Abstract
BackgroundReported rates of Chlamydia trachomatis are on the rise contradicting the declining rates of C. trachomatis associated reproductive sequelae in Western countries. Population based evaluation of the real trend of C. trachomatis infection is important to contemplate prevention efforts. We studied C. trachomatis occurrence during the past 20 years in Finland comparing incidence rate data based on serology and reported C. trachomatis laboratory notifications.MethodsA random sample of 7999 women with two consecutive pregnancies within five years was selected from the population of the Finnish Maternity Cohort (FMC) serum bank stratified by calendar year and age. C. trachomatis IgG antibodies were determined by a standard peptide-ELISA. The reported incidence rates of C. trachomatis infections based on case notifications were obtained from the National Registry of Infectious Diseases (NIDR).ResultsC. trachomatis seroprevalence rates decreased significantly from 1983 to 2003 both in women under 23 years of age (23.3% to 9.2%) and in women between 23–28-years of age (22.2% to 12.6%). However, seroconversion rates increased from 31 per 10000 person years in 1983–85 to 97 per 10000 person years in 2001–2003 (incidence rate ratio 3.2, 95% CI, 1.1–8.7) among the older age group. Seroconversion rate was highest (264) in 1983–1985 in the younger age-group, then declined and subsequently increased again (188) in 2001–2003. The incidence based on seroconversions was in agreement with the reported incidence rates in both age groups.ConclusionC. trachomatis seroprevalence rate decreased during 1983–2003 among fertile-aged women in Finland. During the same time period incidence rates based both on seroconversions and reported laboratory notifications of diagnosed C. trachomatis infections increased. The discrepancy between the C. trachomatis incidence and seroprevalence trends warrants further studies.
Highlights
Reported rates of Chlamydia trachomatis are on the rise contradicting the declining rates of C. trachomatis associated reproductive sequelae in Western countries
To clarify the discordance between the reported infection rates to the National Infectious Disease Register (NIDR) and the seroprevalence rates, we studied the incidence rates of C. trachomatis infection by serology using paired serum bank samples
C. trachomatis seroprevalence trends C. trachomatis seroprevalences did not differ between women who were < 23 years of age and those between 23 and 28 years of age (Figure 1A) as their 95% confidence intervals overlapped at each calendar time point
Summary
Reported rates of Chlamydia trachomatis are on the rise contradicting the declining rates of C. trachomatis associated reproductive sequelae in Western countries. We studied C. trachomatis occurrence during the past 20 years in Finland comparing incidence rate data based on serology and reported C. trachomatis laboratory notifications. Chlamydia trachomatis is a major threat to the reproductive health of women [1]. In the Nordic countries, incidence rates have increased between 1999 and 2005 [3,4,5]. In Finland, the incidence of reported C. trachomatis infections increased by 60% over the last 10 years, peaking in the age group of 15–24 [6]. Since most chlamydial infections are asymptomatic [7], true incidence may well be higher than that based on reports. A total of 401 women were excluded because of missing data. 7999 women were tested for C. trachomatis IgG-antibodies (Table 1)
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