How Much Tubal Factor Infertility Is Caused by Chlamydia? Estimates Based on Serological Evidence Corrected for Sensitivity and Specificity

Malcolm J. Price, A. E. Ades, Nicky J. Welton, John A A Macleod, Katy Turner, Ian Simms, Paddy J. Horner

Research output: Contribution to journalArticle (Academic Journal)peer-review

32 Citations (Scopus)


Objectives: To estimate the proportion of tubal factor infertility (TFI) caused by Chlamydia trachomatis (CT), the etiologic fraction, from a retrospective study of CT antibody prevalence in TFI cases and controls, adjusted for sensitivity and specificity. Methods: We use published data on sensitivity and specificity to estimate the performance of assays in (a) women with a previous CT infection without sequelae and (b) women with TFI caused by CT. A model was developed and applied to antibody prevalence in TFI cases and controls from 1 published case-control study to estimate the proportion of TFI caused by CT. Results: The proportion of TFI episodes that were due to CT infection was estimated to be 45% (credible intervals: 28%, 62%). Models which assume that test sensitivity is higher in women with CT-related TFI than women with previous infection and no sequelae fit the data significantly better than models that assume the same sensitivity in all those previously infected. Conclusions: Greater attention needs to be paid to methods for characterizing the performance of CT antibody tests. Serological studies could be given a greater role both in CT etiology and in monitoring the effects of prevention and control programmes.

Original languageEnglish
Pages (from-to)608-613
Number of pages6
JournalSexually Transmitted Diseases
Issue number8
Publication statusPublished - Aug 2012


  • Adolescent
  • Adult
  • Algorithms
  • Antibodies, Bacterial
  • Chlamydia Infections
  • Chlamydia trachomatis
  • Fallopian Tube Diseases
  • Female
  • Great Britain
  • Humans
  • Infertility, Female
  • Retrospective Studies
  • Sensitivity and Specificity
  • Young Adult

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