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. 2019 Jun;95(4):300-306.
doi: 10.1136/sextrans-2018-053778. Epub 2019 Jan 3.

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

Bernice M Hoenderboom  1   2 , Birgit H B van Benthem  3 , Jan E A M van Bergen  3   4   5 , Nicole H T M Dukers-Muijrers  6   7 , Hannelore M Götz  3   8   9 , Christian J P A Hoebe  6   7 , Arjan A Hogewoning  10 , Jolande A Land  11 , Marianne A B van der Sande  3   12   13 , Servaas A Morré  2   11 , Ingrid V F van den Broek  3
Affiliations

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

Bernice M Hoenderboom et al. Sex Transm Infect. 2019 Jun.

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.

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

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Kaplan-Meier plots of time (years) by chlamydia status since sexual debut. (A) Pelvic inflammatory disease (PID). (B) Ectopic pregnancy. (C) Tubal factor infertility (TFI). Chlamydia positive was defined as a positive PCR-test outcome in the CSI study (CSI-PCR), and/or the presence of chlamydia IgG and/or a self-reported chlamydia infection. CSI, Chlamydia Screening Implementation.
Figure 2
Figure 2
Forest plot of various sensitivity analyses of the risk for pelvic inflammatory disease (PID), ectopic pregnancy and tubal factor infertility (TFI) between chlamydia-positive and chlamydia-negative women in HRs and 95% CI. CSI, Chlamydia Screening Implementation.
See this image and copyright information in PMC

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