Management of Chlamydia trachomatis genital tract infection: screening and treatment challenges
Identifieur interne : 002175 ( Pmc/Checkpoint ); précédent : 002174; suivant : 002176Management of Chlamydia trachomatis genital tract infection: screening and treatment challenges
Auteurs : Brandie D. Taylor ; Catherine L. HaggertySource :
- Infection and drug resistance [ 1178-6973 ] ; 2011.
Abstract
Url:
DOI: 10.2147/IDR.S12715
PubMed: 21694906
PubMed Central: 3108753
Affiliations:
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Management of <italic>Chlamydia trachomatis</italic>
genital tract infection: screening and treatment challenges</title>
<author><name sortKey="Taylor, Brandie D" sort="Taylor, Brandie D" uniqKey="Taylor B" first="Brandie D" last="Taylor">Brandie D. Taylor</name>
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<author><name sortKey="Haggerty, Catherine L" sort="Haggerty, Catherine L" uniqKey="Haggerty C" first="Catherine L" last="Haggerty">Catherine L. Haggerty</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Management of <italic>Chlamydia trachomatis</italic>
genital tract infection: screening and treatment challenges</title>
<author><name sortKey="Taylor, Brandie D" sort="Taylor, Brandie D" uniqKey="Taylor B" first="Brandie D" last="Taylor">Brandie D. Taylor</name>
</author>
<author><name sortKey="Haggerty, Catherine L" sort="Haggerty, Catherine L" uniqKey="Haggerty C" first="Catherine L" last="Haggerty">Catherine L. Haggerty</name>
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<series><title level="j">Infection and drug resistance</title>
<idno type="eISSN">1178-6973</idno>
<imprint><date when="2011">2011</date>
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<front><div type="abstract" xml:lang="en"><p><italic>Chlamydia trachomatis</italic>
is a prevalent sexually transmitted infection that can lead to serious reproductive morbidity. Management and control of <italic>C. trachomatis</italic>
is a challenge, largely due to its asymptomatic nature and our incomplete understanding of its natural history. Although chlamydia screening programs have been implemented worldwide, several countries have observed increasing rates of reported chlamydia cases. We reviewed the literature relating to the long-term complications of <italic>C. trachomatis</italic>
, as well as screening strategies, treatment, and prevention strategies for reducing chlamydia in the population. Articles from 1950–2010 were identified through a Medline search using the keyword “<italic>Chlamydia trachomatis</italic>
” combined with “screening”, “pelvic inflammatory disease”, “endometritis”, “salpingitis”, “infertility”, “ectopic pregnancy”, “urethritis”, “epididymitis”, “proctitis”, “prostatitis”, “reinfection”, “cost-effectiveness”, “treatment”, “vaccines”, or “prevention”. Progression of <italic>C. trachomatis</italic>
varies, and recurrent infections are common. Currently, there is limited evidence on the effectiveness of chlamydia screening. Higher quality studies are needed to determine the efficacy of more frequent screening, on a broader range of sequelae, including infertility and ectopic pregnancy, in addition to pelvic inflammatory disease. Studies should focus on delineating the natural history of recurrent infections, paying particular attention to treatment failures. Furthermore, alternatives to screening, such as vaccines, should continue to be explored.</p>
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<pmc article-type="review-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Infect Drug Resist</journal-id>
<journal-title-group><journal-title>Infection and drug resistance</journal-title>
</journal-title-group>
<issn pub-type="epub">1178-6973</issn>
<publisher><publisher-name>Dove Medical Press</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">21694906</article-id>
<article-id pub-id-type="pmc">3108753</article-id>
<article-id pub-id-type="doi">10.2147/IDR.S12715</article-id>
<article-id pub-id-type="publisher-id">idr-4-019</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Review</subject>
</subj-group>
</article-categories>
<title-group><article-title>Management of <italic>Chlamydia trachomatis</italic>
genital tract infection: screening and treatment challenges</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Taylor</surname>
<given-names>Brandie D</given-names>
</name>
<xref ref-type="corresp" rid="c1-idr-4-019"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Haggerty</surname>
<given-names>Catherine L</given-names>
</name>
