RT Journal Article
SR Electronic
T1 Where to go to in chlamydia control? From infection control towards infectious disease control
JF Sexually Transmitted Infections
JO Sex Transm Infect
FD BMJ Publishing Group Ltd
SP 501
OP 506
DO 10.1136/sextrans-2021-054992
VO 97
IS 7
A1 Jan E A M van Bergen
A1 Bernice Maria Hoenderboom
A1 Silke David
A1 Febe Deug
A1 Janneke C M Heijne
A1 Fleur van Aar
A1 Christian J P A Hoebe
A1 Hanna Bos
A1 Nicole H T M Dukers-Muijrers
A1 Hannelore M Götz
A1 Nicola Low
A1 Servaas Antonie Morré
A1 Bjőrn Herrmann
A1 Marianne A B van der Sande
A1 Henry J C de Vries
A1 Helen Ward
A1 Birgit H B van Benthem
YR 2021
UL http://sti.bmj.com/content/97/7/501.abstract
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.