Alexiou Zoïe W, Hoenderboom Bernice M, Hoebe Christian J P A, Dukers-Muijrers Nicole H T M, Götz Hannelore M, van der Sande Marianne A B, de Vries Henry J C, den Hartog Janneke E, Morré Servaas A, van Benthem Birgit H B
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Institute for Public Health Genomics (IPHG), GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
Lancet Reg Health Eur. 2024 Aug 17;45:101027. doi: 10.1016/j.lanepe.2024.101027. eCollection 2024 Oct.
The clinical and public health relevance of widespread testing for asymptomatic (chlamydia) infections is under debate. To address uncertainties in screening programs, we estimate reproductive tract complication risks following asymptomatic and symptomatic chlamydia infections in a long-term prospective cohort.
A cohort of 5704 reproductive-age women recruited from a chlamydia screening study was followed for up to 14 years. Chlamydia positivity was determined using screening polymerase chain reaction test results, self-reported diagnoses (with/without symptoms), and chlamydia Immunoglobulin G antibodies. Outcome data (pregnancies, pelvic inflammatory disease (PID), ectopic pregnancy, and tubal factor infertility) were collected through self-completed questionnaires. Cox regression calculated adjusted hazard ratios (aHR) with confidence intervals (CI) to compare outcomes between time-updated chlamydia groups since sexual debut.
During 104,612 person-years, 2103 (36.9%) women were chlamydia-positive and 3692 women (64.7%) had been pregnant at least once. Risks for PID, ectopic pregnancy and tubal factor infertility were 1.62 (95% CI 1.20-2.17), 1.84 (95% CI 1.14-2.95) and 2.75 (95% CI 1.53-4.94), compared to chlamydia-negatives. aHRs for PID after symptomatic and asymptomatic infections were 2.29 (95% CI 1.62-3.25) and 1.06 (95% CI 0.66-1.69), respectively. Incidence of PID, ectopic pregnancy and tubal factor infertility after symptomatic chlamydia infection remained low with rates per 1000 person-years of 5.8, 1.9, and 1.8, respectively.
We found a significantly higher risk of PID, ectopic pregnancy and tubal factor infertility in chlamydia-positive women compared to chlamydia-negative women, although the overall incidence rates of complications remained low. Symptomatic, but not asymptomatic, chlamydia infections were associated with PID risk, suggesting the largest disease burden of complications is in this group.
The Netherlands Organisation for Health Research and Development (ZonMW Netherlands) and Research Funding from the Ministry of Health, Welfare and Sports.
对无症状（衣原体）感染进行广泛检测的临床及公共卫生意义仍存在争议。为解决筛查项目中的不确定性问题，我们在一个长期前瞻性队列中评估了无症状和有症状衣原体感染后的生殖道并发症风险。
从一项衣原体筛查研究中招募了5704名育龄妇女组成队列，随访长达14年。衣原体阳性通过筛查聚合酶链反应检测结果、自我报告诊断（有/无症状）以及衣原体免疫球蛋白G抗体来确定。结局数据（妊娠、盆腔炎（PID）、异位妊娠和输卵管因素不孕）通过自我填写问卷收集。Cox回归计算调整后的风险比（aHR）及置信区间（CI），以比较自首次性行为以来不同时间更新的衣原体感染组之间的结局。
在104,612人年中，2103名（36.9%）妇女衣原体呈阳性，3692名妇女（64.7%）至少怀孕过一次。与衣原体阴性妇女相比，PID、异位妊娠和输卵管因素不孕的风险分别为1.62（95%CI 1.20 - 2.17）、1.84（95%CI 1.14 - 2.95）和2.75（95%CI 1.53 - 4.94）。有症状和无症状感染后PID的aHR分别为2.29（95%CI 1.62 - 3.25）和1.06（95%CI 0.66 - 1.69）。有症状衣原体感染后PID、异位妊娠和输卵管因素不孕的发病率每1000人年分别为5.8、1.9和1.8，仍较低。
我们发现衣原体阳性妇女发生PID、异位妊娠和输卵管因素不孕的风险显著高于衣原体阴性妇女，尽管并发症的总体发病率仍然较低。有症状但无症状的衣原体感染与PID风险相关，表明该组并发症的疾病负担最大。
荷兰卫生研究与发展组织（荷兰ZonMW）以及卫生、福利和体育部的研究资助。
