Genital Chlamydia trachomatis Infection is Related to Poor Sexual ...

1132 Cai et al.
women could be then considered as a potential
disease reservoir. Absence of symptoms increases
the risk of infecting sexual partners and may cause
long-term complications in men, too, such as poor
quality of semen and infertility [3,5]. Ct infection
long-term effects include ectopic pregnancy and
tubal inflammation with subsequent infertility
[4,5]. The effects of Ct infections on women’s
sexual quality of life have not been previously
clearly demonstrated [6], although several authors
described symptoms such as dyspareunia and
vaginal discharge as limiting factors in women’s
sexual life [7,8]. Other studies demonstrated that
sexually transmitted diseases (STDs) in general
could have a significant impact on sexual quality of
life, although these studies have been carried out
on specific subject populations, such as sex workers
[6] or adolescents [9,10]. The aim of the present
study was to assess whether genital Ct infection
could induce sexual function alterations in young
sexually active women.
Materials and Methods
Study Design
The present study was planned as cross-sectional,
in line with the definition by Abramson et al. [11],
to test the relationship between Ct genital infection
and sexual quality of life in young women. We
planned this study as cross-sectional due to the fact
that this kind of study describes the relationship
between diseases (or other health-related states)
and other factors of interest as they exist in a specified
population at a particular time, without regard
to what may have preceded or precipitated the
health status found at the time of the study. Female
partners of patients affected by chronic bacterial
prostatitis attending our STDs centre were clinically
and microbiologically evaluated over the last
10 years. All of them underwent microbiological
analyses for common bacteria/yeasts or Ct due to
their sexual relationships with subjects affected by
chronic bacterial prostatitis. All participants
anonymously completed the Female Sexual Function
Index [FSFI questionnaire], in accordance
with Rosen et al. [12]. All patients were then split
into three groups, in accordance with their microbiological
results: Group A—women with genital
Ct infection, Group B—women with genital
bacterial/yeast infection, and Group C—women
negative for genital Ct infection. Data from the
FSFI questionnaire were analyzed in order to test
the differences among the three groups. Group A
was considered as the patients group, while
J Sex Med 2011;8:1131–1137
Groups B and C were considered as control
groups. The ratio between case and control was
established as at least 1:2. The diagnosis of Ct
vaginal infection was carried out in accordance
with Schachter et al. [13], by using self-collected
vaginal swab (VGS) and nucleic acid amplification
tests. In short, we considered positive a Ct patient
with VGS positive for Ct-DNA and/or anti-Ct
mucosal IgA. All patients signed an informed
consent form explaining the nature of the study.
The women did not receive any compensation for
participating in this study. Participation was, then,
voluntary and anonymous. Physical examination
was not carried out in accordance with Schachter
et al. [13]. Finally, in the present study, no information
about therapy, clinical outcome, or
follow-up data has been supplied.
Inclusion and Exclusion Criteria
Patient characteristics consisted of age between 18
and 45 years, premenopausal status, absence of
comorbidities, no medical treatments for pain, no
genital anatomical deformity, no previous genitourinary
surgery, no prescription drug use,
regular sex life, and singular sexual partner during
the last 3 months. Furthermore, all women who
had undergone therapy with antibiotics, nonsteroidal
anti-inflammatory drugs, or steroids for 4
weeks prior to the study were excluded. Additional
exclusion criteria were use of hormone therapy
and pregnancy or lactation. Moreover, all women
who were symptomatic for already known urinary
or genital infections, or who had a medical history
of vulvar itching, fissures, abnormal discharge, and
persistent pain at intercourse were also excluded.
FSFI
The FSFI is a brief multidimensional validated
scale for assessing sexual function in women that
includes 19 questions grouped into six domains
(desire, subjective arousal, lubrication, orgasm,
satisfaction, and pain) with a total score range
between 2 and 36 with higher scores indicating
better functions [12]. In accordance with Giuliano
et al., FSFI cutoff score for female sexual dysfunction
of 23 was used [14]. The questionnaires were
self-administered when the patient arrived at our
centre.
Sample Collection and Laboratory Procedures
All microbiological analyses were carried out in
accordance with Mazzoli et al. [15]. However, in
brief, from each subject, three biological samples
were collected: first void early morning urine