Increasing chlamydia diagnoses but little change in hospitalisations for ectopic pregnancy and infertility among women in New South Wales from 2001 to 2008
Bette Liu A F , Basil Donovan A B , Jim Parker C D , Rebecca Guy A , Jane Hocking E , John M. Kaldor A , Handan Wand A and Louisa Jorm CA The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
B Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000, Australia.
C School of Medicine, University of Western Sydney, Penrith, NSW 2751, Australia.
D Department of Obstetrics and Gynaecology, Campbelltown Hospital, Campbelltown, NSW 2560, Australia.
E School of Population Health, University of Melbourne, Parkville, Vic. 3010, NSW, Australia.
F Corresponding author. Email: Bliu@kirby.unsw.edu.au
Sexual Health 9(4) 355-359 https://doi.org/10.1071/SH11143
Submitted: 11 November 2011 Accepted: 30 January 2012 Published: 11 May 2012
Abstract
Background: As genital chlamydia (Chlamydia trachomatis) notifications have increased in Australia, time trends in hospitalisations for ectopic pregnancy and female infertility between 2001 and 2008 in New South Wales (NSW), Australia, and their relationship to trends in chlamydia notifications in women were assessed. Methods: Annual rates of chlamydia notification, and hospitalisations for female infertility or ectopic pregnancy in women aged 15–44 years in NSW were calculated using routinely collected data. Chlamydia notifications and hospital separations occurring within each year belonging to the same woman were linked using probabilistic linkage of identifiers so that multiple notifications and admissions for one woman in each calendar year were only counted once. Results: From 2001 to 2008, the annual rate of chlamydia diagnoses in women increased from 157 to 477 per 100 000 population (Ptrend < 0.001). Over the same period, the annual hospitalisation rate for women with an ectopic pregnancy decreased from 14.3 to 12.6 per 1000 births (Ptrend < 0.001). This decrease was mostly in women aged 25–44 years, with no appreciable fall in women aged 15–24 years (Ptrend = 0.8). Meanwhile, the hospitalisation rate for women with infertility of female origin did not follow a consistent trend: between 2001 and 2008, it fluctuated between a low of 479 and a high of 554 per 10 000 women who were seeking pregnancy. Conclusions: These trends in ectopic pregnancy and female infertility suggest that the large increase in chlamydia notifications may not reflect hospitalisations for these two proposed chlamydia-related sequelae.
Additional keywords: Australia, pelvic inflammatory disease, reproduction, sequelae.
References
[1] Peipert J. Genital chlamydial infections. N Engl J Med 2003; 349 2424–30.| Genital chlamydial infections.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD3sXpvFGqur0%3D&md5=e1f9ad1432201e83c0b9014cb4ad7331CAS |
[2] Currie M, Bowden F. The importance of chlamydial infections in obstetrics and gynaecology: an update. Aust N Z J Obstet Gynaecol 2007; 47 2–8.
| The importance of chlamydial infections in obstetrics and gynaecology: an update.Crossref | GoogleScholarGoogle Scholar |
[3] Department of Health and Ageing (DoHA). National notifiable diseases surveillance system. Available online at: www9.health.gov.au/cda/Source/Rpt_4.cfm:25 [verified April 2011].
[4] Guy R, Kong F, Goller J, Franklin N, Bergeri I, Dimench W, et al A new national chlamydia sentinel surveillance system in Australia: Evaluation of the first stage of implementation. Commun Dis Intell 2010; 34 319–28.
[5] Chen MY, Fairley CK, Donovan B. Discordance between trends in chlamydia notifications and hospital admission rates for chlamydia related diseases in New South Wales, Australia. Sex Transm Infect 2005; 81 318–22.
| Discordance between trends in chlamydia notifications and hospital admission rates for chlamydia related diseases in New South Wales, Australia.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2MvhtFCkuw%3D%3D&md5=6b3e3a076abb2ff3e60eb1e4a88096b3CAS |
[6] Chen MY, Pan Y, Britt H, Donovan B. Trends in clinical encounters for pelvic inflammatory disease and epididymitis in a national sample of Australian general practices. Int J STD AIDS 2006; 17 384–6.
| Trends in clinical encounters for pelvic inflammatory disease and epididymitis in a national sample of Australian general practices.Crossref | GoogleScholarGoogle Scholar |
[7] Boufous S, Quartararo M, Mohsin M, Parker J. Trends in the incidence of ectopic pregnancy in New South Wales between 1990–1998. Aust N Z J Obstet Gynaecol 2001; 41 436–8.
| Trends in the incidence of ectopic pregnancy in New South Wales between 1990–1998.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2Fmt1aqsg%3D%3D&md5=972069673737ade7c41c401431a249f1CAS |
[8] National Centre for Classification in Health (Sydney). The international statistical classification of diseases and related health problems, 10th revision, Australian Modification (ICD-10-AM). 2nd ed. Lidcombe: National Centre for Classification in Health Sydney; 2000.
