Chlamydia May Pose Less Risk Than Thought

[GUNNER]

The rate of severe complications associated with chlamydia, the most commonly reported sexually transmitted disease, might be lower than commonly thought.

That's good news for women who have had chlamydia, but it also means that the benefits of widely touted screening programs for the infection have also been overestimated, experts said.

"Gains from screening that are predicted from mathematical models have probably been exaggerated," said Dr. Nicola Low, senior lecturer in epidemiology and public health at the University of Bern, in Switzerland. "These gains are in terms of reductions in female reproductive tract problems like pelvic inflammatory disease, ectopic pregnancy and infertility, reduced transmission of chlamydia in the population, and the money saved by avoiding these conditions."

Low is lead author of a study on the finding, which appears in the current issue of Sexually Transmitted Infections.

Others, however, were not convinced by the findings.

"Their methodology and what they found really has a few limitations," said Dr. Rhoda Sperling, an associate professor of obstetrics and gynecology, as well as medical infectious diseases, at Mount Sinai School of Medicine in New York City. "I'm not sure it adds anything new to what we know about chlamydia."

Importantly, Sperling added, the study only looked at hospital-reported complications, while most complications are not diagnosed in a hospital.

Infection with chlamydia trachomatis is the most common preventable cause of pelvic inflammatory disease (PID) in young women. PID, in turn, can lead to ectopic pregnancy and infertility.

Some sources have claimed that up to 40 percent of untreated chlamydia will progress to PID, and that 20 percent to 25 percent of women with PID will have an ectopic pregnancy or become infertile. It's been unclear, however, if these numbers apply to all women.

A chlamydia infection is easily treated, often with a single dose of antibiotics. Detection is also easy, with a urine-sample test; results are generally available within a day.

The authors of this study wanted to estimate the incidence of severe complications from genital chlamydia infection in women.

To do this, they turned to Sweden, which has the world's oldest chlamydia-control program with screening undertaken nationally since the late 1980s. Specifically, they focused on close to 44,000 women aged 15 to 24 in Uppsala county, where chlamydia screening is recommended for women aged 15 to 29 who attend family planning clinics, who are pregnant or who frequent youth clinics.

By the time they were 35, only 5.6 percent of women with chlamydia infection had developed PID, while 3.9 percent of all women had PID. The rate was 4 percent in women who had ever tested negative for chlamydia, and 2.9 percent in those who were never tested.

Overall, 2.3 percent of women had an ectopic pregnancy, 2.7 percent of those testing positive for chlamydia, 2 percent of those testing negative and 1.9 percent for those never screened.

Four percent of the entire group and 6.7 percent of those testing positive for chlamydia became infertile. For those testing negative, the rate was 4.7 percent and 3 percent for those who had never been screened.

For all of these complications, the rates were still much lower than expected, the authors stated.

This is particularly good news in light of the results of one survey that found the great majority of sexually active young American women enrolled in health plans were ignoring recommendations that they get routine screening for chlamydia.

Advice for women who do have chlamydia has not changed, however.

"Any woman who has chlamydia diagnosed either through screening, or because of a test done to investigate symptoms, should take an appropriate course of antibiotics and should ensure that anyone she has had sex with in the past six months also receives antibiotics," Low said. "To avoid becoming re-infected, she should not have sex until both she and her partner have finished their antibiotics."