Impact of Chlamydia trachomatis in the reproductive setting: British Fertility Society Guidelines for practice

Abstract

Chlamydia trachomatis infection of the genital tract is the most common sexually transmitted infection and has a world-wide distribution. The consequences of infection have an adverse effect on the reproductive health of women and are a common cause of infertility. Recent evidence also suggests an adverse effect on male reproduction. There is a need to standardise the approach in managing the impact of C. trachomatis infection on reproductive health. We have surveyed current UK practice towards screening and management of Chlamydia infections in the fertility setting. We found that at least 90% of clinicians surveyed offered screening. The literature on this topic was examined and revealed a paucity of solid evidence for estimating the risks of long-term reproductive sequelae following lower genital tract infection with C. trachomatis. The mechanism for the damage that occurs after Chlamydial infections is uncertain. However, instrumentation of the uterus in women with C. trachomatis infection is associated with a high risk of pelvic inflammatory disease, which can be prevented by appropriate antibiotic treatment and may prevent infected women from being at increased risk of the adverse sequelae, such as ectopic pregnancy and tubal factor infertility. Recommendations for practice have been proposed and the need for further studies is identified.

Keywords:

• Chlamydia
• screening
• infertility
• serology
• NAAT
• guideline
• BFS

Acknowledgements

The authors gratefully acknowledge the expertise of Professor Gary Entrican (Moredun Research Institute, Edinburgh), Professor Sarah Howie (University of Edinburgh) and Dr. Sharon Cameron (Royal Infirmary of Edinburgh) in the preparation of this document.