Prevention of pelvic inflammatory disease by the control of C. trachomatis infection

Objectives: To determine if there is evidence to indicate that screening for Chlamydia trachomatis (chlamydia) is an effective intervention in the prevention of pelvic inflammatory disease (PID). Methods: A systematic review was made of the literature to assess the effectiveness of screening asymptomatic young women for lower genital tract infection with C. trachomatis in the prevention of PID and its major sequelae tubal infertility and ectopic pregnancy. Results: There is considerable literature describing screening for lower genital tract infection with C. trachomatis, but only two randomized controlled trials, two ecological studies and one case-controlled trial were identified. These studies were graded and the evidence pooled. The suggestion that screening for chlamydia is an effective intervention in the prevention of PID is supported by Grade 2 evidence (level B recommendation). However, there are large gaps in the literature. Only small numbers of women have been studied and the follow-up periods are short. The studies have been conducted using mainly culture of cervical swabs to diagnose chlamydial infection and not the more recent nucleic acid based tests. The risk of a woman developing PID following detection of lower tract infection with C. trachomatis is still uncertain. Conclusions: There is evidence to support a level B recommendation that screening for chlamydia using culture is effective in preventing PID in, the short term. Further randomized controlled trials are required to assess screening using nucleic acid based tests and involving longer follow-up periods. (C) 2002 International Federation of Gynecology and Obstetrics. Published by Elsevier Science Ireland Ltd. All rights reserved.