Risk of Pelvic Inflammatory Disease Following Chlamydia trachomatis Infection: Analysis of Prospective Studies With a Multistate Model

Price, Malcolm J; Ades, A E; Angelis, Daniela De; Welton, Nicky J; Macleod, John; Soldan, Kate; Simms, Ian; Turner, Katherine Mary Elizabeth; Horner, Patrick J

doi:10.1093/aje/kws583

Cited by 135 publications

(109 citation statements)

References 53 publications

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“…Chlamydia Trachomatis (CT) is a common sexually transmitted infection of young people which if left untreated will cause pelvic inflammatory disease (PID) in around 16% of women (1). PID may then result in adverse reproductive outcomes such as ectopic pregnancy (EP) or tubal factor infertility (TFI) (2).…”

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confidence: 99%

Proportion of Tubal Factor Infertility due toChlamydia: Finite Mixture Modeling of Serum Antibody Titers

Ades¹,

Price²,

Kounali³

et al. 2017

Am. J. Epidemiol.

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms estimates based on the standard PEF formula from case-control studies were 0% and over 65%.Finite mixture modeling can be applied to serological data to obtain estimates of the proportion of reproductive damage attributable to Chlamydia trachomatis. Further studies should be undertaken using modern assays in contemporary, representative populations. <198 words>

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Proportion of Tubal Factor Infertility due toChlamydia: Finite Mixture Modeling of Serum Antibody Titers

Ades¹,

Price²,

Kounali³

et al. 2017

Am. J. Epidemiol.

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“…Mathematical modeling suggested that PID can occur at any time point during the natural history of an infection; therefore, annual chlamydial screening programs may reduce the incidence of PID (14). A separate model concluded that annual screening could prevent 61% (95% credible interval, 55 to 67%) of Chlamydiaassociated PID (15).…”

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confidence: 99%

Human and Pathogen Factors Associated with Chlamydia trachomatis-Related Infertility in Women

et al. 2015

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SUMMARY Chlamydia trachomatis is the most common bacterial sexually transmitted pathogen worldwide. Infection can result in serious reproductive pathologies, including pelvic inflammatory disease, ectopic pregnancy, and infertility, in women. However, the processes that result in these reproductive pathologies have not been well defined. Here we review the evidence for the human disease burden of these chlamydial reproductive pathologies. We then review human-based evidence that links Chlamydia with reproductive pathologies in women. We present data supporting the idea that host, immunological, epidemiological, and pathogen factors may all contribute to the development of infertility. Specifically, we review the existing evidence that host and pathogen genotypes, host hormone status, age of sexual debut, sexual behavior, coinfections, and repeat infections are all likely to be contributory factors in development of infertility. Pathogen factors such as infectious burden, treatment failure, and tissue tropisms or ascension capacity are also potential contributory factors. We present four possible processes of pathology development and how these processes are supported by the published data. We highlight the limitations of the evidence and propose future studies that could improve our understanding of how chlamydial infertility in women occurs and possible future interventions to reduce this disease burden.

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“…Annual screening would prevent 61% of Chlamydia-related pelvic inflammatory disease in women who became infected. 4 Primary care providers are in a unique position to screen patients for risky behaviors and prevent associated morbidity and mortality.…”

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Practice-Based Quality Improvement Collaborative to Increase Chlamydia Screening in Young Women

et al. 2016

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BACKGROUND AND OBJECTIVE: Chlamydia trachomatis infections are common among sexually active young women. We developed a practice-based quality improvement (QI) collaborative to increase Chlamydia screening in at-risk young women. METHODS: Structured data fields were integrated into the electronic record for practices affiliated with Boston Children’s Hospital. A learning community (LC) was developed. Content included the adolescent well visit, assessment of sexual/risk behaviors, epidemiology of sexually transmitted diseases, and screening methods. The QI initiative effectiveness was assessed by comparing preintervention and postintervention rates of Chlamydia screening by using statistical process control analyses and logistic regressions. RESULTS: LC participants demonstrated significant increases in recommended Chlamydia screening, as illustrated by using Healthcare Effectiveness Data and Information Set (HEDIS) screening rates (LC1: 52.8% preintervention vs 66.7% postintervention [P < .0001]; LC2: 57.8% preintervention vs 69.3% postintervention [P < .0001]). Participating practices reported total improvements larger than nonparticipating practices (13.9% LC1, 11.5% LC2, and 7.8% nonparticipants). QI and LC efforts also led to increased documentation of sexual activity status in the record (LC1: 61.2% preintervention to 91.2% postintervention [P < .0001]; LC2: 43.3% preintervention to 61.2% postintervention [P < .0001]). Nonparticipating practices were more likely to perform indiscriminate screening. CONCLUSIONS: Through our QI and LC efforts, statistically and clinically meaningful improvements in Chlamydia screening rates were attained. Differences in rates of improvement indicate that LC participation likely had effects beyond electronic medical record changes alone. During the project time frame, national HEDIS screening rates remained unchanged, suggesting that the observed improvements were related to the interventions and not to a national trend. As a result of QI tools provided through the LCs, HEDIS screening goals were achieved in a primary care setting.

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Risk of Pelvic Inflammatory Disease Following Chlamydia trachomatis Infection: Analysis of Prospective Studies With a Multistate Model

Cited by 135 publications

References 53 publications

Proportion of Tubal Factor Infertility due toChlamydia: Finite Mixture Modeling of Serum Antibody Titers

Proportion of Tubal Factor Infertility due toChlamydia: Finite Mixture Modeling of Serum Antibody Titers

Human and Pathogen Factors Associated with Chlamydia trachomatis-Related Infertility in Women

Practice-Based Quality Improvement Collaborative to Increase Chlamydia Screening in Young Women

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