Cited by 494Reproductive tract infections researchCervical Cancer and HPV ResearchReproductive Health and Contraception

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

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Price, Malcolm J, Ades, AE, Soldan, Kate, Welton, Nicky J, Macleod, John, Simms, Ian, DeAngelis, Daniela, Turner, Katherine ME, Horner, Paddy J·2016·Health Technology Assessment

DOI 10.3310/hta20220PMC PMC4819202

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Abstract

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.

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Harvard, S. S., Guh, D. P., Bansback, N. J., Richette, P., Saraux, A., Fautrel, B., & Anis, A. H. (2017) · The Journal of Rheumatology · doi:10.3899/jrheum.161399 · Cited by 3
Risk of reproductive complications following chlamydia testing
Price, M. J., Horner, P., & Ades, A. E. (2016) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(16)30379-6 · Cited by 3
Self-citation
Incidence of Microbial Infections in English UK Biobank Participants: Comparison with the General PopulationPreprint
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Randomised controlled trial to evaluate the effectiveness of using the RD-1-based C-Tb skin test as a replacement for blood-based interferon-γ release assay for detection of, and initiation of preventive treatment for, tuberculosis infection: RID-TB:Dx study protocol
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Chlamydia trachomatis Serovars from the C-Complex and the B- and C-Related Complexes Are Significantly More Pathogenic than Those from the B-Complex in C3H/HeN but Not in BALB/c Mice
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“Based on an analysis in the United Kingdom, Price et al. [5] concluded that, for every 1000 C. trachomatis infections in women aged 16–44 years, there are, on average, 171 episodes of PID, 73 episodes of salpingitis, 2 episodes of ectopic pregnancy, and 5.1 women with infertility at age 44 years.”
Influential
What are the broader impacts and value from a randomised controlled trial conducted in six public hospital antenatal clinics in Australia? An impact assessment using the Framework to Assess the Impact from Translational health research
Elvidge, E., Murphy, V. E., Rao, M., Gibson, P. G., McLaughlin, K., Robijn, A. L., Jensen, M. E., Callaway, L. K., Attia, J., Hensley, M., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2023-082795 · Cited by 2
Chlamydia trachomatis and Mycoplasma genitalium
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Red blood cell transfusions in advanced cancer near the end-of-life: narrative review
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Early-stage cost-utility analysis of novel diagnostic tests for giant cell arteritis: a modelling study in UK secondary care
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Chlamydia trachomatis restricts signaling through NOD2 until late in the pathogen’s developmental cycle
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Easily Missed? Giant cell arteritis
Mills-Baker, F., Bakht, T., Nugaliyadde, A., & Paul, A. (2026) · BMJ · doi:10.1136/bmj-2025-086139 · Cited by 2
Conceptualisation and operationalisation of social support in health interventions: a scoping review
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Chlamydia trachomatis Infection
Hocking, J. S., Huston, W. M., & Chen, M. Y. (2017) · Springer eBooks · doi:10.1007/978-3-319-56694-8_3 · Cited by 3
Low yield from imaging after non-E. coliurine tract infections in children treated in primary care and emergency department
Tse, Y., Pickles, C., Owens, S., Malina, M., Peace, R., & Gopal, M. (2023) · Archives of Disease in Childhood · doi:10.1136/archdischild-2022-324930 · Cited by 2
Informing the design of a digital intervention to support sexually transmissible infection care in general practice: a qualitative study exploring the views of clinicians
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Association Between Self‐Reported Infections and Seropositivity Among Pregnant Women With Gastroschisis: A Case Control Study, With Emphasis on Chlamydia trachomatis
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“However, the duration of asymptomatic infections has been estimated to last as long as 12 (Molano et al. 2005) to 16 months (Price et al. 2016).”
Relationship between Chlamydia Trachomatis infection, infertility, and serum 25-hydroxyvitamin D: a cross-sectional study from NHANES 2013–2016
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Serum IgG1 and IgG3 Antibody Responses to Chlamydia trachomatis Pgp3 and Hsp60 in Tubal Factor Infertility
Holster, T., Joki‐Korpela, P., Yu, H. B., Brunham, R. C., Tiitinen, A. E., Paavonen, J. A., & Puolakkainen, M. H. (2025) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiaf092 · Cited by 2
“Ascending C. trachomatis infection damages fallopian tubes and causes pelvic adhesions, particularly after untreated or repeat chlamydial infection [2, 25, 26].”
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Proinflammatory Cytokines in Women with PCOS in Atypical Pathogen Infections
