Relation Between Infection 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

Overview

Journal Sex Transm Infect

Specialty Infectious Diseases

Date 2019 Jan 5

PMID 30606817

Citations 49

Authors

Bernice M Hoenderboom

Birgit H B van Benthem

Jan E A M van Bergen

Nicole H T M Dukers-Muijrers

Hannelore M Gotz

Christian J P A Hoebe

Arjan A Hogewoning

Jolande A Land

Marianne A B van der Sande

Servaas A Morre

Ingrid V F van den Broek

Affiliations

Soon will be listed here.

Abstract

Objectives: A better understanding of 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).

Methods: Women 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.

Results: Of 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).

Conclusion: We 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 Registration: NTR-5597.

Citing Articles

: From Urogenital Infections to the Pathway of Infertility.

Rodrigues R, Sousa C, Barros A, Vale N Genes (Basel). 2025; 16(2).

PMID: 40004534 PMC: 11855039. DOI: 10.3390/genes16020205.

A Large Study About Reproductive Factors That Predict Hysterosalpingography-Identified Tubal Pathology: An Insight into the Necessity of Preconception Screening.

Nako Y, Ota K, Sujino T, Mitsui J, Kamo H, Katsumata S J Clin Med. 2025; 14(1.

PMID: 39797266 PMC: 11721101. DOI: 10.3390/jcm14010179.

Comparison of the urinary microbiome in men who have sex with men with and without Chlamydia trachomatis infection.

Mofolorunsho K, Mabaso N, Nundlall N, Ojo A, Cason E, Abbai N Eur J Clin Microbiol Infect Dis. 2024; 43(11):2159-2170.

PMID: 39259456 PMC: 11534976. DOI: 10.1007/s10096-024-04930-8.

Reproductive tract complication risks following infections: a long-term prospective cohort study from 2008 to 2022.

Alexiou Z, Hoenderboom B, Hoebe C, Dukers-Muijrers N, Gotz H, van der Sande M Lancet Reg Health Eur. 2024; 45:101027.

PMID: 39247903 PMC: 11378087. DOI: 10.1016/j.lanepe.2024.101027.

The Risk of Pelvic Inflammatory Disease in Women Infected With Chlamydia (Chlamydia trachomatis): A Literature Review.

Maqsood N, Daniel J, Forsyth S Cureus. 2024; 16(8):e66316.

PMID: 39238673 PMC: 11377070. DOI: 10.7759/cureus.66316.

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