Comparison of the population excess fraction of Chlamydia trachomatis infection on pelvic inflammatory disease at 12-months in the presence and absence of Chlamydia testing and treatment: Systematic review and retrospective cohort analysis

Bethan Davies, Katy M.E. Turner, Stella Leung, B. Nancy Yu, Maria Frølund, Thomas Benfield, James Blanchard, Henrik Westh, Helen Ward, Berit S. Andersen, Jette Bangsborg, Claus Bohn Christiansen, Ram B. Dessau, Esad Dzajic, Steen Hoffmann, Poul Kjñldgaard, Jørgen Skov Jensen, Tove E. Jensen, Steen Lomborg, Jens K. MøllerInge Panum, Bjarne Rasmussen, Steen Rasmussen, Per Søgaard, Marianne Kragh Thomsen

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12 Citations (Scopus)

Abstract

Background: The impact of Chlamydia trachomatis (chlamydia) control on the incidence of pelvic inflammatory disease (PID) is theoretically limited by the proportion of PID caused by chlamydia. We estimate the population excess fraction (PEF) of treated chlamydia infection on PID at 12-months in settings with widespread chlamydia control (testing and treatment) and compare this to the estimated PEF of untreated chlamydia. Methods: We used two large retrospective population-based cohorts of women of reproductive age from settings with widespread chlamydia control to calculate the PEF of treated chlamydia on PID at 12-months. We undertook a systematic review to identify further studies that reported the risk of PID in women who were tested for chlamydia (infected and uninfected). We used the same method to calculate the PEF in eligible studies then compared all estimates of PEF. Results: The systematic review identified a single study, a randomised controlled trial of chlamydia screening (POPI-RCT). In the presence of testing and treatment <10% of PID at 12-months was attributable to treated (baseline) chlamydia infections (Manitoba: 8.86%(95%CI 7.15-10.75); Denmark: 3.84%(3.26-4.45); screened-arm POPI-RCT: 0.99%(0.00-29.06)). In the absence of active chlamydia treatment 26.44%(11.57-46.32) of PID at 12-months was attributable to untreated (baseline) chlamydia infections (deferred-arm POPI-RCT). The PEFs suggest that eradicating baseline chlamydia infections could prevent 484 cases of PID at 12-months per 100,000 women in the untreated setting and 13-184 cases of PID per 100,000 tested women in the presence of testing and treatment. Conclusion: Testing and treating chlamydia reduced the PEF of chlamydia on PID by 65% compared to the untreated setting. But in the presence of testing and treatment over 90% of PID could not be attributed to a baseline chlamydia infection. More information is needed about the aetiology of PID to develop effective strategies for improving the reproductive health of women.

Original languageEnglish
Article numbere0171551
JournalPLoS ONE
Volume12
Issue number2
DOIs
Publication statusPublished - Feb 2017
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2017 Davies et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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