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“With the increase in the number of C. trachomatis infections, an increase in infertility cases is observed at the level of 35–70% [17], and the risk of PID (symptomatic or asymptomatic) is 17.1% [21].”
Influential
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“or Mycoplasma hominis.(16,17) In addition, these terms are not used to describe genital human papilloma viruses (HPV) which cause cervical cancer in only a minority of those infected, presumably because of the stigma associated with these terms and that there is no effective treatment.”
BackgroundSelf-citation
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Gynaecological emergencies
Gray, T. G., McQueen, V., & Farkas, A. (2018) · InnovAiT Education and inspiration for general practice · doi:10.1177/1755738018809121 · Cited by 2
“There are an estimated 50 000–75 000 cases of PID in England each year, with a third of cases in women aged between 16 and 24 years (Price et al., 2016).”
Background
Severe bullous pemphigoid with excoriation disorder
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Repeat infections with chlamydia in women may be more transcriptionally active with lower responses from some immune genes
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Probiotics for woman’s health focus on urogenital infections and reproductive outcomes
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“The risk of future tubal factor infertility was found to increases with each episode of PID.22 Haggerty et al, reported that the women who tested positive for bacterial vaginosiscausing bacteria in the cervix and/or endometrium were three times more likely to experience infertility.23 Among infertile women, the preval…”
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Protocol for a systematic review and individual participant data meta-analysis for risk factors for lung cancer in individuals with lung nodules identified by low-dose CT screening
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Common Reproductive Infections and their Treatments
Benabbou, A., Malik, J., & Perveen, S. (2025) · BENTHAM SCIENCE PUBLISHERS eBooks · doi:10.2174/9789815313628125010009 · Cited by 1
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“Seroepide-miological studies indicate that in some high-prevalence areas, cumulative infection rates among women of reproductive age can reach 40–60% [5–7].”
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“linfogranuloma venéreo, mais comum nos países desenvolvidos em homens que têm sexo com homens; (c) e como infeção urogenital, sob a forma de cervicite no sexo feminino e como uretrite ou proctite em ambos os sexos.(7) Contudo, é mais frequente a infeção cursar assintomaticamente (cerca de 75% no sexo feminino), pelo q…”
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Authors: Price, M. J., Ades, A., Soldan, K., Welton, N. J., Macleod, J., Simms, I., DeAngelis, D., Turner, K. M., & Horner, P. J.
Affiliations: University of Birmingham (GB)
School of Social and Community Medicine, University of Bristol, Bristol, UK
Public Health England (GB)
University of Bristol (GB)
Public Health England (formerly Health Protection Agency), Colindale, London, UK
University Hospitals Bristol NHS Foundation Trust (GB)
ORCID: Price, Malcolm J
Soldan, Kate
Welton, Nicky J
Macleod, John
Simms, Ian
Horner, Paddy J
Venue: Health Technology Assessment
Publisher: National Institute for Health and Care Research
Published: 2016-03
Volume: 20
Issue: 22
Pages: 1-250
ISSN: 1366-5278 (ISSN-L)
2046-4924
DOI: 10.3310/hta20220
PMC: PMC4819202
OpenAlex: W2309207579
Cited by: 494
References: 266
Citations by year: 2026: 40 · 2025: 40 · 2024: 40 · 2023: 39 · 2022: 51 · 2021: 59 · 2020: 49 · 2019: 71 · 2018: 46 · 2017: 51 · 2016: 8
FWCI: 6.56
Type: journal article
Language: en
Open access: diamond
doi.org
Licence: cc-by-nc
www.nationalarchives.gov.uk/doc/non-commercial-government-licence/non-commercial-government-licence.htm (unspecified)
Locations: Health Technology Assessment (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Bristol Research (University of Bristol) (publishedVersion, cc-by-nc)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
Explore Bristol Research (submittedVersion, cc-by-nc)
Funders: Medical Research Council (G0801947)
Topics: Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
Keywords: Chlamydia trachomatis, chlamydia screening, pelvic inflammatory disease, ectopic pregnancy, tubal infertility, salpingitis, cost-effectiveness, natural history of infection, incidence and prevalence, attributable risk, reproductive outcomes, women's health, National Chlamydia Screening Programme
MeSH terms: Pelvic Inflammatory Disease, Adolescent, Adult, Bayes Theorem, Chlamydia Infections, Chlamydia trachomatis, Female, United Kingdom, Humans, Mass Screening, Pregnancy, Pregnancy, Ectopic, Incidence, Prevalence, Young Adult

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

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