{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T08:28:36Z","timestamp":1793780916415,"version":"4.6.1"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T00:00:00Z","timestamp":1680652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100020087","name":"Huizhou Science and Technology Bureau","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100020087","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p><jats:italic>Chlamydia trachomatis<\/jats:italic> infection, the most prevalent sexually transmitted bacterial infection worldwide, is a significant cause of infertility. Many countries have introduced the widespread use of serologic assays for IgG seropositivity to chlamydial plasmid gene product 3 (Pgp3). However, data on the association between the level of Pgp3-IgG in the multiplex bead array assay (Pgp3AbMBA) and female infertility are still scarce.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cross-sectional analysis included 1,425 women from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2016.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the fully adjusted logistic regression model, each standard deviation increments of Pgp3AbMBA (SD = 17,079.63) led to a 28% increase in the risk of infertility. The relationship remained consistent in women who had been pregnant and women who gave birth. Smooth curve fitting revealed that the association was linear across the entire range of Pgp3AbMBA. Subgroup analysis suggested that the association was significantly stronger in women who had ever used marijuana and lived in poverty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study revealed a linear and independent association between the level of Pgp3AbMBA and self-reported infertility in U.S. women. Furthermore, we found that women who had ever used marijuana and lived in poverty were at the highest risk of infertility upon chlamydial infection.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1117245","type":"journal-article","created":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T05:28:35Z","timestamp":1680672515000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Association between serum Chlamydia trachomatis antibody levels and infertility among reproductive-aged women in the U.S."],"prefix":"10.3389","volume":"11","author":[{"given":"Peiyi","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyun","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,4,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1016\/j.clinbiochem.2018.03.012","article-title":"Fertility and infertility: definition and epidemiology","volume":"62","author":"Borght","year":"2018","journal-title":"Clin Biochem."},{"key":"B2","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1136\/bmj.327.7415.610","article-title":"ABC of subfertility Tubal subfertility","volume":"327","author":"Khalaf","year":"2003","journal-title":"BMJ."},{"key":"B3","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1093\/humupd\/dmw025","article-title":"The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance","volume":"22","author":"Balen","year":"2016","journal-title":"Hum Reprod Update."},{"key":"B4","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1016\/j.fertnstert.2018.06.036","article-title":"Cervicovaginal microbiota, women's health, and reproductive outcomes","volume":"110","author":"Kroon","year":"2018","journal-title":"Fertil Steril."},{"key":"B5","first-page":"834","article-title":"Prevalence of Chlamydia trachomatis genital infection among persons aged 14-39 years\u2013United States, 2007-2012","volume":"63","author":"Torrone","year":"2014","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e629","DOI":"10.1093\/cid\/ciaa1879","article-title":"Seroprevalence of Chlamydia trachomatis among female adults in the United States: The National Health and Nutrition Examination Surveys","volume":"73","author":"Petersen","year":"2021","journal-title":"Clin Infect Dis."},{"key":"B7","unstructured":"2020"},{"key":"B8","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1136\/sextrans-2019-053999","article-title":"Pregnancy and fertility-related adverse outcomes associated with Chlamydia trachomatis infection: a global systematic review and meta-analysis","volume":"96","author":"Tang","year":"2020","journal-title":"Sex Transm Infect."