot is still ongoing with a target completion date of March 30, 2009. Preliminary information as of Jan 26, 2009 shows that 42 street-involved women have accessed this program. 73.5% were aboriginal, 89.7% reported no fixed address and the median age was 26 years (range: 13 39 years). In total, 34 (81.0%) were pregnant. STI testing was performed by the WIS team, STD Outreach team and other clinicians. Overall, 28 pregnant women were screened for syphilis with 5 (17.8%) having a reactive syphilis EIA; of these two were newly identified infectious cases of syphilis. One mother delivered an infant with congenital syphilis and the other was treated in the 2nd trimester and is yet to deliver. All pregnant women tested for HIV (n = 27) were negative; one previously HIV positive woman was not retested. Of 31 women tested for gonorrhoea, 4 (12.9%) were positive. Of 29 tested for chlamydia, 5 (17.2%) were positive. Surveillance data for the geographical region and time period served by the pilot will be reviewed to determine cases of pregnant women with infectious syphilis not reached by this pilot program and possible reasons for this. Additional outcome measures such as number of contacts with the WIS team and referral to services will also be reported. Conclusions With an initial target of 15 women during the first year of the program, this pilot program has already reached and provided expanded services and support to 42 street involved pregnant women. P257 Association of Chlamydia trachomatis infection with female infertility A. Malik1 , M. Rizvi1 *, S. Jain1 , I. Shukla1 , S. Hakim1 . 1 Aligarh Muslim University, Aligarh, India Objectives: Chlamydia trachomatis an important sexually transmitted pathogen is being implicated as an aetiological agent in female infertility. The present study was conducted to assess the prevalence of C. trachomatis in infertile women in North India and to assess the diagnostic value of cell culture, antigen and antibody in its detection. Methods: Women of primary and secondary infertility (n = 110) and 30 healthy term pregnant women as control group were enrolled in the study. Detailed clinical history of each patient was noted. Endocervical swabs were collected for culture of C. trachomatis on cycloheximide treated McCoy cell line and for antigen detection by ELISA. Serum samples were collected for antibody detection by ELISA. Results: C. trachomatis was detected in 29 (26.3%) females by cell culture while 20 (18.8%) patients infected with C. trachomatis were identified by antigen detection. IgG antibody to C. trachomatis was detected in 41 (37.2%) cases suffering from Chlamydia infection. One control was positive for Chlamydia by both cell culture and antigen detection. P < 0.01. Two healthy controls were antibody positive P < 0.01. Overall Chlamydial positivity was found in 51 (46.3%) women. 21 (41.2%) women with Chlamydia infection had primary infertility while majority 30 (58.8%) had secondary infertility. Majority of infected women were asymptomatic 37 (72.5%). Conclusions: A significantly high rate of C. trachomatis infection was seen in cases of both primary and secondary infertility. IgG antibody was detected in maximum cases followed by cell culture and antigen detection. The presence of current infection by Chlamydia trachomatis points to recurrent nature of infection over a period of time which leads to infertility. P258 APTIMA Combo 2® testing detects additional cases of N. gonorrhoeae in community settings J. Kapala1 *, K. Biers1 , M. Cox1 , M. Kamionka1 , J. Sumner1 , D. Jang2 , M. Chernesky2 . 1 Gamma-Dynacare Medical Laboratories, Brampton, Canada, 2 McMaster University/St. Joseph’s Healthcare, Hamilton, Canada Objective: Lower genital tract infections with Neisseria gonorrhoeae [GC] may be asymptomatic and accompanied with Chlamydia trachomatis [CT]. Attempts to culture GC from clinical samples can be unsuccessful. A commercial transcription mediated amplification