Symptomatic Chlamydia Linked to Higher Reproductive Risk

In a recent prospective cohort study, Dutch researchers examined the risks of reproductive problems following both symptomatic and asymptomatic Chlamydia trachomatis (chlamydia) infections. The report was published in The Lancet Regional Health – Europe.

They discovered that while the prevalence of these problems remained low, only symptomatic chlamydia infections significantly raised the risk of pelvic inflammatory disease (PID), ectopic pregnancy, and tubal factor infertility.

Context
The most prevalent bacterial sexually transmitted infection worldwide is chlamydia trachomatis. The goal of its extensive testing is to lower problems like PID, which can result in ectopic pregnancy and tubal infertility. Individual-level screening lowers the incidence of PID, but population-level impact has been difficult to achieve, particularly in situations of asymptomatic individuals, which are prevalent.

Prior randomized controlled trials have suggested higher risks of reproductive problems following chlamydia infection; however, their accuracy has been hampered by data misclassification and uneven diagnosis techniques.

A more precise evaluation of the effect of chlamydia on female fertility may be possible through prospective studies that include updated chlamydia status and thorough fertility results.

In order to potentially inform chlamydia policy and treatment, researchers evaluated the long-term risks of chlamydia-associated complications (PID, tubal factor infertility, and ectopic pregnancy) and their impact on pregnancy. They did this by comparing the outcomes for asymptomatic and symptomatic infections.

About the study
In this study, 5704 reproductive-age women with a mean age of 35.3 years were included in a long-term prospective cohort from the Netherlands Chlamydia Cohort Study. Of the participants, 64.7% had experienced at least one pregnancy. They were followed from 2008 to 2022 after being selected from a previous chlamydia screening research.

Through the use of questionnaires, information on chlamydia infections, pregnancies, and reproductive difficulties was gathered and combined with screening data from the past.

Based on polymerase chain reaction (PCR) test findings, self-reported infections, and serological testing for the presence of chlamydia antibodies, chlamydia exposure was categorized.

The purpose of the study was to compare the time to pregnancy, ectopic pregnancy hazards, tubal factor infertility, and risk of PID in women with chlamydia (n = 2103) against those without (n = 3691) over a period of time.

Student’s t-test, Mann-Whitney U-test, chi-square tests, Kaplan-Meier curves, the Cox proportional hazards regression model, confounder evaluation, and stratified and sensitivity analysis were all used in the statistical study.

In summary
The study concludes by outlining the long-term hazards to reproductive health that chlamydia infections carry, emphasizing that infections with symptoms increase the likelihood of consequences such tubal factor infertility, ectopic pregnancy, and post-infection diarrhea.

The researchers stress the significance of primary prevention, early detection, and prompt treatment of chlamydia, especially in young women, notwithstanding the low frequency of reproductive concerns found in the study.

To enhance health outcomes for women of reproductive age, customized chlamydia screening and public health measures will be needed in the future. These strategies must also take social and healthcare access inequities into account.

For more information: Reproductive tract complication risks following Chlamydia trachomatis infections: a long-term prospective cohort study from 2008 to 2022., The Lancet Regional Health – Europe, https://doi.org/10.1016/j.lanepe.2024.101027