PT  - JOURNAL ARTICLE
AU  - Jan E A M van Bergen
AU  - Bernice Maria Hoenderboom
AU  - Silke David
AU  - Febe Deug
AU  - Janneke C M Heijne
AU  - Fleur van Aar
AU  - Christian J P A Hoebe
AU  - Hanna Bos
AU  - Nicole H T M Dukers-Muijrers
AU  - Hannelore M Götz
AU  - Nicola Low
AU  - Servaas Antonie Morré
AU  - Bjőrn Herrmann
AU  - Marianne A B van der Sande
AU  - Henry J C de Vries
AU  - Helen Ward
AU  - Birgit H B van Benthem
TI  - Where to go to in chlamydia control? From infection control towards infectious disease control
AID  - 10.1136/sextrans-2021-054992
DP  - 2021 Nov 01
TA  - Sexually Transmitted Infections
PG  - 501--506
VI  - 97
IP  - 7
4099  - http://sti.bmj.com/content/97/7/501.short
4100  - http://sti.bmj.com/content/97/7/501.full
SO  - Sex Transm Infect2021 Nov 01; 97
AB  - Objectives The clinical and public health relevance of widespread case finding by testing for asymptomatic chlamydia infections is under debate. We wanted to explore future directions for chlamydia control and generate insights that might guide for evidence-based strategies. In particular, we wanted to know the extent to which we should pursue testing for asymptomatic infections at both genital and extragenital sites.Methods We synthesised findings from published literature and from discussions among national and international chlamydia experts during an invitational workshop. We described changing perceptions in chlamydia control to inform the development of recommendations for future avenues for chlamydia control in the Netherlands.Results Despite implementing a range of interventions to control chlamydia, there is no practice-based evidence that population prevalence can be reduced by screening programmes or widespread opportunistic testing. There is limited evidence about the beneficial effect of testing on pelvic inflammatory disease prevention. The risk of tubal factor infertility resulting from chlamydia infection is low and evidence on the preventable fraction remains uncertain. Overdiagnosis and overtreatment with antibiotics for self-limiting and non-viable infections have contributed to antimicrobial resistance in other pathogens and may affect oral, anal and genital microbiota. These changing insights could affect the outcome of previous cost–effectiveness analysis.Conclusion The balance between benefits and harms of widespread testing to detect asymptomatic chlamydia infections is changing. The opinion of our expert group deviates from the existing paradigm of ‘test and treat’ and suggests that future strategies should reduce, rather than expand, the role of widespread testing for asymptomatic chlamydia infections.