Antibody testing in estimating past exposure to chlamydia trachomatis in the Netherlands chlamydia cohort study

The asymptomatic course of Chlamydia trachomatis (CT) infections can result in underestimated CT lifetime prevalence. Antibody testing might improve this estimate. We assessed CT antibody positivity and predictive factors thereof in the Netherlands Chlamydia Cohort Study. Women who had >1 CT Nucleic Acid Amplification Test (NAAT) in the study (2008–2011) and who provided self-reported information on NAATs were tested for CT major outer membrane protein specific IgG in serum (2016). CT antibody positivity was assessed and predictive factors were identified using multivariable logistic regressions, separately for CT-positive women (>1 positive NAAT or >1 self-reported positive CT test) and CT-negative women (negative by study NAAT and self

Relation between Chlamydia trachomatis infection and pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in a Dutch cohort of women previously tested for chlamydia in a chlamydia screening trial

Objectives A better understanding of Chlamydia trachomatis infection (chlamydia)–related sequelae can provide a framework for effective chlamydia control strategies. The objective of this study was to estimate risks and risk factors of pelvic inflammatory disease (PID), ectopic pregnancy and tubal factor infertility (TFI) with a follow-up time of up until 8 years in women previously tested for chlamydia in the Chlamydia Screening Implementation study (CSI) and participating in the Netherlands Chlamydia Cohort Study (NECCST). Methods Women who participated in the CSI 2008–2011 (n=13 498) were invited in 2015–2016 for NECCST. Chlamydia positive was defined as a positive CSI-PCR test, positive chlamydia serology and/or selfreported infection (time dependent). Data on PID, ectopic pregnancy and TFI were collected by self-complete

Pregnancies and Time to Pregnancy in Women With and Without a PreviousChlamydia trachomatisInfection

Background: A Chlamydia trachomatis infection (chlamydia) can result in tubal factor infertility in women. To assess if this association results in fewer pregnant women, we aimed to assess pregnancy incidences and time to pregnancy among women with a previous chlamydia infection compared with women without one and who were participating in the Netherlands Chlamydia Cohort Study (NECCST). Methods: The NECCST is a cohort of women of reproductive age tested for chlamydia in a chlamydia screening trial between 2008 and 2011 and reinvited for NECCST in 2015 to 2016. Chlamydia status (positive/negative) was defined using chlamydia screening trial–nucleic acid amplification test results, chlamydia immunoglobulin G presence in serum, or self-reported chlamydia infections. Data on pregnancies were collected via questionnaires in 2015–2016 and 2017–2018. Overall p

Can Previous Associations of Single Nucleotide Polymorphisms in the TLR2, NOD1, CXCR5, and IL10 Genes in the Susceptibility to and Severity of Chlamydia trachomatis Infections Be Confirmed?

Clear inter-individual differences exist in the response to C. trachomatis (CT) infections and reproductive tract complications in women. Host genetic variation like single nucleotide polymorphisms (SNPs) have been associated with differences in response to CT infection, and SNPs might be used as a genetic component in a tubal-pathology predicting algorithm. Our aim was to confirm the role of four genes by investigating proven associated SNPs in the susceptibility and severity of a CT infection. A total of 1201 women from five cohorts were genotyped and analyzed for TLR2 + 2477 G > A, NOD1 + 32656 T -> GG, CXCR5 + 10950 T > C, and IL10 - 1082 A > G. Results confirmed that NOD1 + 32656 T ->GG was associated with an increased risk of a symptomatic CT infection (OR: 1.9, 95%CI: 1.1-3.4, p = 0.02), but we did not observe an association with late complications. IL10 - 1082 A > G appeared to increase the risk of late complications (i.e., ectopic pregnancy/tubal factor infertility) following a CT infection (OR = 2.8, 95%CI: 1.1-7.1, p = 0.02). Other associations were not found. Confirmatory studies are important, and large cohorts are warranted to further investigate SNPs' role in the susceptibility and severity of a CT infection

Sexually transmitted infections in the Netherlands in 2017.

