Relation betweenChlamydia trachomatisinfection 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

Abstract

ObjectivesA 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).MethodsWomen 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.ResultsOf 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).ConclusionWe 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 registrationNTR-5597.

Risk factors of tubal infertility in a tertiary hospital in a low-resource setting: a case-control study

“…Voluntary termination of pregnancy is illegal in Cameroon. Therefore, most of these procedures are carried out in unorthodox conditions, sometimes by unqualified health or non-health professionals, resulting in increased rates of peritonitis, sepsis, and subsequent infertility [25][26][27][28].…”

“…Young women in particular should be targeted for screening and intervention on "fertility protection". Of specific concern are the "silent" or atypical cases of PID that may present with vague symptoms but are not associated with pain; these infections are often only identified retrospectively during an infertility investigation [27,28]. Unfortunately, there are no regular screening programmes for STI in Cameroon and in most cases only the antibody (serology) test for chlamydia is used.…”

“…However, infections that damage the tubes to cause ectopic gestation usually affect both tubes. In addition, surgery for ectopic pregnancy may lead to post-operative adhesions especially when done by open surgery or laparotomy [27,31,32]. That still, medical treatment of ectopic pregnancy with methotrexate has been reported in some studies in Cameroon and elsewhere [33][34][35].…”

“…The practice of safe sex has been advocated as a means of reducing sexually transmitted infections (STI's) and their sequelae that may lead to tubal infertility [43][44][45]. As already mentioned screening young girls for Chlamydia trachomatis and treating suspected cases of C. trachomatis infection is another important modality to avoid complications like pelvic inflammatory disease [27]. Furthermore, treatment of sexual partners of those infected will reduce reinfection among couples.…”

Impact of genital Chlamydia trachomatis infection on reproductive outcomes among infertile women undergoing tubal flushing: a retrospective cohort at a fertility centre in Uganda

“…Considering that 70-80% of C. trachomatis infections go unrecognised [15], persistent infection may increase the risk for pelvic inflammatory disease, tubal factor related infertility and ectopic pregnancy [15][16][17]. Moreover, all these sequelae can increase the severity of any pre-existing tubal pathology which may reduce the chance of pregnancy after tubal flushing.…”