Chlamydia trachomatis-Specific Heat Shock Proteins 60 Antibodies can Serve as Prognostic Marker in Secondary Infertile Women R. Dutta, R. Jha, S. Salhan, A. Mittal Abstract Background: The magnitude of reproductive morbidity associated with sexually transmitted Chlamydia trachomatis infection is enormous. A predictive serological test for upper genital tract infection would be a desirable diagnostic tool as C. trachomatis infection may lead to various immunopatho- logical sequelae such as infertility, or ectopic pregnancy. Materials and Methods: Female patients (n = 198) attend- ing gynecology outpatient department of Safdarjung hospital were enrolled for the study and clinically characterized into four groups on the basis of their symptoms; discharge, chronic cervicitis, primary and secondary infertility. Sero- logical detection of C. trachomatis was done by ELISA using specific peptide sequences of major outer membrane protein (MOMP), Chlamydia heat shock protein (cHSP60 and 10). Results: Significant high seropositivity to chlamydial anti- cHSP60 antibodies were detected in patients with secondary infertility. A significant percent of chlamydial reinfection was observed in patients having secondary infertility (82.6%; p < 0.01) and chronic cervicitis (64.28%; p < 0.05). Considering IgG MOMP ELISA as a test standard, anti-cHSP60 antibodies showed higher sensitivity (90.91%) and specificity (89.47%) than cHSP10 ELISA (75.6% and 73.87%) in the secondary infertile group. Further anti- cHSP60 antibodies’ detection had a sensitivity of 67.33% and a specificity of 90.67% in secondary infertile women when compared with DFA and PCR. Conclusions: Our data suggest that detection of anti- cHSP60 antibodies would help in early prognosis of immunopathological sequelae in C. trachomatis-infected women and thereby in instituting appropriate therapy for controlling C. trachomatis infection at an early stage. Infection 2008; 36: 374–378 DOI 10.1007/s15010-008-7129-9 Introduction Genital Chlamydia trachomatis infections are the most prevalent sexually transmitted bacterial disease recog- nized throughout the world. In majority of the women, long-term persistent C. trachomatis infection is often asymptomatic or clinically silent [1]. Chronic chlamydial infection may affect female upper genital tract leading to secondary tubal infertility, pelvic inflammatory disease (PID), chronic pelvic pain, salpingitis and ectopic preg- nancies [2]. A WHO study documented that 18%–20% of infertile women are infected with C. trachomatis world- wide [3] and in India, 28%–30% of infertile women were reported to be C. trachomatis infected, which is quite high in terms of world scenario [4–8]. Recently, we have reported a significant high sero- prevalence of both anti-cHSP60 and 10 antibodies in C. trachomatis-infected women from North India [9]. In addition, elevated antibody titer of both IgG cHSP60 and 10 antibodies were detected in patients with infertility. Owing to the significant association between the sero- logical responses of HSPs with the progressive disease, we next evaluated among cHSP60 and 10 as to which cHSP is more reliable for early diagnosis and if cHSP60 can be used as a prognostic marker for sequelae of C. trachomatis infection in women. The present study will not only help in the designing a cost-effective serological test, but also in the early prognosis of Chlamydia-infected women having clinical relevance and can facilitate the gynecologist for the therapy of choice. Methods Study Population A total of 198 women (age group = 16–50 years) attending the outpatient department (from June 2005 to September 2006) of Safdarjung Hospital, New Delhi, India, for gynecological com- plaints (cervical discharge, lower abdominal pain, cervicitis and infertility) were enrolled for the study after informed written consent and approval of Hospital Ethical Board Committee. R. Dutta, R. Jha, A. Mittal (corresponding author), Institute of Pathology, ICMR, Safdarjung Hospital Campus, Post Box No. 4909, New Delhi, 110 029, India; Phone: (+91/11) -26198402, Fax: -26198401, e-mail: amittal_cp@rediffmail.com S. Salhan Dept. of Gynecology and Obstetrics, Safdarjung Hospital, New Delhi, 110 029, India Received: March 15, 2007 Æ Revision accepted: March 3, 2008 Published online: July 19, 2008 Infection Brief Report 374 Infection 36 Æ 2008 Æ No. 4 Ó URBAN &VOGEL