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Abstract
Background: Uncertainty in the risk of reproductive complications (pelvic inflammatory disease (PID), ectopic pregnancy (EP) and tubal factor infertility (TFI)) following chlamydia infection and repeat infection hampers the design of evidence-based chlamydia control programmes. We estimate the association between diagnosed chlamydia and episodes of hospital healthcare (in-patient, out-patient and emergency department) for a reproductive complication.
Methods: We constructed and analysed a retrospective population-based cohort of women aged 15-44 years from administrative records in Denmark (1995-2012).
Findings: The 516,720 women (103,344 positive, 182,879 negative, 230,497 never-tested) had a mean follow-up of 7.96 years. Compared to women with only negative tests, the risk of each complication was 30% higher in women with ≥1 positive test (adjusted hazard ratios (AHRs) PID 1·50(1·43-1·57); EP 1·31(1·25-1·38); TFI 1·37(1·24-1·52)) and 60% lower in women who were never-tested (AHRs PID 0·33(0·31-0·35); EP 0·42(0·39-0·44); TFI 0·29(0·25-0·33)). A positive test had a minor absolute impact on health as the difference in the lifetime incidence of complications was small between women who tested positive and those who tested negative (PID 0.6%; EP 0.2%; TFI 0·1%). Repeat infections increased the risk of PID by a further 20% (AHR 1·20(1·11-1·31)).
Interpretation: A single diagnosed chlamydia infection increased the risk of all complications and a repeat diagnosed infection further increased the risk of PID. Therefore control programmes must prevent first and repeat infections to improve women’s reproductive health.
Methods: We constructed and analysed a retrospective population-based cohort of women aged 15-44 years from administrative records in Denmark (1995-2012).
Findings: The 516,720 women (103,344 positive, 182,879 negative, 230,497 never-tested) had a mean follow-up of 7.96 years. Compared to women with only negative tests, the risk of each complication was 30% higher in women with ≥1 positive test (adjusted hazard ratios (AHRs) PID 1·50(1·43-1·57); EP 1·31(1·25-1·38); TFI 1·37(1·24-1·52)) and 60% lower in women who were never-tested (AHRs PID 0·33(0·31-0·35); EP 0·42(0·39-0·44); TFI 0·29(0·25-0·33)). A positive test had a minor absolute impact on health as the difference in the lifetime incidence of complications was small between women who tested positive and those who tested negative (PID 0.6%; EP 0.2%; TFI 0·1%). Repeat infections increased the risk of PID by a further 20% (AHR 1·20(1·11-1·31)).
Interpretation: A single diagnosed chlamydia infection increased the risk of all complications and a repeat diagnosed infection further increased the risk of PID. Therefore control programmes must prevent first and repeat infections to improve women’s reproductive health.
Original language | English |
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Pages (from-to) | 1057-1064 |
Number of pages | 8 |
Journal | Lancet Infectious Diseases |
Volume | 16 |
Issue number | 9 |
Early online date | 8 Jun 2016 |
DOIs | |
Publication status | Published - 1 Sep 2016 |
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Projects
- 1 Finished
Profiles
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Dr Katherine Mary Elizabeth Turner
- Bristol Medical School (PHS) - Reader in Infectious Disease Epidemiology
- Bristol Population Health Science Institute
- Health Protection Research Unit (HPRU)
- Biostatistics, Epidemiology, Mathematics and Ecology
- Infection and Immunity
Person: Academic , Member