Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease, Ectopic Pregnancy, and Female Infertility: A Retrospective Cohort Study Among Primary Care Patients

Casper D. J. den Heijer, Christian J. P. A. Hoebe, Johanna H. M. Driessen, Petra Wolffs, Ingrid V. F. van den Broek, Bernice M. Hoenderboom, Rachael Williams, Frank de Vries, Nicole H. T. M. Dukers-Muijrers

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: We evaluated the risk of pelvic inflammatory disease (PID), ectopic pregnancy, and infertility in women with a previous Chlamydia trachomatis (CT) diagnosis compared with women who tested negative for CT and CT untested women, considering both targeted and incidental (ie, prescribed for another indication) use of CT-effective antibiotics. METHODS: This was a retrospective study of women aged 12-25 years at start of follow-up within the Clinical Practice Research Datalink GOLD database linked to index of multiple deprivation quintiles, 2000-2013. CT test status and antibiotic use were determined in a time-dependent manner. Risk of PID, ectopic pregnancy, or female infertility were evaluated using of Cox proportional hazard models. RESULTS: We studied 857 324 women, contributing 6 457 060 person-years. Compared with women who tested CT-negative, women who tested CT-positive had an increased risk of PID (adjusted hazard ratio [aHR], 2.36; 95% confidence interval [CI], 2.01-2.79), ectopic pregnancy (aHR, 1.87; 95% CI, 1.38-2.54), and infertility (aHR, 1.85; 95% CI, 1.27-2.68). The PID risk was higher for women with 2 or more positive CT tests than those with 1 positive test. PID risk increased with the number of previous antibiotic prescriptions, regardless of CT test status. CONCLUSIONS: We showed an association between CT-positive tests and 3 adverse reproductive health outcomes. Moreover, this risk increased with repeat CT infections. CT-effective antibiotic use showed no decreased risks of subsequent PID regardless of CT history. Our results confirm the reproductive health burden of CT, which requires adequate public health interventions.
Original languageEnglish
Pages (from-to)1517-1525
JournalClinical Infectious Diseases
Volume69
Issue number9
DOIs
Publication statusPublished - 2019

Cite this

den Heijer, Casper D. J. ; Hoebe, Christian J. P. A. ; Driessen, Johanna H. M. ; Wolffs, Petra ; van den Broek, Ingrid V. F. ; Hoenderboom, Bernice M. ; Williams, Rachael ; de Vries, Frank ; Dukers-Muijrers, Nicole H. T. M. / Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease, Ectopic Pregnancy, and Female Infertility: A Retrospective Cohort Study Among Primary Care Patients. In: Clinical Infectious Diseases. 2019 ; Vol. 69, No. 9. pp. 1517-1525.
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title = "Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease, Ectopic Pregnancy, and Female Infertility: A Retrospective Cohort Study Among Primary Care Patients",
abstract = "BACKGROUND: We evaluated the risk of pelvic inflammatory disease (PID), ectopic pregnancy, and infertility in women with a previous Chlamydia trachomatis (CT) diagnosis compared with women who tested negative for CT and CT untested women, considering both targeted and incidental (ie, prescribed for another indication) use of CT-effective antibiotics. METHODS: This was a retrospective study of women aged 12-25 years at start of follow-up within the Clinical Practice Research Datalink GOLD database linked to index of multiple deprivation quintiles, 2000-2013. CT test status and antibiotic use were determined in a time-dependent manner. Risk of PID, ectopic pregnancy, or female infertility were evaluated using of Cox proportional hazard models. RESULTS: We studied 857 324 women, contributing 6 457 060 person-years. Compared with women who tested CT-negative, women who tested CT-positive had an increased risk of PID (adjusted hazard ratio [aHR], 2.36; 95{\%} confidence interval [CI], 2.01-2.79), ectopic pregnancy (aHR, 1.87; 95{\%} CI, 1.38-2.54), and infertility (aHR, 1.85; 95{\%} CI, 1.27-2.68). The PID risk was higher for women with 2 or more positive CT tests than those with 1 positive test. PID risk increased with the number of previous antibiotic prescriptions, regardless of CT test status. CONCLUSIONS: We showed an association between CT-positive tests and 3 adverse reproductive health outcomes. Moreover, this risk increased with repeat CT infections. CT-effective antibiotic use showed no decreased risks of subsequent PID regardless of CT history. Our results confirm the reproductive health burden of CT, which requires adequate public health interventions.",
author = "{den Heijer}, {Casper D. J.} and Hoebe, {Christian J. P. A.} and Driessen, {Johanna H. M.} and Petra Wolffs and {van den Broek}, {Ingrid V. F.} and Hoenderboom, {Bernice M.} and Rachael Williams and {de Vries}, Frank and Dukers-Muijrers, {Nicole H. T. M.}",
year = "2019",
doi = "10.1093/cid/ciz429",
language = "English",
volume = "69",
pages = "1517--1525",
journal = "Clinical Infectious Diseases",
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den Heijer, CDJ, Hoebe, CJPA, Driessen, JHM, Wolffs, P, van den Broek, IVF, Hoenderboom, BM, Williams, R, de Vries, F & Dukers-Muijrers, NHTM 2019, 'Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease, Ectopic Pregnancy, and Female Infertility: A Retrospective Cohort Study Among Primary Care Patients' Clinical Infectious Diseases, vol. 69, no. 9, pp. 1517-1525. https://doi.org/10.1093/cid/ciz429

Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease, Ectopic Pregnancy, and Female Infertility: A Retrospective Cohort Study Among Primary Care Patients. / den Heijer, Casper D. J.; Hoebe, Christian J. P. A.; Driessen, Johanna H. M.; Wolffs, Petra; van den Broek, Ingrid V. F.; Hoenderboom, Bernice M.; Williams, Rachael; de Vries, Frank; Dukers-Muijrers, Nicole H. T. M.

In: Clinical Infectious Diseases, Vol. 69, No. 9, 2019, p. 1517-1525.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease, Ectopic Pregnancy, and Female Infertility: A Retrospective Cohort Study Among Primary Care Patients

AU - den Heijer, Casper D. J.

AU - Hoebe, Christian J. P. A.

AU - Driessen, Johanna H. M.

AU - Wolffs, Petra

AU - van den Broek, Ingrid V. F.

AU - Hoenderboom, Bernice M.

AU - Williams, Rachael

AU - de Vries, Frank

AU - Dukers-Muijrers, Nicole H. T. M.

PY - 2019

Y1 - 2019

N2 - BACKGROUND: We evaluated the risk of pelvic inflammatory disease (PID), ectopic pregnancy, and infertility in women with a previous Chlamydia trachomatis (CT) diagnosis compared with women who tested negative for CT and CT untested women, considering both targeted and incidental (ie, prescribed for another indication) use of CT-effective antibiotics. METHODS: This was a retrospective study of women aged 12-25 years at start of follow-up within the Clinical Practice Research Datalink GOLD database linked to index of multiple deprivation quintiles, 2000-2013. CT test status and antibiotic use were determined in a time-dependent manner. Risk of PID, ectopic pregnancy, or female infertility were evaluated using of Cox proportional hazard models. RESULTS: We studied 857 324 women, contributing 6 457 060 person-years. Compared with women who tested CT-negative, women who tested CT-positive had an increased risk of PID (adjusted hazard ratio [aHR], 2.36; 95% confidence interval [CI], 2.01-2.79), ectopic pregnancy (aHR, 1.87; 95% CI, 1.38-2.54), and infertility (aHR, 1.85; 95% CI, 1.27-2.68). The PID risk was higher for women with 2 or more positive CT tests than those with 1 positive test. PID risk increased with the number of previous antibiotic prescriptions, regardless of CT test status. CONCLUSIONS: We showed an association between CT-positive tests and 3 adverse reproductive health outcomes. Moreover, this risk increased with repeat CT infections. CT-effective antibiotic use showed no decreased risks of subsequent PID regardless of CT history. Our results confirm the reproductive health burden of CT, which requires adequate public health interventions.

AB - BACKGROUND: We evaluated the risk of pelvic inflammatory disease (PID), ectopic pregnancy, and infertility in women with a previous Chlamydia trachomatis (CT) diagnosis compared with women who tested negative for CT and CT untested women, considering both targeted and incidental (ie, prescribed for another indication) use of CT-effective antibiotics. METHODS: This was a retrospective study of women aged 12-25 years at start of follow-up within the Clinical Practice Research Datalink GOLD database linked to index of multiple deprivation quintiles, 2000-2013. CT test status and antibiotic use were determined in a time-dependent manner. Risk of PID, ectopic pregnancy, or female infertility were evaluated using of Cox proportional hazard models. RESULTS: We studied 857 324 women, contributing 6 457 060 person-years. Compared with women who tested CT-negative, women who tested CT-positive had an increased risk of PID (adjusted hazard ratio [aHR], 2.36; 95% confidence interval [CI], 2.01-2.79), ectopic pregnancy (aHR, 1.87; 95% CI, 1.38-2.54), and infertility (aHR, 1.85; 95% CI, 1.27-2.68). The PID risk was higher for women with 2 or more positive CT tests than those with 1 positive test. PID risk increased with the number of previous antibiotic prescriptions, regardless of CT test status. CONCLUSIONS: We showed an association between CT-positive tests and 3 adverse reproductive health outcomes. Moreover, this risk increased with repeat CT infections. CT-effective antibiotic use showed no decreased risks of subsequent PID regardless of CT history. Our results confirm the reproductive health burden of CT, which requires adequate public health interventions.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/31504315

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DO - 10.1093/cid/ciz429

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EP - 1525

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

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