</contrib>
<aff id="af1-idr-4-019">University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA, USA</aff>
</contrib-group>
<author-notes><corresp id="c1-idr-4-019">Correspondence: Brandie DePaoli Taylor, University of Pittsburgh, Department of Epidemiology, 3602 Fifth Ave, Pittsburgh, PA 15213, USA, Tel +1 412 302 5687, Fax +1 412 383 1121, Email <email>depaolib@edc.pitt.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="collection"><year>2011</year>
</pub-date>
<pub-date pub-type="epub"><day>20</day>
<month>1</month>
<year>2011</year>
</pub-date>
<volume>4</volume>
<fpage>19</fpage>
<lpage>29</lpage>
<history><date date-type="received"><day>19</day>
<month>1</month>
<year>2011</year>
</date>
</history>
<permissions><copyright-statement>© 2011 Taylor and Haggerty, publisher and licensee Dove Medical Press Ltd.</copyright-statement>
<copyright-year>2011</copyright-year>
<license><license-p>This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><p><italic>Chlamydia trachomatis</italic>
is a prevalent sexually transmitted infection that can lead to serious reproductive morbidity. Management and control of <italic>C. trachomatis</italic>
is a challenge, largely due to its asymptomatic nature and our incomplete understanding of its natural history. Although chlamydia screening programs have been implemented worldwide, several countries have observed increasing rates of reported chlamydia cases. We reviewed the literature relating to the long-term complications of <italic>C. trachomatis</italic>
, as well as screening strategies, treatment, and prevention strategies for reducing chlamydia in the population. Articles from 1950–2010 were identified through a Medline search using the keyword “<italic>Chlamydia trachomatis</italic>
” combined with “screening”, “pelvic inflammatory disease”, “endometritis”, “salpingitis”, “infertility”, “ectopic pregnancy”, “urethritis”, “epididymitis”, “proctitis”, “prostatitis”, “reinfection”, “cost-effectiveness”, “treatment”, “vaccines”, or “prevention”. Progression of <italic>C. trachomatis</italic>
varies, and recurrent infections are common. Currently, there is limited evidence on the effectiveness of chlamydia screening. Higher quality studies are needed to determine the efficacy of more frequent screening, on a broader range of sequelae, including infertility and ectopic pregnancy, in addition to pelvic inflammatory disease. Studies should focus on delineating the natural history of recurrent infections, paying particular attention to treatment failures. Furthermore, alternatives to screening, such as vaccines, should continue to be explored.</p>
</abstract>
<kwd-group><kwd><italic>Chlamydia trachomatis</italic>
</kwd>
<kwd>sexually transmitted disease</kwd>
<kwd>chlamydia screening</kwd>
<kwd>chlamydia treatment</kwd>
</kwd-group>
</article-meta>
</front>
<floats-group><table-wrap id="t1-idr-4-019" position="float"><label>Table</label>
<caption><p>Randomized trials examining the effectiveness of screening in preventing pelvic inflammatory disease in nonpregnant women</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" valign="top" rowspan="1" colspan="1"><bold>Author/year</bold>
</th>
<th align="left" valign="top" rowspan="1" colspan="1"><bold>Study population</bold>
</th>
<th align="left" valign="top" rowspan="1" colspan="1"><bold>Methods</bold>
</th>
<th align="left" valign="top" rowspan="1" colspan="1"><bold>Randomization</bold>
</th>
<th align="left" valign="top" rowspan="1" colspan="1"><bold>Results</bold>
</th>
</tr>
</thead>
<tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Oakeshott et al<xref ref-type="bibr" rid="b92-idr-4-019">92</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">2529 sexually active female students, aged 16–27 years, recruited from 20 universities in London, UK.</td>
<td align="left" valign="top" rowspan="1" colspan="1">Participants provided self-collected vaginal samples at baseline and completed a questionnaire on sexual health. CT was diagnosed using TMA. After one year, participants completed a questionnaire about possible symptoms of PID and sexual behavior over the past year. Medical records were collected for 17% and three doctors blinded to study group and CT status at baseline allocated reported PID cases into probable, possible, or no PID, using the CDC guidelines and Hager’s criteria.</td>
<td align="left" valign="top" rowspan="1" colspan="1">98.6% (2529/2563) were randomly allocated for immediate CT screening and treatment (1259) or deferred screening (1186; vaginal samples analyzed after one year) using random number tables. 94% (2377/2529) were followed up after one year.</td>