In 2017, a total of 150,593 consultations were registered at the Dutch Sexual Health Centres (SHC), an increase of 5% compared to 2016. This increase was highest among MSM (+12.9%), and less strong among women (+2.6%) and heterosexual men (+0.5%). Of all SHC visitors, 46% was female (69,375 consultations), 23% heterosexual male (35,242 consultations) and 30% MSM (45,553 consultations). In 416 consultations (0.3%), the client was transgender. Similar to 2016, 16% of SHC visitors had two or more registered visits in 2017. This percentage was highest among MSM (35%) and lower among heterosexual men (9%) and women (11%). The percentage of people with a positive STI test (chlamydia, gonorrhoea, infectious syphilis, HIV or infectious hepatitis B) was 18.4% in both 2016 and 2017. The positivity rate among heterosexual men increased from 13.9% in 2013 to 19.6% in 2017 (19.2% in 2016). Among women, the positivity rate increased from 13.2% in 2013 to 16.3% in 2017, but remained stable compared with 2016 (16.2%). The positivity rate among MSM varied between 19.2% and 21.7% over time (20.5% in 2017). Positivity rates were highest among visitors who were notified for STI (33.0%) and among HIV-positive visitors (32.5%), though the positivity rates among HIV-positive people were lower compared to previous years. Positivity rates were also high among those who reported STI symptoms (26.1%) and people who had an STI in the past year (25.1%). Overall positivity rates varied between 14.7 and 21.7% in the SHC regions. The total number of STI-related episodes recorded at general practices (GP) (based on a selection of 350 GPs in the Netherlands and extrapolated to the total Dutch population) is almost twice the number reported at SHC, with an estimated 281,300 episodes (STI infections and ‘fear of STI’) in 2016. This is an increase from the 267,400 episodes recorded in 2015. The reporting rate of STI-related episodes at the GP increased mainly among people aged 25 years or older (from 15.9/1,000 population to 16.9/1,000 population). Bacterial STI In 2017, chlamydia was diagnosed 21,404 times at the SHC, an increase of 3% compared to 2016. Most chlamydia infections were diagnosed in people younger than 25 years of age (64%). There is an increasing trend in the chlamydia positivity rate among heterosexual men: from 10.6% in 2008 to 18.3% in 2017 (18.0% in 2016). Among women, the positivity rate also increased in the same period, but remained stable in 2017 (15.4%) compared to 2016 (15.3%). The positivity rate among MSM has fluctuated around 10.0% in recent years (9.5% in 2017). Among HIV-positive MSM, a decrease in positivity rate was seen from 17.6% in 2014 to 14.6% in 2017. The number of lymphogranuloma venereum (LGV, an infection caused by an invasive strain of chlamydia) diagnoses increased again in 2017, but the positivity rate remained stable. Of those with LGV, 55% were known to be HIV-positive. The number of estimated chlamydia episodes reported in general practice (36,500) was fairly stable compared to the previous year, but slightly increased among people aged 25 and older. Reporting rates of chlamydia episodes per 1,000 population were the same in both 2016 and 2015. The number of reported acute hepatitis B cases in the notification data was similar in both years (114 in 2017 versus 111 in 2016). Sexual contact was the most reported transmission route (69%). The number of reported acute hepatitis C cases has fluctuated around 60 cases from 2011 onwards (58 in 2017). The main reported transmission route for acute hepatitis C was sexual contact between men. In conclusion, the number of STI tests continues to increase both at SHC and the GP. However, in contrast with increases in the previous years, positivity rates remained fairly stable in 2017 compared to 2016. It is important to maintain an integrated surveillance of STIs and STI risks among high-risk groups that visit SHC. Keeping track of lower risk groups/the general population, who test mainly though other care providers or self-testing, is also important. As in previous years, SHC data show that groups at high risk for STI, as reflected in high positivity rates, were people notified for STI by their (ex) partner, people who reported STI symptoms, were HIV-positive, and those who had an STI in the past year. Although high-risk groups are more strongly prioritised in SHC, this suggests that further efforts, such as promotion of condom use, repeat testing, and more effective (timely and complete) partner notification are needed to ensure that people in high-risk groups are effectively targeted. Testing and treatment strategies need to be optimised to maximize the effect of control efforts and to reach those most in need of care. (aut. ref.

Where to go to in chlamydia control? From infection control towards infectious disease control

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

Where to go to in chlamydia control? From infection control towards infectious disease control

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

Pregnancies and Time to Pregnancy in Women With and Without a Previous Chlamydia trachomatis Infection

Background: A Chlamydia trachomatis infection (chlamydia) can result in tubal factor infertility in women. To assess if this association results in fewer pregnant women, we aimed to assess pregnancy incidences and time to pregnancy among women with a previous chlamydia infection compared with women without one and who were participating in the Netherlands Chlamydia Cohort Study (NECCST). Methods: The NECCST is a cohort of women of reproductive age tested for chlamydia in a chlamydi

Hoedt u voor artikel 4:36 Awb. Problemen rond het gebruik van uitvoeringsovereenkomsten bij susidieverstrekking.1997

Background: Chlamydia trachomatis (CT), the most common bacterial sexually transmitted infection (STI) among young women, can result in serious sequelae. Although the course of infection is often asymptomatic, CT may cause pelvic inflammatory disease (PID), leading to severe complications, such as prolonged time to pregnancy, ectopic pregnancy, and tubal factor subfertility. The risk of and risk factors for complications following CT-infection have not been assessed in a long-term prospective cohort study, the preferred design to define infections and complications adequately. Methods: In the Netherlands Chlamydia Cohort Study (NECCST), a cohort of women of reproductive age with and without a history of CT-infection is followed over a minimum of ten years to investigate (CT-related) reproductive tract complications. This study is a follow-up of the Chlamydia Screening Implementation (CSI) study, executed between 2008 and 2011 in the Netherlands. For NECCST, female CSI participants who consented to be approached for follow-up studies (n = 14,685) are invited, and prospectively followed until 2022. Four data collection moments are foreseen every two consecutive years. Questionnaire data and blood samples for CT-Immunoglobulin G (IgG) measurement are obtained as well as host DNA to determine specific genetic biomarkers related to susceptibility and severity of infection. CT-history will be based on CSI test outcomes, self-reported infections and CT-IgG presence. Information on (time to) pregnancies and the potential long-term complications (i.e. PID, ectopic pregnancy and (tubal factor) subfertility), will be acquired by questionnaires. Reported subfertility will be verified in medical registers. Occurrence of these late complications and prolonged time to pregnancy, as a proxy for reduced fertility due to a previous CT-infection, or other risk factors, will be investigated using longitudinal statistical procedures. Discussion: In the proposed study, the occurrence of late complications following CT-infection and its risk factors will be assessed. Ultimately, provided reliable risk fac