{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:56:01Z","timestamp":1790776561622,"version":"4.1.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2019,8,24]],"date-time":"2019-08-24T00:00:00Z","timestamp":1566604800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"Netherlands Organisation for Health Research and Development","doi-asserted-by":"publisher","award":["522002013"],"award-info":[{"award-number":["522002013"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>We evaluated the risk of pelvic inflammatory disease (PID), ectopic pregnancy, and infertility in women with a previous Chlamydia trachomatis (CT) diagnosis compared with women who tested negative for CT and CT untested women, considering both targeted and incidental (ie, prescribed for another indication) use of CT-effective antibiotics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a retrospective study of women aged 12\u201325 years at start of follow-up within the Clinical Practice Research Datalink GOLD database linked to index of multiple deprivation quintiles, 2000\u20132013. CT test status and antibiotic use were determined in a time-dependent manner. Risk of PID, ectopic pregnancy, or female infertility were evaluated using of Cox proportional hazard models.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We studied 857 324 women, contributing 6 457 060 person-years. Compared with women who tested CT-negative, women who tested CT-positive had an increased risk of PID (adjusted hazard ratio [aHR], 2.36; 95% confidence interval [CI], 2.01\u20132.79), ectopic pregnancy (aHR, 1.87; 95% CI, 1.38\u20132.54), and infertility (aHR, 1.85; 95% CI, 1.27\u20132.68). The PID risk was higher for women with 2 or more positive CT tests than those with 1 positive test. PID risk increased with the number of previous antibiotic prescriptions, regardless of CT test status.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We showed an association between CT-positive tests and 3 adverse reproductive health outcomes. Moreover, this risk increased with repeat CT infections. CT-effective antibiotic use showed no decreased risks of subsequent PID regardless of CT history. Our results confirm the reproductive health burden of CT, which requires adequate public health interventions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciz429","type":"journal-article","created":{"date-parts":[[2019,5,27]],"date-time":"2019-05-27T15:13:28Z","timestamp":1558970008000},"page":"1517-1525","source":"Crossref","is-referenced-by-count":131,"title":["Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease, Ectopic Pregnancy, and Female Infertility: A Retrospective Cohort Study Among Primary Care Patients"],"prefix":"10.1093","volume":"69","author":[{"given":"Casper D J","family":"den Heijer","sequence":"first","affiliation":[{"name":"Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Heerlen"},{"name":"Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Heerlen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian J P A","family":"Hoebe","sequence":"additional","affiliation":[{"name":"Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Heerlen"},{"name":"Department of Medical Microbiology,Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+ (MUMC+), Maastricht"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna H M","family":"Driessen","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Heerlen"},{"name":"Department of Clinical Pharmacy and Toxicology CAPHRI, School for Nutrition and Translational Research in Metabolism, MUMC+, Maastricht"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Wolffs","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology,Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+ (MUMC+), Maastricht"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid V F","family":"van den Broek","sequence":"additional","affiliation":[{"name":"Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernice M","family":"Hoenderboom","sequence":"additional","affiliation":[{"name":"Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael","family":"Williams","sequence":"additional","affiliation":[{"name":"Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, United 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