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The natural history of Chlamydia trachomatis infection in women: a multi-parameter evidence synthesis.

Abstract The evidence base supporting the National Chlamydia Screening Programme, initiated in 2003, has been questioned repeatedly, with little consensus on modelling assumptions, parameter values or evidence sources to be used in cost-effectiveness analyses. The purpose of this project was to assemble all available evidence on the prevalence and incidence of Chlamydia trachomatis (CT) in the UK and its sequelae, pelvic inflammatory disease (PID), ectopic pregnancy (EP) and tubal factor infertility (TFI) to review the evidence base in its entirety, assess its consistency and, if possible, arrive at a coherent set of estimates consistent with all the evidence.
PMID
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Authors

Mayor MeshTerms

Chlamydia Infections

Mass Screening

Keywords
Journal Title health technology assessment (winchester, england)
Publication Year Start




PMID- 27007215
OWN - NLM
STAT- MEDLINE
DA  - 20160324
DCOM- 20161227
LR  - 20161230
IS  - 2046-4924 (Electronic)
IS  - 1366-5278 (Linking)
VI  - 20
IP  - 22
DP  - 2016 Mar
TI  - The natural history of Chlamydia trachomatis infection in women: a
      multi-parameter evidence synthesis.
PG  - 1-250
LID - 10.3310/hta20220 [doi]
AB  - BACKGROUND AND OBJECTIVES: The evidence base supporting the National Chlamydia
      Screening Programme, initiated in 2003, has been questioned repeatedly, with
      little consensus on modelling assumptions, parameter values or evidence sources
      to be used in cost-effectiveness analyses. The purpose of this project was to
      assemble all available evidence on the prevalence and incidence of Chlamydia
      trachomatis (CT) in the UK and its sequelae, pelvic inflammatory disease (PID),
      ectopic pregnancy (EP) and tubal factor infertility (TFI) to review the evidence 
      base in its entirety, assess its consistency and, if possible, arrive at a
      coherent set of estimates consistent with all the evidence. METHODS: Evidence was
      identified using 'high-yield' strategies. Bayesian Multi-Parameter Evidence
      Synthesis models were constructed for separate subparts of the clinical and
      population epidemiology of CT. Where possible, different types of data sources
      were statistically combined to derive coherent estimates. Where evidence was
      inconsistent, evidence sources were re-interpreted and new estimates derived on a
      post-hoc basis. RESULTS: An internally coherent set of estimates was generated,
      consistent with a multifaceted evidence base, fertility surveys and routine UK
      statistics on PID and EP. Among the key findings were that the risk of PID
      (symptomatic or asymptomatic) following an untreated CT infection is 17.1% [95%
      credible interval (CrI) 6% to 29%] and the risk of salpingitis is 7.3% (95% CrI
      2.2% to 14.0%). In women aged 16-24 years, screened at annual intervals, at best,
      61% (95% CrI 55% to 67%) of CT-related PID and 22% (95% CrI 7% to 43%) of all PID
      could be directly prevented. For women aged 16-44 years, the proportions of PID, 
      EP and TFI that are attributable to CT are estimated to be 20% (95% CrI 6% to
      38%), 4.9% (95% CrI 1.2% to 12%) and 29% (95% CrI 9% to 56%), respectively. The
      prevalence of TFI in the UK in women at the end of their reproductive lives is
      1.1%: this is consistent with all PID carrying a relatively high risk of
      reproductive damage, whether diagnosed or not. Every 1000 CT infections in women 
      aged 16-44 years, on average, gives rise to approximately 171 episodes of PID and
      73 of salpingitis, 2.0 EPs and 5.1 women with TFI at age 44 years. CONCLUSIONS
      AND RESEARCH RECOMMENDATIONS: The study establishes a set of interpretations of
      the major studies and study designs, under which a coherent set of estimates can 
      be generated. CT is a significant cause of PID and TFI. CT screening is of
      benefit to the individual, but detection and treatment of incident infection may 
      be more beneficial. Women with lower abdominal pain need better advice on when to
      seek early medical attention to avoid risk of reproductive damage. The study
      provides new insights into the reproductive risks of PID and the role of CT.
      Further research is required on the proportions of PID, EP and TFI attributable
      to CT to confirm predictions made in this report, and to improve the precision of
      key estimates. The cost-effectiveness of screening should be re-evaluated using
      the findings of this report. FUNDING: The Medical Research Council grant
      G0801947.
FAU - Price, Malcolm J
AU  - Price MJ
AD  - Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
FAU - Ades, A E
AU  - Ades AE
AD  - School of Social and Community Medicine, University of Bristol, Bristol, UK.
FAU - Soldan, Kate
AU  - Soldan K
AD  - Public Health England (formerly Health Protection Agency), Colindale, London, UK.
FAU - Welton, Nicky J
AU  - Welton NJ
AD  - School of Social and Community Medicine, University of Bristol, Bristol, UK.
FAU - Macleod, John
AU  - Macleod J
AD  - School of Social and Community Medicine, University of Bristol, Bristol, UK.
FAU - Simms, Ian
AU  - Simms I
AD  - Public Health England (formerly Health Protection Agency), Colindale, London, UK.
FAU - DeAngelis, Daniela
AU  - DeAngelis D
AD  - Public Health England (formerly Health Protection Agency), Colindale, London, UK.
AD  - Medical Research Council Biostatistics Unit, Cambridge, UK.
FAU - Turner, Katherine Me
AU  - Turner KM
AD  - School of Social and Community Medicine, University of Bristol, Bristol, UK.
FAU - Horner, Paddy J
AU  - Horner PJ
AD  - School of Social and Community Medicine, University of Bristol, Bristol, UK.
AD  - Bristol Sexual Health Centre, University Hospital Bristol NHS Foundation Trust,
      Bristol, UK.
LA  - eng
GR  - G0801947/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - England
TA  - Health Technol Assess
JT  - Health technology assessment (Winchester, England)
JID - 9706284
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Bayes Theorem
MH  - *Chlamydia Infections/complications/diagnosis/epidemiology
MH  - Chlamydia trachomatis/*physiology
MH  - Female
MH  - Humans
MH  - Incidence
MH  - *Mass Screening
MH  - Pelvic Inflammatory Disease/epidemiology/etiology
MH  - Pregnancy
MH  - Pregnancy, Ectopic/epidemiology/etiology
MH  - Prevalence
MH  - United Kingdom/epidemiology
MH  - Young Adult
PMC - PMC4819202
OID - NLM: PMC4819202
EDAT- 2016/03/24 06:00
MHDA- 2016/12/28 06:00
CRDT- 2016/03/24 06:00
AID - 10.3310/hta20220 [doi]
PST - ppublish
SO  - Health Technol Assess. 2016 Mar;20(22):1-250. doi: 10.3310/hta20220.

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