Screening and Treating Chlamydia trachomatis Genital Infection to Prevent Pelvic Inflammatory Disease: Interpretation of Findings From Randomized Controlled Trials

and †British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
Sexually transmitted diseases (Impact Factor: 2.84). 02/2013; 40(2):97-102. DOI: 10.1097/OLQ.0b013e31827bd637
Source: PubMed


We critically reviewed randomized controlled trials evaluating chlamydia screening to prevent pelvic inflammatory disease (PID) and explored factors affecting interpretation and translation of trial data into public health prevention. Taken together, data from these trials offer evidence that chlamydia screening and treatment is an important and useful intervention to reduce the risk of PID among young women. However, the magnitude of benefit to be expected from screening may have been overestimated based on the earliest trials. It is likely that chlamydia screening programs have contributed to declines in PID incidence through shortening prevalent infections, although the magnitude of their contribution remains unclear. Program factors such as screening coverage as well as natural history factors such as risk of PID after repeat chlamydia infection can be important in determining the impact of chlamydia screening on PID incidence in a population. Uptake of chlamydia screening is currently suboptimal, and expansion of screening among young, sexually active women remains a priority. To reduce transmission and repeat infections, implementation of efficient strategies to treat partners of infected women is also essential. Results of ongoing randomized evaluations of the effect of screening on community-wide chlamydia prevalence and PID will also be valuable.

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    • "Such risk factors, particularly tubal disease, smoking and advanced maternal age, are both more prevalent in infertile women (Strandell et al., 1999) and also described as risk factors for EP (Farquhar, 2005). Of these, tubal disease has been the focus of much debate (Roberts et al., 2007; Land et al., 2010; Aghaizu et al., 2011; Turner et al., 2011, 2014; Gillespie et al., 2012; Tuite et al., 2012; Gottlieb et al., 2013; Huang et al., 2013; Fifer and Ison, 2014; de Wit et al., 2015), particularly with regard to the cost effectiveness of organized screening programmes for Chlamydia trachomatis, a sexually transmitted infection (STI) associated with pelvic inflammatory disease (PID), tubal disease and EP. In 2012, a total of 1 422 976 cases of C. trachomatis (643.3 and 262.6 cases per 100 000 females and males, respectively) were reported to have occurred in the USA alone (Centers for Disease Control and Prevention, 2014), making it the most commonly reported STI in developed countries (Roberts et al., 2007). "
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    ABSTRACT: STUDY QUESTION Have the advancement of assisted reproductive technologies (ART) and changes in the incidence of specific causes of infertility-altered ectopic pregnancy (EP) rates following ART over time in the UK?
    Full-text · Article · Jan 2016 · Human Reproduction
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    • "Human Papillomavirus (HPV) and Chlamydia trachomatis are considered among the most common sexually transmitted infections worldwide [Bosch et al., 2012; Forman et al., 2012; Ferná ndez-Benítez et al., 2013; Gottlieb et al., 2013]. A persistent infection with an oncogenic high risk- HPV type is recognized as a crucial event for cervical cancer development [Bosch et al., 2008]. "
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    ABSTRACT: Chlamydia trachomatis causing chronic inflammatory diseases has investigated as possible human papillomavirus (HPV) cofactor in cervical cancer. The aim of this study is to evaluate the prevalence of Chlamydia trachomatis and HPV co-infection in different cohorts of asymptomatic women from a Northern Italy area at high incidence for cervical cancer. Cervical samples from 441 females were collected from Cervical Cancer Screening Program, Sexually Transmitted Infectious and Assisted Reproductive Technology centres. HPV and Chlamydia trachomatis were detected simultaneously and genotyped using a highly sensitive bead based assay. The overall prevalence of Chlamydia trachomatis was estimated 9.7%, in contrast with the reported national data of 2.3%, and co-infection with HPV was diagnosed in the 17% of the samples. In females ≤ 25 years of age, the infection reached a peak of 22% and co-infection with HPV of 45.8% (P < 0.001). Of note, in young females diagnosed with low grade cervical lesions, no significant difference between Chlamydia trachomatis and HPV distribution was observed, while differently, HPV co-infection was found significantly associated to the presence of intraepithelial lesions when compared to older females (20% vs. 1%; P < 0.001). In this study, the use of a high sensitive molecular technique exhibited higher analytical sensitivity than the referred assays for the diagnosis of Chlamydia trachomatis and HPV co-infection in asymptomatic females, leading to reduction of the potential to identify incorrectly the infection status. An active screening for timely treatment of Chlamydia trachomatis infection is suggested in young females to evaluate a possible decrease in incidence of pre-cancer intraepithelial lesions. J. Med. Virol. © 2014 Wiley Periodicals, Inc.
    Full-text · Article · Aug 2014 · Journal of Medical Virology
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    • "Temporary health states might involve different methods for valuation, and there is a need to consider how preferences for temporary and permanent states are combined [44]. Fifth, the sequelae associated with chlamydia sometimes occur many years after the initial infection [37], and so issues of time preference are likely to have an effect on the valuation of the health states [45] [46]. Finally, the burdens associated with the disease are asymmetrical; although both men and women experience infection, the main complications associated with chlamydia affect women of reproductive age [31], but fertility problems can affect others besides the woman herself. "
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    ABSTRACT: Economic evaluations of interventions to prevent and control sexually transmitted infections such as Chlamydia trachomatis are increasingly required to present their outcomes in terms of quality-adjusted life-years using preference-based measurements of relevant health states. The objectives of this study were to critically evaluate how published cost-effectiveness studies have conceptualized and valued health states associated with chlamydia and to examine the primary evidence available to inform health state utility values (HSUVs). A systematic review was conducted, with searches of six electronic databases up to December 2012. Data on study characteristics, methods, and main results were extracted by using a standard template. Nineteen economic evaluations of relevant interventions were included. Individual studies considered different health states and assigned different values and durations. Eleven studies cited the same source for HSUVs. Only five primary studies valued relevant health states. The methods and viewpoints adopted varied, and different values for health states were generated. Limitations in the information available about HSUVs associated with chlamydia and its complications have implications for the robustness of economic evaluations in this area. None of the primary studies could be used without reservation to inform cost-effectiveness analyses in the United Kingdom. Future debate should consider appropriate methods for valuing health states for infectious diseases, because recommended approaches may not be suitable. Unless we adequately tackle the challenges associated with measuring and valuing health-related quality of life for patients with chlamydia and other infectious diseases, evaluating the cost-effectiveness of interventions in this area will remain problematic.
    Full-text · Article · Jan 2014 · Value in Health
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