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.

SHINE SA Media Release: Response to ABC report on Long Acting Reversible Contraception (LARCs)

SHINE SA, Issued: 13 December 2017

SHINE SA believes that decisions about contraception should be made in conjunction with a health care professional and that everyone should have access to accurate and unbiased information to enable appropriate informed contraceptive choice.

LARCs (Long Acting Reversible Contraception) including the levonorgestrel IUD1 (Mirena) and the subdermal implant (Implanon NXT) are the most effective reversible methods of contraception available. They have the additional advantage of being long lasting, convenient to use and generally well regarded by most users. LARC method failure rates rival that of tubal sterilization at <1% and unintended pregnancy rates are lower than those reported for contraceptive pill users.

Like all progestogen only contraceptive methods, LARCs may result in a change of bleeding pattern which may include no bleeding, frequent or prolonged bleeding. Users of the levonorgestrel IUD most commonly experience a reduction in bleeding over time and it is used as a treatment for Heavy Menstrual Bleeding for this reason. Only 1 in 5 users of the contraceptive implant have an increase in bleeding that persists beyond the first few months.

LARC use, and in particular the subdermal implant, is not known to be associated with pelvic inflammatory disease (PID) which is an infection of the upper part of the female reproductive system namely the uterus, fallopian tubes, and ovaries. PID is a known side effect of IUD insertion but occurs in less than 1 in 300 people. The risk of PID is only increased for the first 3 weeks after insertion, after which it returns to the previous background risk. Users of IUDs are encourage to return at any sign of infection and when treated promptly with antibiotics are unlikely to experience any long term complications.