<td align="left" valign="top" rowspan="1" colspan="1">Incidence of PID was 1.3% (15/1191) for screened group and 1.9% (23/1186) for controls (RR 0.65, 95% CI 0.34–1.22). 9.5% (7/74) of CT positive women at baseline in control group developed PID. 1.6% (1/63) of CT positive women in screening group developed PID (RR 0.17, 95% CI 0.03–1.01).</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Østergaard et al<xref ref-type="bibr" rid="b121-idr-4-019">121</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">1700 sexually active female high school students from Denmark, aged ≥15 years.</td>
<td align="left" valign="top" rowspan="1" colspan="1">Intervention group received a home sampling kit at baseline and questionnaire. Those who were CT-positive (diagnosed by TMA) were referred for treatment. The control group received the same questionnaire with an offer of free testing at a local clinic or doctor’s office. Home sampling kits were sent at follow-up to determine CT incidence. Follow-up questionnaire collected information on treatment or hospitalization for PID during the past year. Medical records were sought through the central Danish register for prescriptions related to PID.</td>
<td align="left" valign="top" rowspan="1" colspan="1">5487 female high school students were randomized (1:1) by simple redeeming to a home sampling group (2603) or a usual care group (2884). 43% (2351/5487) responded to the baseline questionnaire. Among sexually active females 55% (930/1700) were followed for 1 year.</td>
<td align="left" valign="top" rowspan="1" colspan="1">Incidence of PID was 2.1% in the intervention group and 4.2% in the control group (<italic>P</italic>
= 0.045).</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Scholes et al<xref ref-type="bibr" rid="b120-idr-4-019">120</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">2607 sexually active female HMO enrollees aged 18–34 years from Washington State, US.</td>
<td align="left" valign="top" rowspan="1" colspan="1">Self-administered questionnaires were mailed to single HMO enrollees to determine those at high risk of CT (based on age, race, gravidity, and sexual partner in the past 12 months). Emphasis was placed on contacting nonresponders who were assigned to the screening group. In the screening group swabs were tested for CT by ELISA. Specimens collected by cytobrush were tested by chlamydia cell culture. Control group (usual care) saw their providers as needed. Both groups received a follow-up questionnaire at 12 months and were asked about diagnosis of PID. Outpatient and inpatient databases were used to identify those participants with a diagnosis of PID. Medical records of those with possible cases of PID were reviewed by blinded abstracters to determine PID status (based on signs, symptoms, and laboratory findings).</td>
<td align="left" valign="top" rowspan="1" colspan="1">57% (20,836/36,547) responded to the initial questionnaire and 85% (17,725) of responders were ineligible. Of the 13% eligible (2607), 1009 were randomly assigned (authors did not give randomization method) to the screening group and 1598 to the usual care group. 64% (645/1009) of women in the screening group were tested for CT. 76% were followed-up at 12 months.</td>
<td align="left" valign="top" rowspan="1" colspan="1">Databases identified 57 participants diagnosed with PID. Medical records showed a clinical diagnosis of PID in 37 participants. Additional 5 were identified in chart review. 9 confirmed cases of incident PID in the screening group and 33 in the usual care group (RR 0.44, 95% CI 0.20–0.90).</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn id="tfn1-idr-4-019"><p><bold>Abbreviations:</bold>
CT, <italic>Chlamydia trachomatis</italic>
; TMA, transcription mediated amplification; PID, pelvic inflammatory disease; CDC, Centers for Disease Control; RR, relative risk; CI, confidence interval; HMO, health maintenance organization; ELISA, enzyme-linked immunosorbent assay.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
<affiliations><list></list>
<tree><noCountry><name sortKey="Haggerty, Catherine L" sort="Haggerty, Catherine L" uniqKey="Haggerty C" first="Catherine L" last="Haggerty">Catherine L. Haggerty</name>
<name sortKey="Taylor, Brandie D" sort="Taylor, Brandie D" uniqKey="Taylor B" first="Brandie D" last="Taylor">Brandie D. Taylor</name>
</noCountry>
</tree>
</affiliations>
</record>
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