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Timing of progression from Chlamydia trachomatis infection to pelvic inflammatory disease: a mathematical modelling study.

Herzog, SA; Althaus, CL; Heijne, JC; Oakeshott, P; Kerry, S; Hay, P; Low, N (2012) Timing of progression from Chlamydia trachomatis infection to pelvic inflammatory disease: a mathematical modelling study. BMC INFECTIOUS DISEASES, 12 (187). ISSN 1471-2334 https://doi.org/10.1186/1471-2334-12-187
SGUL Authors: Hay, Phillip Edward Oakeshott, Philippa

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Abstract

BACKGROUND: Pelvic inflammatory disease (PID) results from the ascending spread of microorganisms from the vagina and endocervix to the upper genital tract. PID can lead to infertility, ectopic pregnancy and chronic pelvic pain. The timing of development of PID after the sexually transmitted bacterial infection Chlamydia trachomatis (chlamydia) might affect the impact of screening interventions, but is currently unknown. This study investigates three hypothetical processes for the timing of progression: at the start, at the end, or throughout the duration of chlamydia infection. METHODS: We develop a compartmental model that describes the trial structure of a published randomised controlled trial (RCT) and allows each of the three processes to be examined using the same model structure. The RCT estimated the effect of a single chlamydia screening test on the cumulative incidence of PID up to one year later. The fraction of chlamydia infected women who progress to PID is obtained for each hypothetical process by the maximum likelihood method using the results of the RCT. RESULTS: The predicted cumulative incidence of PID cases from all causes after one year depends on the fraction of chlamydia infected women that progresses to PID and on the type of progression. Progression at a constant rate from a chlamydia infection to PID or at the end of the infection was compatible with the findings of the RCT. The corresponding estimated fraction of chlamydia infected women that develops PID is 10% (95% confidence interval 7-13%) in both processes. CONCLUSIONS: The findings of this study suggest that clinical PID can occur throughout the course of a chlamydia infection, which will leave a window of opportunity for screening to prevent PID.

Item Type: Article
Additional Information: PubMed ID: 22883325 © 2012 Herzog et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Adolescent, Chlamydia trachomatis, Female, Humans, Lymphogranuloma Venereum, Models, Theoretical, Pelvic Inflammatory Disease, Randomized Controlled Trials as Topic, Young Adult, Science & Technology, Life Sciences & Biomedicine, Infectious Diseases, Chlamydia infection, Pelvic inflammatory disease, Mathematical model, Compartmental model, Randomised controlled trials, COST-EFFECTIVENESS, GENITAL-INFECTION, WOMEN, PREVENTION, COHORT, TRIAL, RISK
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: BMC INFECTIOUS DISEASES
ISSN: 1471-2334
Dates:
DateEvent
11 August 2012Published
Web of Science ID: WOS:000311719900001
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URI: https://openaccess.sgul.ac.uk/id/eprint/101420
Publisher's version: https://doi.org/10.1186/1471-2334-12-187

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