TY - JOUR
T1 - Where to go to in chlamydia control?
T2 - From infection control towards infectious disease control
AU - van Bergen, Jan E. A. M.
AU - Hoenderboom, Bernice Maria
AU - David, Silke
AU - Deug, Febe
AU - Heijne, Janneke C. M.
AU - van Aar, Fleur
AU - Hoebe, Christian J. P. A.
AU - Bos, Hanna
AU - Dukers-Muijrers, Nicole H. T. M.
AU - Götz, Hannelore M.
AU - Low, Nicola
AU - Morré, Servaas Antonie
AU - Herrmann, Björn
AU - van der Sande, Marianne A. B.
AU - de Vries, Henry J. C.
AU - Ward, Helen
AU - van Benthem, Birgit H. B.
N1 - Publisher Copyright: © 2021 Author(s). Published by BMJ.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Objectives: The clinical and public health relevance of widespread case finding by testing for asymptomatic chlamydia infections is under debate. We wanted to explore future directions for chlamydia control and generate insights that might guide for evidence-based strategies. In particular, we wanted to know the extent to which we should pursue testing for asymptomatic infections at both genital and extragenital sites. Methods: We synthesised findings from published literature and from discussions among national and international chlamydia experts during an invitational workshop. We described changing perceptions in chlamydia control to inform the development of recommendations for future avenues for chlamydia control in the Netherlands. Results: Despite implementing a range of interventions to control chlamydia, there is no practice-based evidence that population prevalence can be reduced by screening programmes or widespread opportunistic testing. There is limited evidence about the beneficial effect of testing on pelvic inflammatory disease prevention. The risk of tubal factor infertility resulting from chlamydia infection is low and evidence on the preventable fraction remains uncertain. Overdiagnosis and overtreatment with antibiotics for self-limiting and non-viable infections have contributed to antimicrobial resistance in other pathogens and may affect oral, anal and genital microbiota. These changing insights could affect the outcome of previous cost-effectiveness analysis. Conclusion: The balance between benefits and harms of widespread testing to detect asymptomatic chlamydia infections is changing. The opinion of our expert group deviates from the existing paradigm of 'test and treat' and suggests that future strategies should reduce, rather than expand, the role of widespread testing for asymptomatic chlamydia infections.
AB - Objectives: The clinical and public health relevance of widespread case finding by testing for asymptomatic chlamydia infections is under debate. We wanted to explore future directions for chlamydia control and generate insights that might guide for evidence-based strategies. In particular, we wanted to know the extent to which we should pursue testing for asymptomatic infections at both genital and extragenital sites. Methods: We synthesised findings from published literature and from discussions among national and international chlamydia experts during an invitational workshop. We described changing perceptions in chlamydia control to inform the development of recommendations for future avenues for chlamydia control in the Netherlands. Results: Despite implementing a range of interventions to control chlamydia, there is no practice-based evidence that population prevalence can be reduced by screening programmes or widespread opportunistic testing. There is limited evidence about the beneficial effect of testing on pelvic inflammatory disease prevention. The risk of tubal factor infertility resulting from chlamydia infection is low and evidence on the preventable fraction remains uncertain. Overdiagnosis and overtreatment with antibiotics for self-limiting and non-viable infections have contributed to antimicrobial resistance in other pathogens and may affect oral, anal and genital microbiota. These changing insights could affect the outcome of previous cost-effectiveness analysis. Conclusion: The balance between benefits and harms of widespread testing to detect asymptomatic chlamydia infections is changing. The opinion of our expert group deviates from the existing paradigm of 'test and treat' and suggests that future strategies should reduce, rather than expand, the role of widespread testing for asymptomatic chlamydia infections.
KW - chlamydia Infections
KW - diagnostic screening programs
KW - health services research
KW - infection control
KW - pelvic inflammatory disease
UR - http://www.scopus.com/inward/record.url?scp=85106948649&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/sextrans-2021-054992
DO - https://doi.org/10.1136/sextrans-2021-054992
M3 - Article
C2 - 34045364
SN - 1368-4973
VL - 97
SP - 501
EP - 506
JO - Sexually transmitted infections
JF - Sexually transmitted infections
IS - 7
M1 - 10.1136/sextrans-2021-054992
ER -