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Randomized Controlled Trial
. 2010 Apr 8:340:c1642.
doi: 10.1136/bmj.c1642.

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

Pippa Oakeshott  1 , Sally Kerry, Adamma Aghaizu, Helen Atherton, Sima Hay, David Taylor-Robinson, Ian Simms, Phillip Hay
Affiliations
Randomized Controlled Trial

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

Pippa Oakeshott et al. BMJ. .

Abstract

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.

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Conflict of interest statement

Competing interests: All authors have completed the unified competing interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare (1) no financial support for the submitted work from anyone other than their employer; (2) no financial relationships with commercial entities that might have an interest in the submitted work; (3) no spouses, partners, or children with relationships with commercial entities that might have an interest in the submitted work; and (4) no non-financial interests that may be relevant to the submitted work.

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References

    1. Centers for Disease Control. Sexually transmitted diseases treatment guidelines. MMWR 2006;55:56-7.
    1. European Centre for Disease Prevention and Control. Chlamydia control in Europe. ECDC, 2009.
    1. National Institute for Health and Clinical Excellence. Revised rapid review of evidence for the effectiveness of screening for genital chlamydia infection in sexually active young women and men. NICE, 2006.
    1. Scholes D, Stergachis A, Heidrich F, Andrilla H, Holmes K, Stamm W. Prevention of pelvic inflammatory disease by screening for cervical chlamydia infection. N Engl J Med 1996;334:1362-6. - PubMed
    1. Abter E, Mahmud M. Screening for chlamydia to prevent pelvic inflammatory disease. N Engl J Med 1996;335:1531. - PubMed

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