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1892","DOI":"10.1016\/j.vaccine.2013.01.024","article-title":"Chlamydia trachomatis control requires a vaccine","volume":"31","author":"Brunham","year":"2013","journal-title":"Vaccine."},{"key":"B10","doi-asserted-by":"publisher","first-page":"18","DOI":"10.3109\/07853890.2010.546365","article-title":"Chlamydia trachomatis infections of the female genital tract: state of the art","volume":"44","author":"Paavonen","year":"2012","journal-title":"Ann Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/S1473-3099(04)01254-X","article-title":"Can Chlamydia trachomatis directly damage your sperm?","volume":"5","author":"Eley","year":"2005","journal-title":"Lancet Infect Dis."},{"key":"B12","doi-asserted-by":"publisher","first-page":"c1642","DOI":"10.1136\/bmj.c1642","article-title":"Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial","volume":"340","author":"Oakeshott","year":"2010","journal-title":"BMJ."},{"key":"B13","doi-asserted-by":"publisher","first-page":"2424","DOI":"10.1056\/NEJMcp030542","article-title":"Clinical practice. Genital chlamydial infections","volume":"349","author":"Peipert","year":"2003","journal-title":"N Engl J Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1111\/j.1600-0897.2010.00819.x","article-title":"Chlamydia trachomatis, a hidden epidemic: effects on female reproduction and options for treatment","volume":"63","author":"Carey","year":"2010","journal-title":"Am J Reprod Immunol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1152\/physrev.00013.2018","article-title":"The female response to seminal fluid","volume":"100","author":"Schjenken","year":"2020","journal-title":"Physiol Rev."},{"key":"B16","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1128\/CMR.00035-15","article-title":"Human and pathogen factors associated with Chlamydia trachomatis-related infertility in women","volume":"28","author":"Menon","year":"2015","journal-title":"Clin Microbiol Rev."},{"key":"B17","doi-asserted-by":"publisher","first-page":"2795","DOI":"10.1111\/j.1462-5822.2007.00996.x","article-title":"Interleukin-1 is the initiator of fallopian tube destruction during Chlamydia trachomatis infection","volume":"9","author":"Hvid","year":"2007","journal-title":"Cell Microbiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"517","DOI":"10.3109\/23744235.2016.1160421","article-title":"Association of Chlamydia trachomatis with infertility and clinical manifestations: a systematic review and meta-analysis of case-control studies","volume":"48","author":"Ahmadi","year":"2016","journal-title":"Infect Dis."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.1016\/S1473-3099(16)30092-5","article-title":"Risk of reproductive complications following chlamydia testing: a population-based retrospective cohort study in Denmark","volume":"16","author":"Davies","year":"2016","journal-title":"Lancet Infect Dis."},{"key":"B20","doi-asserted-by":"publisher","first-page":"13655","DOI":"10.1038\/s41598-021-93318-1","article-title":"Results from a large cross-sectional study assessing Chlamydia trachomatis, Ureaplasma spp. and Mycoplasma hominis urogenital infections in patients with primary infertility","volume":"11","author":"Paira","year":"2021","journal-title":"Sci Rep."},{"key":"B21","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1136\/sextrans-2018-053778","article-title":"Relation between Chlamydia trachomatis infection and pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in a Dutch cohort of women previously tested for chlamydia in a chlamydia screening trial","volume":"95","author":"Hoenderboom","year":"2019","journal-title":"Sex Transm Infect."},{"key":"B22","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1097\/00007435-200305000-00016","article-title":"Gonorrhea prevalence and coinfection with chlamydia in women in the United States, 2000","volume":"30","author":"Dicker","year":"2003","journal-title":"Sex Transm Dis."},{"key":"B23","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1111\/j.1447-0756.2004.00181.x","article-title":"Analysis of the prevalence of bacterial vaginosis and Chlamydia trachomatis infection in 6083 pregnant women at a hospital in Otaru, Japan","volume":"30","author":"Shimano","year":"2004","journal-title":"J Obstet Gynaecol Res."},{"key":"B24","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1086\/367658","article-title":"Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection","volume":"36","author":"Wiesenfeld","year":"2003","journal-title":"Clin Infect Dis."