Chlamydia trachomatis: impact on human reproduction

Chlamydia trachomatis infections are the most prevalent bacterial sexually transmitted infections (STI) recognized throughout the world. Worldwide, th e magnitude of morbidity associated with sexually transmitted chlamydial in fections is enormous. C. trachomatis is a common cause of urethritis and ce rvicitis, and sequelae include pelvic inflammatory disease (PID), ectopic p regnancy, tubal factor infertility epididymitis, proctitis and reactive art hritis. The sharp worldwide increase in the incidence of Pm during the past two decades has kd to the secondary epidemics of tubal factor infertility and ectopic pregnancy Chlamydial PID is the most important preventable caus e of infertility and adverse pregnancy outcome. Chlamydial infections, like STI in general, are primarily a woman's health care issue since the manife stations and consequences are more damaging to the reproductive health in w omen than in men. Based on the available evidence, approximately 20% of wom en with chlamydial lower genital tract infection will develop PID, approxim ately 4% develop chronic pelvic pain? 3% infertility, and 2% adverse pregna ncy outcome. However, these estimates are based on relatively weak evidence . Research on the link between C. trachomatis and male aspects of infertili ty has been much more limited. Currently recommended treatment regimens inc lude azithromycin in a single dose or doxycycline for 7 days. These therapi es are highly efficacious. Timely management of ses partners is essential f or decreasing the risk for re-infection. Immunopathogenesis of C. trachomat is infection is one of the main focal points of current research into Chlam ydia. Chlamydial infection fills the general prerequisites for disease prev ention by screening, i.e. chlamydial infections are highly: prevalent, usua lly asymptomatic, are associated with significant morbidity, can be reliabl y diagnosed, and are treatable. Screening programmes for C. trachomatis wil l be of paramount importance in the prevention of long-term sequelae. The c ost of screening is only a fraction of the health care costs incurred due t o complications resulting from undiagnosed and untreated chlamydial infecti ons. Current strategies to control C. trachomatis still largely depend on c linic-based screening of symptomatic patients, and have not been successful The development of highly sensitive and specific nucleic acid amplificatio n tests for the diagnosis of chlamydial infections has been an important ad vance in the ability to conduct population-based screening programmes to pr event complications. Thus, the case for screening is clearly made, but much detail remains to be worked out.