Postgraduate Training for Applied Epidemiology (PAE, German Field Epidemiology Training Programme), Robert Koch Institute, Berlin, Germany.
Department for Infectious Disease Epidemiology, Unit of Gastrointestinal Infections, Zoonoses, and Tropical Infections, Robert Koch Institute (RKI), Berlin, Germany.
BMC Public Health. 2022 Jun 3;22(1):1107. doi: 10.1186/s12889-022-13456-7.
Chlamydia trachomatis (chlamydia) is a common, frequently asymptomatic, sexually transmitted infection. It can result in severe sequelae, such as ectopic pregnancy and infertility. In Germany, chlamydia is not notifiable. An opportunistic screening program for women < 25 years was introduced in 2008. The aim of this research was to triangulate different data sources to describe the epidemiological situation of chlamydia in Germany and to investigate whether the current target group of the chlamydia screening program aligns with these findings.
Urine specimens from participants from population-based health examination surveys of children (2014-17) and adults (2008-11) were tested for chlamydia, using nucleic acid amplification testing. These data were used to generate weighted chlamydia prevalence estimates by age group and sex. Data from a nationwide chlamydia laboratory sentinel system (2014-16) were used to calculate the positive proportion among individuals tested for chlamydia by age, sex and test reason.
Using data from the population-based surveys, we found a chlamydia prevalence estimate of 2.8% (95% confidence interval (CI) 1.0-7.5%) among all 15- to 17-year-old girls and of 9.6% (95% CI 0.0-23) among those reporting to be sexually active. In adult women, we found the highest prevalence among 18- to 24-year-olds (all: 2.3%; 95% CI 1.0-5.3%; sexually active: 3.1%; 95% CI 1.3-7.0%). In adult men, we found the highest prevalence among 25- to 29-year-olds (all: 3.5%; 95% CI 1.6-7.7%; sexually active: 3.3%; 95% CI 1.3-7.8%). Data from the chlamydia laboratory sentinel showed the highest positive proportion among those opportunistically screened in 19-year-old women (6.1%; 95%- CI 5.9-6.4%), among those screened due to pregnancy in 15-year-old girls (10%; 95% CI 8.5-12%), and among those tested due to symptoms or a positive partner in 19-year-old women (10%; 95% CI 9.8-11%) and 19-year-old men (24%; 95% CI 22-26%).
Chlamydia seems to mainly affect adolescents and young adults in Germany, with similar overall prevalence in men and women, but with slightly different age distributions. Women at highest risk of chlamydia are covered by the current screening program but given the on-going discussions in high-income countries on cost-effectiveness and benefit-to-harm ratio of these programs, the program-aim needs reconsideration.
沙眼衣原体（衣原体）是一种常见的、常无症状的性传播感染。它可导致严重的后遗症，如宫外孕和不孕。在德国，衣原体不报告。2008 年，德国推出了一项针对 25 岁以下女性的机会性筛查计划。本研究的目的是利用不同的数据来源来描述德国衣原体的流行病学情况，并调查当前衣原体筛查计划的目标人群是否与这些发现相符。
使用核酸扩增检测对来自儿童（2014-17 年）和成人（2008-11 年）人群健康检查调查的参与者的尿液标本进行衣原体检测。这些数据用于根据年龄组和性别生成加权衣原体患病率估计值。使用全国衣原体实验室监测系统（2014-16 年）的数据，按年龄、性别和检测原因计算衣原体检测阳性比例。
使用基于人群的调查数据，我们发现所有 15-17 岁女孩的衣原体患病率估计值为 2.8%（95%置信区间 1.0-7.5%），报告有性行为的女孩为 9.6%（95%置信区间 0.0-23）。在成年女性中，我们发现 18-24 岁的女性患病率最高（所有：2.3%；95%置信区间 1.0-5.3%；有性行为：3.1%；95%置信区间 1.3-7.0%）。在成年男性中，我们发现 25-29 岁的男性患病率最高（所有：3.5%；95%置信区间 1.6-7.7%；有性行为：3.3%；95%置信区间 1.3-7.8%）。衣原体实验室监测数据显示，19 岁女性机会性筛查中阳性比例最高（6.1%；95%置信区间 5.9-6.4%），15 岁女孩因妊娠筛查中阳性比例最高（10%；95%置信区间 8.5-12%），19 岁女性因症状或阳性伴侣筛查中阳性比例最高（10%；95%置信区间 9.8-11%）和 19 岁男性（10%；95%置信区间 9.8-11%）和 19 岁男性（24%；95%置信区间 22-26%）。
在德国，衣原体似乎主要影响青少年和年轻成年人，男性和女性的总体患病率相似，但年龄分布略有不同。感染衣原体风险最高的女性都涵盖在当前的筛查计划中，但鉴于高收入国家正在讨论这些计划的成本效益和利弊比，计划目标需要重新考虑。
