Where to go to in chlamydia control? From infection control towards infectious disease control

Jan E. A. M. van Bergen, Bernice Maria Hoenderboom, Silke David, Febe Deug, Janneke C. M. Heijne, Fleur van Aar, Christian J. P. A. Hoebe, Hanna Bos, Nicole H. T. M. Dukers-Muijrers, Hannelore M. Götz, Nicola Low, Servaas Antonie Morré, Björn Herrmann, Marianne A. B. van der Sande, Henry J. C. de Vries, Helen Ward, Birgit H. B. van Benthem

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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.
Original languageEnglish
Article number10.1136/sextrans-2021-054992
Pages (from-to)501-506
Number of pages6
JournalSexually Transmitted Infections
Volume97
Issue number7
Early online date2021
DOIs
Publication statusPublished - 1 Nov 2021

Keywords

  • chlamydia Infections
  • diagnostic screening programs
  • health services research
  • infection control
  • pelvic inflammatory disease

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