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

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Objectives

A better understanding of Chlamydia trachomatis infection (chlamydia)–related sequelae can provide a framework for effective chlamydia control strategies. The objective of this study was to estimate risks and risk factors of pelvic inflammatory disease (PID), ectopic pregnancy and tubal factor infertility (TFI) with a follow-up time of up until 8 years in women previously tested for chlamydia in the Chlamydia Screening Implementation study (CSI) and participating in the Netherlands Chlamydia Cohort Study (NECCST).

Methods

Women who participated in the CSI 2008–2011 (n=13 498) were invited in 2015–2016 for NECCST. Chlamydia positive was defined as a positive CSI-PCR test, positive chlamydia serology and/or self-reported infection (time dependent). Data on PID, ectopic pregnancy and TFI were collected by self-completed questionnaires. Incidence rates and HRs were compared between chlamydia-positive and chlamydia-negative women corrected for confounders.

Results

Of 5704 women included, 29.5% (95% CI 28.3 to 30.7) were chlamydia positive. The incidence rate of PID was 1.8 per 1000 person-years (py) (1.6 to 2.2) overall, 4.4 per 1000 py (3.3 to 5.7) among chlamydia positives compared with 1.4 per 1000 py (1.1 to 1.7) for chlamydia negatives. For TFI, this was 0.4 per 1000 py (0.3 to 0.5) overall, 1.3 per 1000 py (0.8 to 2.1) and 0.2 per 1000 py (0.1 to 0.4) among chlamydia positives and negatives, respectively. And for ectopic pregnancy, this was 0.6 per 1000 py (0.5 to 0.8) overall, 0.8 per 1000 py (0.4 to 1.5) and 0.6 per 1000 py (0.4 to 0.8) for chlamydia negatives. Among chlamydia-positive women, the strongest risk factor for PID was symptomatic versus asymptomatic infection (adjusted HR 2.88, 1.4 to 4.5) and for TFI age <20 versus >24 years at first infection (HR 4.35, 1.1 to 16.8).

Conclusion

We found a considerably higher risk for PID and TFI in chlamydia-positive women, but the incidence for ectopic pregnancy was comparable between chlamydia-positive and chlamydia-negative women. Overall, the incidence rates of sequelae remained low.

Trial registration

NTR-5597.

Related collections

Most cited references 25

Record: found
Abstract: found
Article: not found

Sexually transmitted infections: challenges ahead.

Magnus Unemo, Catriona S. Bradshaw, Jane Hocking … (2017)

WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research. In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control. Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease. The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials. Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches. STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control. Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation. Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health.

0 comments Cited 245 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial

Pippa Oakeshott, Sally M. Kerry, Adamma Aghaizu … (2010)

Objective To determine whether screening and treating women for chlamydial infection reduces the incidence of pelvic inflammatory disease over the subsequent 12 months. Design Randomised controlled trial. Setting Common rooms, lecture theatres, and student bars at universities and further education colleges in London. Participants 2529 sexually active female students, mean age 21 years (range 16-27). Intervention Participants completed a questionnaire and provided self taken vaginal swabs, with follow-up after one year. Samples were randomly allocated to immediate testing and treatment for chlamydial infection, or storage and analysis after a year (deferred screening controls). Main outcome measure Incidence of clinical pelvic inflammatory disease over 12 months. Results Baseline prevalence of chlamydia was 5.4% (68/1254) in screened women and 5.9% (75/1265) in controls. 94% (2377/2529) of women were followed up after 12 months. The incidence of pelvic inflammatory disease was 1.3% (15/1191) in screened women compared with 1.9% (23/1186) in controls (relative risk 0.65, 95% confidence interval 0.34 to 1.22). Seven of 74 control women (9.5%, 95% confidence interval 4.7% to 18.3%) who tested positive for chlamydial infection at baseline developed pelvic inflammatory disease over 12 months compared with one of 63 (1.6%) screened women (relative risk 0.17, 0.03 to 1.01). However, most episodes of pelvic inflammatory disease occurred in women who tested negative for chlamydia at baseline (79%, 30/38). 22% (527/2377) of women reported being tested independently for chlamydia during the trial. Conclusion Although some evidence suggests that screening for chlamydia reduces rates of pelvic inflammatory disease, especially in women with chlamydial infection at baseline, the effectiveness of a single chlamydia test in preventing pelvic inflammatory disease over 12 months may have been overestimated. Trial registration ClinicalTrials.gov NCT00115388.

0 comments Cited 85 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Effectiveness of yearly, register based screening for chlamydia in the Netherlands: controlled trial with randomised stepped wedge implementation

Ingrid V F van den Broek, Jan van Bergen, Elfi E H G Brouwers … (2012)

