Prevalence of Chlamydia trachomatis in the general population in Germany – a triangulation of data from two population-based health surveys and a laboratory sentinel system

Abstract

Background Chlamydia trachomatis (chlamydia) is a common, frequently asymptomatic, sexually transmitted infection. It can result in severe sequelae, such as ectopic pregnancy and infertility. In Germany, chlamydia is not notifiable. An opportunistic screening program for women < 25 years was introduced in 2008. The aim of this research was to triangulate different data sources to describe the epidemiological situation of chlamydia in Germany and to investigate whether the current target group of the chlamydia screening program aligns with these findings. Methods Urine specimens from participants from population-based health examination surveys of children (2014–17) and adults (2008–11) were tested for chlamydia, using nucleic acid amplification testing. These data were used to generate weighted chlamydia prevalence estimates by age group and sex. Data from a nationwide chlamydia laboratory sentinel system (2014–16) were used to calculate the positive proportion among individuals tested for chlamydia by age, sex and test reason. Results Using data from the population-based surveys, we found a chlamydia prevalence estimate of 2.8% (95% confidence interval (CI) 1.0–7.5%) among all 15- to 17-year-old girls and of 9.6% (95% CI 0.0–23) among those reporting to be sexually active. In adult women, we found the highest prevalence among 18- to 24-year-olds (all: 2.3%; 95% CI 1.0–5.3%; sexually active: 3.1%; 95% CI 1.3–7.0%). In adult men, we found the highest prevalence among 25- to 29-year-olds (all: 3.5%; 95% CI 1.6–7.7%; sexually active: 3.3%; 95% CI 1.3–7.8%). Data from the chlamydia laboratory sentinel showed the highest positive proportion among those opportunistically screened in 19-year-old women (6.1%; 95%- CI 5.9–6.4%), among those screened due to pregnancy in 15-year-old girls (10%; 95% CI 8.5–12%), and among those tested due to symptoms or a positive partner in 19-year-old women (10%; 95% CI 9.8–11%) and 19-year-old men (24%; 95% CI 22–26%). Conclusions Chlamydia seems to mainly affect adolescents and young adults in Germany, with similar overall prevalence in men and women, but with slightly different age distributions. Women at highest risk of chlamydia are covered by the current screening program but given the on-going discussions in high-income countries on cost-effectiveness and benefit-to-harm ratio of these programs, the program-aim needs reconsideration.

Prevalence of sexually transmitted infections in women of the Czech Republic Armed Forces: a cross-sectional pilot study

“…German study estimates the highest prevalence of 2.3% among 18-24-year-olds. 18 Groups in our study differed in the age of coitarche. Women from G1 were more prone to start their sexual life at an earlier age.…”

“…This multiplex real-time PCR-based method targets the L1 region of the viral genome and allows simultaneous genotyping of 28 HPV types and an internal control. Two PCR reactions were performed for each sample to detect the 19 HR HPV types (HPV 16,18,26,31,33,35,39,45,51,52,53,56,58,59, 66, 68, 69, 73, 82) and the 9 LR HPV types (HPV 6,11,40,42,43,44,54,61,70). Negative and positive controls were included in all PCR runs.…”

Evaluation of Chlamydia trachomatis Genotypes in Endocervical Specimens by Sequence Analysis of ompA Gene among Women in Tehran

“…A recent study in Tanzania showed that 11% of young students (aged 18–24) were infected with chlamydia [ 14 ]. On the other hand, in Germany, only 2.8% of the females were infected with CT which shows that the frequency rates are significantly lower in developed countries [ 15 ]. According to a comprehensive study conducted in Tehran, in 2006, among 1052 women who referred to women's clinics, 12.3% were positive in terms of the presence of CT [ 16 ].…”