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Fewer reproductive complications seen, despite increased chlamydia rates
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Despite the increasing rates of Chlamydia trachomatis, the reproductive complications of the infection are declining, researchers from British Columbia, Canada, suggest.
“The best explanation for these two seemingly contradictory occurrences is what we have called the Arrested Immunity Hypothesis,” Michael Rekart, MD, of the British Columbia Centre for Disease Control in Vancouver, Canada, told Infectious Disease News. “That is, early enhanced efforts to diagnose and treat Chlamydia infection have arrested the development of natural immunity, thereby increasing the likelihood of reinfection. But early treatment may also be arresting the immunopathology triggered by persistent infection, thereby reducing complications such as pelvic inflammatory disease and ectopic pregnancy.”
Michael Rekart
Rekart and colleagues analyzed data from two sources within the British Columbia Ministry of Health Services: Medical Services Plan and the provincial Discharge Abstract Database. They identified cases of pelvic inflammatory disease and ectopic pregnancy from 1992 to 2009 in women of reproductive age. They then compared trends to provincial chlamydia surveillance data.
From 1997 to 2009, the incidence of chlamydia infection among women of reproductive age increased from 401.7/100,000 population to 934.6/100,000 population. From 1992 to 2009, hospitalizations related to pelvic inflammatory disease decreased by 80%. From 1992 to 2003, hospitalizations related to ectopic pregnancy decreased by 50%, but they have increased since 2003.
“These data should encourage practitioners and public health officials to ‘stay the course’,” Rekart said. “Chlamydia control is working, just not in the way we anticipated. Screening, early diagnosis and treatment and partner follow-up are affecting reproductive health in a positive way, even though Chlamydia cases are rising. We should all pay attention to people previously infected whose risk of reinfection is especially high because of their own behavior and because of the possibility of reinfection due to arrested natural immunity.”
Rekart said that there are several areas that deserve further study, including Chlamydia vaccine research, the effect of antimicrobial treatment on cellular and humoral immunity to Chlamydia, the magnitude of pelvic inflammatory disease and ectopic pregnancy due to Chlamydia and immunological explanations for the observed trends in Chlamydia epidemiology.
Disclosure: Rekart reports no relevant financial disclosures.
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