},{"key":"B25","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1136\/sti.2005.017186","article-title":"Incidence of severe reproductive tract complications associated with diagnosed genital chlamydial infection: the Uppsala Women's Cohort Study","volume":"82","author":"Low","year":"2006","journal-title":"Sex Transm Infect."},{"key":"B26","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1136\/sextrans-2013-051074","article-title":"Chlamydia trachomatis IgG seroprevalence in the general population of the Netherlands in 1996 and in 2007: differential changes by gender and age","volume":"90","author":"van Aar","year":"2014","journal-title":"Sex Transm Infect."},{"key":"B27","doi-asserted-by":"publisher","first-page":"918","DOI":"10.3390\/microorganisms8060918","article-title":"Screening of Chlamydia trachomatis and Waddlia chondrophila antibodies in women with tubal factor infertility","volume":"8","author":"van Dooremalen","year":"2020","journal-title":"Microorganisms."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1522","DOI":"10.1016\/j.fertnstert.2015.08.022","article-title":"Chlamydia trachomatis immunoglobulin G3 seropositivity is a predictor of reproductive outcomes in infertile women with patent fallopian tubes","volume":"104","author":"Steiner","year":"2015","journal-title":"Fertil Steril."},{"key":"B29","doi-asserted-by":"publisher","first-page":"6017","DOI":"10.1128\/JB.00847-10","article-title":"Characterization of pgp3, a Chlamydia trachomatis plasmid-encoded immunodominant antigen","volume":"192","author":"Chen","year":"2010","journal-title":"J Bacteriol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1128\/CVI.00021-09","article-title":"Pgp3 antibody enzyme-linked immunosorbent assay, a sensitive and specific assay for seroepidemiological analysis of Chlamydia trachomatis infection","volume":"16","author":"Wills","year":"2009","journal-title":"Clin Vaccine Immunol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1662","DOI":"10.4269\/ajtmh.17-0292","article-title":"Comparison of platforms for testing antibody responses against the Chlamydia trachomatis antigen pgp3","volume":"97","author":"Gwyn","year":"2017","journal-title":"Am J Trop Med Hyg."},{"key":"B32","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.mimet.2018.02.017","article-title":"Evaluation of the reproducibility of a serological test for antibodies to Chlamydia trachomatis pgp3: a potential surveillance tool for trachoma programs","volume":"147","author":"Kaur","year":"2018","journal-title":"J Microbiol Methods."},{"key":"B33","doi-asserted-by":"publisher","first-page":"e0151497","DOI":"10.1371\/journal.pone.0151497","article-title":"Chlamydia trachomatis pgp3 antibody persists and correlates with self-reported infection and behavioural risks in a blinded cohort study","volume":"11","author":"Horner","year":"2016","journal-title":"PLoS ONE."},{"key":"B34","first-page":"1","article-title":"National Health and Nutrition Examination Survey, 2015-2018: sample design and estimation procedures","volume":"184","author":"Chen","year":"2020","journal-title":"Vital Health Stat."},{"key":"B35","unstructured":"National Center for Health Statistics (NCHS) Ethics Review Board (ERB) Approval. National Health and Nutrition Examination Survey"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e296","DOI":"10.1097\/EDE.0b013e3181577654","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"4","author":"von Elm","year":"2007","journal-title":"PLoS Med."},{"key":"B37","doi-asserted-by":"publisher","first-page":"e1873","DOI":"10.1371\/journal.pntd.0001873","article-title":"CT694 and pgp3 as serological tools for monitoring trachoma programs","volume":"6","author":"Goodhew","year":"2012","journal-title":"PLoS Negl Trop Dis."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1177\/0956462418785244","article-title":"Comparison of three serological assays to measure antibody response to chlamydia antigen pgp3 in adolescent and young adults with pelvic inflammatory disease","volume":"29","author":"Dize","year":"2018","journal-title":"Int J STD AIDS."