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Anti‐chlamydia IgG and IgA are insufficient to prevent endometrial chlamydia infection in women, and increased anti‐chlamydia IgG is associated with enhanced risk for incident infection
Author(s) -
Darville Toni,
Albritton Hannah L.,
Zhong Wujuan,
Dong Li,
O'Connell Catherine M.,
Poston Taylor B.,
Quayle Alison J.,
Goonetilleke Nilu,
Wiesenfeld Harold C.,
Hillier Sharon L.,
Zheng Xiaojing
Publication year - 2019
Publication title -
american journal of reproductive immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.071
H-Index - 97
eISSN - 1600-0897
pISSN - 1046-7408
DOI - 10.1111/aji.13103
Subject(s) - chlamydia , antibody , medicine , immunology , immunoglobulin g , chlamydia trachomatis , hazard ratio , immunoglobulin a , antigen , confidence interval
Problem Chlamydia infections in women can ascend to the upper genital tract, and repeated infections are common, placing women at risk for sequelae. The protective role of anti‐chlamydia antibodies to surface exposed antigens in ascending and incident infection is unclear. Method of study A whole‐bacterial ELISA was used to quantify chlamydia‐specific IgG and IgA in serum and cervical secretions of 151 high‐risk women followed longitudinally. Correlations were determined between antibody and cervical burden, and causal mediation analysis investigated the effect of antibody on ascension. We examined the relationship of antibody to incident infection using the marginal Cox model. Results Serum and cervical anti‐chlamydia IgG and cervical IgA levels correlated inversely with cervical burden. While lower burden was associated with reduced ascension, causal mediation analysis revealed that the indirect effects of antibody mediated through reductions in bacterial burden were insufficient to prevent ascension. Analysis of women uninfected at enrollment revealed that serum and cervical anti‐chlamydia IgG were associated with increased risk of incident infection; hazard ratio increased 3.6‐fold (95% CI, 1.3‐10.3), and 22.6‐fold (95% CI, 3.1‐165.2) with each unit of serum and cervical IgG, respectively. Conclusion Although anti‐chlamydia IgG and IgA correlated with reduced cervical chlamydia burden, they failed to prevent ascension and increased levels of anti‐chlamydia IgG were associated with increased risk for incident infection.