How can we improve outcomes of chlamydia control programmes?

Schachter, Julius; Chow, Joan M.

doi:10.1016/s1473-3099(16)30131-1

Cited by 1 publication

(2 citation statements)

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Section: Methodsmentioning

confidence: 99%

“…Tubal tissue damage might already have occurred between acquisition of the infection and the detection, which might partly explain why tested (and treated) women have higher complication rates compared with those not tested. [20][21][22] Realistic estimates of the preventable fraction of adverse fertility outcomes are difficult to obtain as observational studies are fraught with bias. 22 There are no controlled studies using TFI and ectopic pregnancy as outcome measure.…”

Section: Reviewmentioning

confidence: 99%

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Where to go to in chlamydia control? From infection control towards infectious disease control

et al. 2021

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ObjectivesThe clinical and public health relevance of widespread case finding by testing for asymptomatic chlamydia infections is under debate. We wanted to explore future directions for chlamydia control and generate insights that might guide for evidence-based strategies. In particular, we wanted to know the extent to which we should pursue testing for asymptomatic infections at both genital and extragenital sites.MethodsWe synthesised findings from published literature and from discussions among national and international chlamydia experts during an invitational workshop. We described changing perceptions in chlamydia control to inform the development of recommendations for future avenues for chlamydia control in the Netherlands.ResultsDespite implementing a range of interventions to control chlamydia, there is no practice-based evidence that population prevalence can be reduced by screening programmes or widespread opportunistic testing. There is limited evidence about the beneficial effect of testing on pelvic inflammatory disease prevention. The risk of tubal factor infertility resulting from chlamydia infection is low and evidence on the preventable fraction remains uncertain. Overdiagnosis and overtreatment with antibiotics for self-limiting and non-viable infections have contributed to antimicrobial resistance in other pathogens and may affect oral, anal and genital microbiota. These changing insights could affect the outcome of previous cost–effectiveness analysis.ConclusionThe balance between benefits and harms of widespread testing to detect asymptomatic chlamydia infections is changing. The opinion of our expert group deviates from the existing paradigm of ‘test and treat’ and suggests that future strategies should reduce, rather than expand, the role of widespread testing for asymptomatic chlamydia infections.

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Section: Methodsmentioning

confidence: 99%