Prevalence of Genital Chlamydia Trachomatis in Iran: a Systematic Review and Meta-analysis

Objective: To determine the overall prevalence of Chlamydia trachomatis in Iranian males and females and to find out the effect of this bacterium on fertility potential and its association with urogenital symptoms.

Methods: We searched both English and Persian electronic databases using keywords 'Chlamydia', 'Chlamydia trachomatis', 'prevalence', 'incidence', 'frequency', 'epidemiology' and 'Iran'. Finally, after some exclusion, 34 studies from different regions of Iran were included in our study, and a meta-analysis was performed to determine pooled prevalence estimates for each group.

Results: C. trachomatis prevalence for women and men was high and ranged from 0 to 32.7% and 0 to 23.3%, respectively (95% CI). The pooled prevalence of the bacterium in the female population was 12.3% (95% CI: 10.6-14.2%) and in men was 10.9% (95% CI: 7.6-15.4%). A high level of heterogeneity was seen for both men (I(2)  = 77.4%; P < 0.001) and women (I(2)  = 77.5%; P < 0.001); but in men and not in women, some evidence for publication bias was observed [Egger's test (two-tailed P = 0.013); Begg's test (two-tailed P = 0.025)]. In females analysis of symptomatic/infertile group with asymptomatic/fertile group in females, the overall OR was above 1 and the overall P-value was below zero.

Conclusions: This bacterium may play a role in female infertility or be associated with clinical manifestations; thus, planning national programmes for adequate diagnosis of genital infections caused by this pathogen is necessary. Furthermore, screening strategies, particularly for asymptomatic individuals, and treatment of infected people can reduce consequent complications.