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Once upon a time, it all seemed so simple. Early trials of chlamydia screening looked promising in reducing the incidence of pelvic inflammatory disease, so attention quickly turned to evaluating means of delivery, and it was widely assumed that prevalence would rapidly fall. As the optimism of a new millennium faded, chlamydia prevalence was shown in a range of studies to remain stubbornly resistant to control activities or to decline regardless of testing patterns. A number of population based studies suggest that pelvic inflammatory disease (PID) is also in decline in many settings, for reasons which remain unclear. So what is the impact of chlamydia screening or other control activities? Are we selecting for less symptomatic strains (and if so, are they less damaging …
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