[9] Australian Bureau of Statistics (ABS). Australian demographic statistics. Canberra: ABS; March 2010. Available online at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Mar%202010?OpenDocument [verified April 2011].
[10] Walker J, Walker S. The incidence of genital Chlamydia trachomatis in a cohort of young Australian women. In International Society for STD Research Conference; 10–13 July, 2011; Quebec, Canada.
[11] Centre for Health Record Linkage (CHeReL). Quality assurance. Eveleigh: CHeReL; 2011. Available online at: http://www.cherel.org.au/quality-assurance [verified April 2011].
[12] Laws P, Sullivan E. Australia’s mothers and babies 2008. Canberra: Australian Institute of Health and Welfare; 2010.
[13] Lain S, Ford J, Raynes-Greenow C, Hadfield RM, Simpson JM, Morris JM, et al The impact of the Baby Bonus payment in New South Wales: who is having “one for the country”? Med J Aust 2009; 190 238–41.
[14] Condous G. Ectopic pregnancy: challenging accepted management strategies. Aust N Z J Obstet Gynaecol 2009; 49 346–51.
| Ectopic pregnancy: challenging accepted management strategies.Crossref | GoogleScholarGoogle Scholar |
[15] National Centre in HIV Epidemiology and Clinical Research (NCHECR). HIV, viral hepatitis and sexually transmissible infections in Australia annual surveillance report 2010. Sydney: NCHECR, University of New South Wales; 2010.
[16] Morgan J, Colonne C, Bell A. Trends of reported chlamydia infections and related complications in New Zealand, 1998–2008. Sex Health 2011; 8 412–8.
| Trends of reported chlamydia infections and related complications in New Zealand, 1998–2008.Crossref | GoogleScholarGoogle Scholar |
[17] Bakken IJ. Chlamydia trachomatis and ectopic pregnancy: recent epidemiological findings. Curr Opin Infect Dis 2008; 21 77–82.
| Chlamydia trachomatis and ectopic pregnancy: recent epidemiological findings.Crossref | GoogleScholarGoogle Scholar |
[18] Bakken IJ, Skjeldestad FE, Lydersen S, Nordbo SA. Births and ectopic pregnancies in a large cohort of women tested for Chlamydia trachomatis. Sex Transm Dis 2007; 34 739–43.
[19] Low N, Egger M, Sterne J, Harbord RM, Ibrahim F, Lindblom B, et al Incidence of severe reproductive tract complications associated with diagnosed genital chlamydia infection: the Uppsala Women’s Cohort Study. Sex Transm Infect 2006; 82 212–8.
| Incidence of severe reproductive tract complications associated with diagnosed genital chlamydia infection: the Uppsala Women’s Cohort Study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28zgsVKhtg%3D%3D&md5=7346f29eedb331a73f848063aef7551cCAS |
[20] Andersen B, Ostergaard L, Puho E, Skriver MV, Schonoheyder H. Ectopic preganancies and reproductive capacity after Chlamydia trachomatis positive and negative test results: a historical follow-up study. Sex Transm Dis 2005; 32 377–81.
| Ectopic preganancies and reproductive capacity after Chlamydia trachomatis positive and negative test results: a historical follow-up study.Crossref | GoogleScholarGoogle Scholar |
[21] Homan G, Davies M, Norman R. The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review. Hum Reprod Update 2007; 13 209–23.
| The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2s3jsVKltg%3D%3D&md5=618bba12563f1964f8df677829eed571CAS |
[22] Kong F, Guy R, Hocking J, et al Australian general practitioner chlamydia testing rates among young people. Med J Aust 2011; 194 249–52.
[23] Weström L, Joesoef R, Reynolds G, Hagdu A, Thompson SE. Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis 1992; 19 185–92.
| Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results.Crossref | GoogleScholarGoogle Scholar |
[24] Hoover K, Tao G, Kent C. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol 2010; 115 495–502.
| Trends in the diagnosis and treatment of ectopic pregnancy in the United States.Crossref | GoogleScholarGoogle Scholar |
[25] Charles J, Pan Y, Britt H. Management of infertility in Australian general practice. Aust Fam Physician 2005; 34 104–5.
[26] Taylor L, Travis S, Pym M, Henderson-Smart D. How useful are hospital morbidity data for monitoring conditions occurring in the perinatal period? Aust N Z J Obstet Gynaecol 2005; 45 36–41.
| How useful are hospital morbidity data for monitoring conditions occurring in the perinatal period?Crossref | GoogleScholarGoogle Scholar |
