In the Journals

Chlamydia increases risk for PID, ectopic pregnancy, female infertility

Results from a large retrospective study confirmed an association between Chlamydia trachomatis and an increased risk for pelvic inflammatory disease, ectopic pregnancy and female infertility, researchers reported.

Chlamydia trachomatis (CT) is the most prevalent bacterial sexually transmitted infection with the highest incidence in 15 to 24 year olds. We know that CT can cause substantial burden of disease in women with pelvic inflammatory disease (PID) and subsequently ectopic pregnancy and infertility. However, the strength of the association between CT and adverse reproductive health outcomes is part of an ongoing scientific debate,” Christian J.P.A. Hoebe, MD, PhD, SPH, head of the Department of Sexual Health, Infectious Diseases and Environmental Health at the South Limburg Public Health Service in the Netherlands, told Infectious Disease News.

“Studying this topic is highly challenging as we cannot establish the natural course of CT consequences prospectively in CT-positive women because effective antibiotic treatment is (ethically) obligate,” Hoebe continued. “Therefore, our aim was to assess the incidence of PID, ectopic pregnancy and female infertility in women with a previous CT diagnosis compared with women who have tested negative for CT and women who have not been tested for CT.”

Hoebe and colleagues performed a retrospective study using data on women aged 12 to 25 years from the Clinical Practice Research Datalink GOLD database, which includes medical records for more than 11 million patients in the United Kingdom, they explained.

In total, 857,324 women were included in the study. Their analysis showed that women who tested positive for CT had an increased risk for PID (adjusted HR = 2.36; 95% CI, 2.01-2.79), ectopic pregnancy (aHR = 1.87; 95% CI, 1.38-2.54) and infertility (aHR = 1.85; 95% CI, 1.27-2.68), when compared with women who tested negative for CT. The researchers also found that the PID risk was higher for women with two or more positive CT tests than those with only one positive test. Additionally, PID risk increased with the number of previous antibiotic prescriptions, regardless of CT test status, according to the study.

“Our findings provide evidence that women with a positive CT test registered at the [general practice] have a higher risk for adverse reproductive health outcomes. Adequate treatment with antibiotics needs to be provided in the individual patient with attention to potential reinfection — therefore partner management and testing for repeat infections after 4 to 6 months should be in place at each general practitioner and at STI clinics,” Hoebe said.

“Our results confirm the reproductive health burden of CT and show the need for adequate public health interventions (enhanced testing efforts in at-risk groups) against CT as still many CT infections are hidden to adequate diagnosis and treatment.” – by Caitlyn Stulpin

Disclosures: Hoebe reports no relevant financial disclosures. Please see the study for all other authors’ disclosures.

Results from a large retrospective study confirmed an association between Chlamydia trachomatis and an increased risk for pelvic inflammatory disease, ectopic pregnancy and female infertility, researchers reported.

Chlamydia trachomatis (CT) is the most prevalent bacterial sexually transmitted infection with the highest incidence in 15 to 24 year olds. We know that CT can cause substantial burden of disease in women with pelvic inflammatory disease (PID) and subsequently ectopic pregnancy and infertility. However, the strength of the association between CT and adverse reproductive health outcomes is part of an ongoing scientific debate,” Christian J.P.A. Hoebe, MD, PhD, SPH, head of the Department of Sexual Health, Infectious Diseases and Environmental Health at the South Limburg Public Health Service in the Netherlands, told Infectious Disease News.

“Studying this topic is highly challenging as we cannot establish the natural course of CT consequences prospectively in CT-positive women because effective antibiotic treatment is (ethically) obligate,” Hoebe continued. “Therefore, our aim was to assess the incidence of PID, ectopic pregnancy and female infertility in women with a previous CT diagnosis compared with women who have tested negative for CT and women who have not been tested for CT.”

Hoebe and colleagues performed a retrospective study using data on women aged 12 to 25 years from the Clinical Practice Research Datalink GOLD database, which includes medical records for more than 11 million patients in the United Kingdom, they explained.

In total, 857,324 women were included in the study. Their analysis showed that women who tested positive for CT had an increased risk for PID (adjusted HR = 2.36; 95% CI, 2.01-2.79), ectopic pregnancy (aHR = 1.87; 95% CI, 1.38-2.54) and infertility (aHR = 1.85; 95% CI, 1.27-2.68), when compared with women who tested negative for CT. The researchers also found that the PID risk was higher for women with two or more positive CT tests than those with only one positive test. Additionally, PID risk increased with the number of previous antibiotic prescriptions, regardless of CT test status, according to the study.

“Our findings provide evidence that women with a positive CT test registered at the [general practice] have a higher risk for adverse reproductive health outcomes. Adequate treatment with antibiotics needs to be provided in the individual patient with attention to potential reinfection — therefore partner management and testing for repeat infections after 4 to 6 months should be in place at each general practitioner and at STI clinics,” Hoebe said.

“Our results confirm the reproductive health burden of CT and show the need for adequate public health interventions (enhanced testing efforts in at-risk groups) against CT as still many CT infections are hidden to adequate diagnosis and treatment.” – by Caitlyn Stulpin

Disclosures: Hoebe reports no relevant financial disclosures. Please see the study for all other authors’ disclosures.