},{"key":"B39","unstructured":"National Center for Health Statistics. National Health and Nutrition Examination Survey (NHANES) Tutorials\u2014Module 3\u2014Weighting"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1517","DOI":"10.1093\/cid\/ciz429","article-title":"Chlamydia trachomatis and the risk of pelvic inflammatory disease, ectopic pregnancy, and female infertility: a retrospective cohort study among primary care patients","volume":"69","author":"den Heijer","year":"2019","journal-title":"Clin Infect Dis."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.1093\/cid\/ciab506","article-title":"High plasmid gene protein 3 (pgp3) Chlamydia trachomatis seropositivity, pelvic inflammatory disease, and infertility among women, National Health and Nutrition Examination Survey, United States, 2013-2016","volume":"73","author":"Anyalechi","year":"2021","journal-title":"Clin Infect Dis."},{"key":"B42","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1136\/sextrans-2011-050386","article-title":"Effect of time since exposure to Chlamydia trachomatis on chlamydia antibody detection in women: a cross-sectional study","volume":"89","author":"Horner","year":"2013","journal-title":"Sex Transm Infect."},{"key":"B43","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1186\/1471-2334-14-216","article-title":"Longitudinal analysis of antibody responses to trachoma antigens before and after mass drug administration","volume":"14","author":"Goodhew","year":"2014","journal-title":"BMC Infect Dis."},{"key":"B44","doi-asserted-by":"publisher","first-page":"1818","DOI":"10.1093\/humrep\/dez098","article-title":"Marijuana smoking and outcomes of infertility treatment with assisted reproductive technologies","volume":"34","author":"Nassan","year":"2019","journal-title":"Hum Reprod."},{"key":"B45","doi-asserted-by":"publisher","first-page":"E425","DOI":"10.1007\/BF02854916","article-title":"Endocannabinoid signaling directs periimplantation events","volume":"8","author":"Wang","year":"2006","journal-title":"AAPS J."},{"key":"B46","doi-asserted-by":"publisher","first-page":"2122","DOI":"10.1172\/JCI28621","article-title":"Fatty acid amide hydrolase deficiency limits early pregnancy events","volume":"116","author":"Wang","year":"2006","journal-title":"J Clin Invest."},{"key":"B47","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1021\/cn300014e","article-title":"Endocannabinoid signaling in female reproduction","volume":"3","author":"Sun","year":"2012","journal-title":"ACS Chem Neurosci."},{"key":"B48","doi-asserted-by":"publisher","first-page":"1989","DOI":"10.1093\/humrep\/dep065","article-title":"Fluctuation in anandamide levels from ovulation to early pregnancy in in-vitro fertilization-embryo transfer women, and its hormonal regulation","volume":"24","author":"El-Talatini","year":"2009","journal-title":"Hum Reprod."},{"key":"B49","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1016\/j.ajog.2022.05.056","article-title":"Impact of cannabinoids on pregnancy, reproductive health, and offspring outcomes","volume":"227","author":"Lo","year":"2022","journal-title":"Am J Obstet Gynecol."},{"key":"B50","doi-asserted-by":"publisher","first-page":"2910","DOI":"10.3390\/ph3092910","article-title":"From fertilisation to implantation in mammalian pregnancy-modulation of early human reproduction by the endocannabinoid system","volume":"3","author":"Bambang","year":"2010","journal-title":"Pharmaceuticals."},{"key":"B51","first-page":"1","author":"Bishaw","year":"2007","journal-title":"Income, Earnings, and Poverty From the 2005 American Community Survey."},{"key":"B52","first-page":"27","article-title":"Syntax of referencing","author":"Unnithan-Kumar","year":"2001","journal-title":"Emotion, Agency and Access to Healthcare: Women's Experiences of Reproduction in Jaipur"},{"key":"B53","doi-asserted-by":"publisher","first-page":"e037905","DOI":"10.1136\/bmjopen-2020-037905","article-title":"Retrospective cross-sectional analysis of the changes in marijuana use in the USA, 2005-2018","volume":"10","author":"Mitchell","year":"2020","journal-title":"BMJ Open."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1117245\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T05:28:50Z","timestamp":1680672530000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1117245\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,5]]},"references-count":53,"alternative-id":["10.3389\/fpubh.2023.1117245"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1117245","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,5]]},"article-number":"1117245"}}