Women who undergo uterine instrumentation are considered at risk for
pelvic infections by Chlamydia trachomatis, which may derive either from ascending endocervical
infections or from reactivation of micro-organisms persisting in the genital tract after previous
chlamydia infections. Women presenting at fertility clinics frequently undergo uterine instrumentation (e.g. hysterosalpingography and laparoscopy with hydrotubation). Studies in subfertile women using
DNA amplification techniques have shown that the prevalence of endocervical
chlamydia infections is low (1.8%). In contrast, in 30-60% of subfertile women chlamydia
IgG antibodies can be found in serum, indicating previous
chlamydia infections. It has been demonstrated that, several years after
chlamydia infections, viable micro-organisms may still be present in the upper genital tract. Therefore, subfertile women with chlamydia
antibodies should be considered at risk for reactivation of persistent
chlamydia infections after uterine instrumentation, even after exclusion of endocervical
chlamydia infections. Moreover, in subfertile women without chlamydia
antibodies, the presence of viable micro-organisms in the genital tract cannot be excluded. As a consequence, prophylactic
antibiotics before uterine instrumentation should be considered in all subfertile women, instead of endocervical screening for C. trachomatis and treatment of positive cases only.