Human Reproduction Update Advance Access published online on October 14, 2009
Human Reproduction Update, doi:10.1093/humupd/dmp035
Epidemiology of Chlamydia trachomatis infection in women and the cost-effectiveness of screening
1 Department of Obstetrics and Gynaecology, University Medical Center Groningen, PO Box 30 001, 9700 RB Groningen, The Netherlands 2 STI AIDS Netherlands, Amsterdam, The Netherlands 3 Centre for Infectious Disease Control, RIVM, Bilthoven, The Netherlands 4 Laboratory of Immunogenetics, Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands 5 Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
To whom correspondence should be addressed at: 6 Correspondence address. E-mail: j.a.land{at}og.umcg.nl
BACKGROUND: The majority of Chlamydia trachomatis infections in women are asymptomatic, but may give rise to pelvic inflammatory disease (PID) and tubal infertility. Screening programmes aim at reducing morbidity in individuals by early detection and treatment, and at decreasing the overall prevalence of infection in the population. A number of modelling studies have tried to calculate the threshold prevalence of chlamydia lower genital tract infection above which screening becomes cost-effective. There is considerable debate over the exact complication rates after chlamydia infections, and more precise estimates of PID and tubal infertility are needed, for instance to be inserted in economic models.
METHODS: With reference to key studies and systematic reviews, an overview is provided focusing on the epidemiology of chlamydia infection and the risk-estimates of its late complications.
RESULTS: In the literature, the generally assumed risk of developing PID after lower genital tract chlamydia infection varies considerably, and is up to 30%. For developing tubal infertility after PID the risks are 10–20%. This implies that the risk of test-positive women of developing tubal infertility would range between 0.1 and 6%. We included chlamydia IgG antibody testing in a model and estimated a risk of tubal infertility up to 4.6%.
CONCLUSION: The risk of developing late complications after chlamydia lower genital tract infection appears low. High quality RCTs dealing with the transition from cervicitis to infertility are needed to broaden the evidence. In screening programmes, chlamydia antibody testing, as an intermediate marker for potential adverse sequelae, might enable more precise estimates.
Key words: Chlamydia trachomatis / infertility / epidemiology / screening / cost-effectiveness
Received on May 23, 2009; revised August 18, 2009; accepted on August 21, 2009