TY - JOUR
T1 - Risk of reproductive complications following chlamydial testing
T2 - A population-based retrospective cohort study in Denmark
AU - Davies, Bethan
AU - Turner, Katy
AU - Frølund, Maria
AU - Ward, Helen
AU - May, Margaret
AU - Rasmussen, Steen
AU - Benfield, Thomas
AU - Westh, Henrik
PY - 2016/9/1
Y1 - 2016/9/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84999853091&partnerID=8YFLogxK
U2 - 10.1016/S1473-3099(16)30092-5
DO - 10.1016/S1473-3099(16)30092-5
M3 - Article (Academic Journal)
C2 - 27289389
AN - SCOPUS:84999853091
VL - 16
SP - 1057
EP - 1064
JO - Lancet Infectious Diseases
JF - Lancet Infectious Diseases
SN - 1473-3099
IS - 9
ER -