Objective To evaluate the effectiveness of register based, yearly chlamydia screening. Design Controlled trial with randomised stepped wedge implementation in three blocks. Setting Three regions of the Netherlands: Amsterdam, Rotterdam, and South Limburg. Participants 317 304 women and men aged 16-29 years listed on municipal registers at start of trial. Intervention From March 2008 to February 2011, the Chlamydia Screening Implementation programme offered yearly chlamydia screening tests. Postal invitations asked people to use an internet site to request a kit for self collection of samples, which would then be sent to regional laboratories for testing. Treatment and partner notification were done by the general practitioner or at a sexually transmitted infection clinic. Main outcome measures Primary outcomes were the percentage of chlamydia tests positive (positivity), percentage of invitees returning a specimen (uptake), and estimated chlamydia prevalence. Secondary outcomes were positivity according to sex, age, region, and sociodemographic factors; adherence to screening invitations; and incidence of self reported pelvic inflammatory disease. Results The participation rate was 16.1% (43 358/269 273) after the first invitation, 10.8% after the second, and 9.5% after the third, compared with 13.0% (6223/48 031) in the control block invited at the end of round two of the intervention. Chlamydia positivity in the intervention blocks at the first invitation was the same as in the control block (4.3%) and 0.2% lower at the third invitation (odds ratio 0.96 (95% confidence interval 0.83 to 1.10)). No substantial decreases in positivity were seen after three screening rounds in any region or sociodemographic group. Among the people who participated three times (2.8% of all invitees), positivity fell from 5.9% to 2.9% (odds ratio 0.49 (0.47 to 0.50)). Conclusions There was no statistical evidence of an impact on chlamydia positivity rates or estimated population prevalence from the Chlamydia Screening Implementation programme after three years at the participation levels obtained. The current evidence does not support a national roll out of this register based chlamydia screening programme. Trial registration NTR 3071 (Netherlands Trial Register, www.trialregister.nl).

0 comments Cited 67 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): Sex Transm Infect

Journal ID (iso-abbrev): Sex Transm Infect

Journal ID (hwp): sextrans

Journal ID (publisher-id): sti

Title: Sexually Transmitted Infections

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Print): 1368-4973

ISSN (Electronic): 1472-3263

Publication date (Print): June 2019

Publication date (Electronic): 3 January 2019

Volume: 95

Issue: 4

Pages: 300-306

Affiliations

[1 ] departmentEpidemiology and Surveillance Unit, Centre for Infectious Disease Control , National Institute for Public Health and the Environment , Bilthoven, The Netherlands

[2 ] departmentLaboratory of Immunogenetics, Department of Medical Microbiology and Infection Control , VU University Medical Center , Amsterdam, The Netherlands

[3 ] departmentDepartment of General Practice, Division Clinical Methods and Public Health , Academic Medical Center , Amsterdam, The Netherlands

[4 ] STI AIDS Netherlands (SOA AIDS Nederland) , Amsterdam, The Netherlands

[5 ] departmentDepartment of Sexual Health, Infectious Diseases and Environmental Health , South Limburg Public Health Service (GGD South Limburg) , Geleen, The Netherlands

[6 ] departmentDepartment of Medical Microbiology, Care and Public Health Research Institute (CAPHRI) , Maastricht University Medical Centre (MUMC+) , Maastricht, The Netherlands

[7 ] departmentDepartment Infectious Disease Control , Municipal Public Health Service Rotterdam-Rijnmond (GGD Rotterdam) , Rotterdam, The Netherlands

[8 ] departmentDepartment of Public Health , Erasmus MC—University Medical Center Rotterdam , Rotterdam, The Netherlands

[9 ] departmentSTI Outpatient Clinic , Public Health Service of Amsterdam (GGD Amsterdam) , Amsterdam, The Netherlands

[10 ] departmentDepartment of Genetics and Cell Biology, Research School GROW (School for Oncology and Developmental Biology), Faculty of Health, Medicine and Life Sciences , Institute for Public Health Genomics (IPHG), University of Maastricht , Maastricht, The Netherlands

[11 ] departmentJulius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht, The Netherlands

[12 ] departmentDepartment of Public Health , Institute of Tropical Medicine , Antwerp, Belgium

Author notes

[Correspondence to ] Dr Bernice M Hoenderboom, Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven 3720, The Netherlands; bernice.hoenderboom@ 123456rivm.nl

Author information

Bernice M Hoenderboom http://orcid.org/0000-0003-0146-6198

Hannelore M Götz http://orcid.org/0000-0002-1236-6224

Article

Publisher ID: sextrans-2018-053778

DOI: 10.1136/sextrans-2018-053778

PMC ID: 6585279

PubMed ID: 30606817

SO-VID: 78cd1463-55b1-47a6-baab-46d9ad1ded51

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 25 July 2018

Date revision received : 30 October 2018

Date accepted : 15 November 2018

Funding

Funded by: The Ministry of Health, Welfare and Sports, the Netherlands;

Award ID: NA

Funded by: FundRef http://dx.doi.org/10.13039/501100001826, ZonMw;

Award ID: 50-53000-98-103

Custom metadata

special-feature unlocked

ScienceOpen disciplines: Sexual medicine

Keywords: chlamydia trachomatis,pelvic inflammatory disease,ectopic pregnancy,tubal factor infertility,serology,cohort study

Data availability:

ScienceOpen disciplines: Sexual medicine

Keywords: chlamydia trachomatis, pelvic inflammatory disease, ectopic pregnancy, tubal factor infertility, serology, cohort study

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

Read this article at

Abstract

Objectives

Methods

Results

Conclusion

Trial registration

Related collections

Bioscientifica Reproduction

Most cited references 25

Sexually transmitted infections: challenges ahead.

Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial

Effectiveness of yearly, register based screening for chlamydia in the Netherlands: controlled trial with randomised stepped wedge implementation

Author and article information

Journal

Affiliations

Author notes

Author information

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 125

Cited by 35

Most referenced authors 527