Impact of intensified testing for urogenital Chlamydia trachomatis infections: A randomized study with nine year of follow-up
Résumé
Background DNA amplification assays are increasingly being used to facilitate testing of asymptomatic individuals for urogenital Chlamydia trachomatis. The long-term clinical benefit in terms of avoided infertility and ectopic pregnancy is unknown. Methods In 1997, a total of 15,459 women and 14,980 men aged 21-23 were living in Aarhus County, Denmark. A random sample of 4,000 women and 5,000 men were contacted by mail and offered the opportunity to be tested for C. trachomatis by means of a sample obtained at home and mailed directly to the laboratory. The remaining 11,459 women and 9,980 men received usual care and constituted the control population. All men and women were subsequently followed for nine years by use of Danish health registers. We collected data on pelvic inflammatory disease (PID), ectopic pregnancy (EP), infertility diagnoses, in-vitro fertilization (IVF) treatment, and births in women, and on epididymitis in men. The screening and control groups were compared using Cox regression analyses and the intention-to-screen principle. Results Among women, we found no differences between the screening group and the control group: hazard ratios (95% confidence interval) for: PID, 1.12 (0.70-1.79); EP, 0.97 (0.63-1.51); infertility, 0.87 (0.71-1.07); IVF treatment, 0.88 (0.62-1.26); and births, 1.02 (0.95-1.10). In men, the hazard ratio for epididymitis was 1.25 (0.70-2.24). Conclusions A population based offer to be tested for urogenital C. trachomatis infection by use of non-invasive samples and DNA-amplification did not reduce the long-term risk of reproductive complications in women or epididymitis in men.
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