Epidemiology of Chlamydia trachomatis infection in women and the cost-effectiveness of screening

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 prevalenc...

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Bibliographic Details
Published in:Human reproduction update 2010-03, Vol.16 (2), p.189-204
Main Authors: Land, J.A., Van Bergen, J.E.A.M., Morré, S.A., Postma, M.J.
Format: Article
Language:English
Subjects:
Antibodies, Bacterial - blood
Antigens, Bacterial - analysis
Chlamydia Infections - complications
Chlamydia Infections - diagnosis
Chlamydia Infections - epidemiology
Chlamydia Infections - prevention & control
Chlamydia trachomatis
Chlamydia trachomatis - genetics
Chlamydia trachomatis - immunology
Chlamydia trachomatis - isolation & purification
Cost-Benefit Analysis
cost-effectiveness
DNA, Bacterial - analysis
DNA, Bacterial - genetics
epidemiology
Female
Humans
infertility
Infertility, Female - etiology
Infertility, Female - prevention & control
Mass Screening - economics
Models, Biological
Pelvic Inflammatory Disease - etiology
Pelvic Inflammatory Disease - prevention & control
RNA, Bacterial - analysis
RNA, Bacterial - genetics
screening
Staining and Labeling
Uterine Cervicitis - etiology
Uterine Cervicitis - prevention & control
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Summary: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.
ISSN:1355-4786
1460-2369
DOI:10.1093/humupd/dmp035