Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease, Ectopic Pregnancy, and Female Infertility: A Retrospective Cohort Study Among Primary Care Patients.
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.
|ジャーナル名||Clinical infectious diseases : an official publication of the Infectious Diseases Society of America|
|投稿者||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|
|組織名||Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of;Pharmaceutical Sciences, Heerlen.;Department of Sexual Health, Infectious Diseases and Environmental Health, Public;Health Service South Limburg, Heerlen.;Department of Medical Microbiology,Care and Public Health Research Institute;(CAPHRI), Maastricht University Medical Center+ (MUMC+), Maastricht.;Department of Clinical Pharmacy and Toxicology CAPHRI, School for Nutrition and;Translational Research in Metabolism, MUMC+, Maastricht.;Epidemiology and Surveillance Unit, Centre for Infectious Disease Control,;National Institute for Public Health and the Environment, Bilthoven, The;Netherlands.;Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory;Agency, London, United Kingdom.|