Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease, Ectopic Pregnancy, and Female Infertility

Clinical Infectious Diseases, ciz429, https://doi.org/10.1093/cid/ciz429
Published: 24 August 2019

Abstract

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.

STI’S on the rise in SA – free campaign resources (SHINE SA media release)

SHINE SA, April 2, 2019

Sexually transmitted infection (STI) rates are on the rise in South Australia, with around 1 in 20 young people infected with chlamydia¹. Left untreated chlamydia can lead to infection of the reproductive systems and long term consequences. Having one STI also increases the risk of being infected with another. As such it’s important that young people in SA are encouraged to practise safer sex as well as getting a sexual health check.

In response to this rise in STIs, SHINE SA is excited to announce the launch of their Sexual Health Check campaign and related resources for use across South Australia. These resources can be used by organisations including universities, secondary schools, youth services, general practice and community health services.

The Sexual Health Check campaign aims to raise awareness of STIs as well as highlight how easy it is to get a sexual health check.
According to the most recent epidemiological report released by SA Health in 2017, STI and blood borne viruses (BBVs) have jumped 14% compared to the previous five years.

In 2017:

  • there were 8,181 new infections of STIs and BBVs, this is a 7% increase compared to 2016
  • 77% of infections were in people aged 15 to 29 years.

SHINE SA encourages young people to receive a sexual health check at a SHINE SA clinic, their local doctor or Aboriginal Health service. SHINE SA offers FREE sexual health checks as well as counselling to South Australians under the age of 30 with a Medicare Card.

Dr Amy Moten, SHINE SA’s Coordinator of Medical Education said:
“STIs are on the rise, so practicing safer sex and having regular testing is vital. Left untreated, serious infection may occur and lead to complications such as infertility, chronic pelvic pain and ectopic pregnancy. As most people don’t have any symptoms, lack of testing contributes to the continued spread of the disease”.

SHINE SA hopes other health and education organisations and media outlets can assist by promoting and sharing the Sexual Health Check campaign. By doing so we can help raise awareness of STIs in the community and encourage young people to access sexual heath checks.

  • The free campaign resources including a Sexual Health + STIs FAQ booklet, posters and social media tiles can be downloaded here
  • For further information contact Tracey Hutt, Director Workforce Education and Development, by email here 
  • Download this media release

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¹ http://www.sti.guidelines.org.au/populations-and-situations/young-people

 

 

Translation and implementation of the Australian-led PCOS guideline

Translation and implementation of the Australian-led PCOS guideline: clinical summary and translation resources from the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

Med J Aust 2018; 209 (7 Suppl): S3-S8. || doi: 10.5694/mja18.00656
Published online: 2018-10-01

Abstract

Introduction: We have developed the first international evidence-based guideline for the diagnosis and management of polycystic ovary syndrome (PCOS), with an integrated translation program incorporating resources for health professionals and consumers. The development process involved an extensive Australian-led international and multidisciplinary collaboration of health professionals and consumers over 2 years. The guideline is approved by the National Health and Medical Research Council and aims to support both health professionals and women with PCOS in improving care, health outcomes and quality of life. A robust evaluation process will diagnoenable practice benchmarking and feedback to further inform evidence-based practice. We propose that this methodology could be used in developing and implementing guidelines for other women’s health conditions and beyond.

Main recommendations: The recommendations cover the following broad areas: diagnosis, screening and risk assessment depending on life stage; emotional wellbeing; healthy lifestyle; pharmacological treatment for non-fertility indications; and assessment and treatment of infertility.

Changes in management as a result of this guideline: •Diagnosis:▪when the combination of hyperandrogenism and ovulatory dysfunction is present, ultrasound examination of the ovaries is not necessary for diagnosis of PCOS in adult women;▪requires the combination of hyperandrogenism and ovulatory dysfunction in young women within 8 years of menarche, with ultrasound examination of the ovaries not recommended, owing to the overlap with normal ovarian physiology; and▪adolescents with some clinical features of PCOS, but without a clear diagnosis, should be regarded as “at risk” and receive follow-up assessment.•Screening for metabolic complications has been refined and incorporates both PCOS status and additional metabolic risk factors.•Treatment of infertility: letrozole is now first line treatment for infertility as it improves live birth rates while reducing multiple metapregnancies compared with clomiphene citrate.

Informed consent, individual care vital to ensure reproductive rights of transgender Australians

The Conversation

By Damien Riggs

July 11, 2018 6.02am AEST

For any person needing medical care, informed consent is vital. Yet for transgender people, informed consent may be hindered by how medical professionals share information. This is especially the case in the context of reproductive health, where speaking about reproductive materials is often highly gendered.

Both the World Professional Association for Transgender Health Standards of Care and the Royal Children’s Hospital’s Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents emphasise the importance of discussing fertility preservation as an option for transgender people. Yet little guidance is given on how to do so in ways that are inclusive.

Gonorrhoea and syphilis on the rise among among heterosexual men and women in Melbourne

ABC News, 16th January 2018

Melbourne is facing a rapid increase in cases of the sexually transmitted diseases syphilis and gonorrhoea.

Data from the Melbourne Sexual Health Clinic shows the number of gonorrhoea infections has increased 30 per cent annually since 2015.

Broader definition of polycystic ovary syndrome is harming women: Australian experts

The Age, 

In an opinion article in the latest British Medical Journal, Australian researchers argue that an expanded definition had inadvertently led to overdiagnosis, and therefore too much treatment and even harm.

The widening of the definition (to include the sonographic presence of polycystic ovaries) in 2003 led to a dramatic increase in cases, from 5 to 21 per cent.