Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease : the POPI (prevention of pelvic infection) trial

Oakeshott, Pippa, Kerry, Sally, Aghaizu, Adamma, Atherton, Helen, Hay, Sima, Taylor-Robinson, David, Simms, Ian and Hay, Phillip (2010) Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease : the POPI (prevention of pelvic infection) trial. BMJ, 340, [c1642]. (doi:10.1136/bmj.c1642).

Abstract

Objective: to determine whether screening and treating women for chlamydial infection reduces the incidence of pelvic inflammatory disease over the subsequent 12 months.

Design: randomised controlled trial.

Setting: common rooms, lecture theatres, and student bars at universities and further education colleges in London.

Participants: 2529 sexually active female students, mean age 21 years (range 16-27).

Intervention: participants completed a questionnaire and provided self taken vaginal swabs, with follow-up after one year. Samples were randomly allocated to immediate testing and treatment for chlamydial infection, or storage and analysis after a year (deferred screening controls).

Main outcome measure: incidence of clinical pelvic inflammatory disease over 12 months.

Results: baseline prevalence of chlamydia was 5.4% (68/1254) in screened women and 5.9% (75/1265) in controls. 94% (2377/2529) of women were followed up after 12 months. The incidence of pelvic inflammatory disease was 1.3% (15/1191) in screened women compared with 1.9% (23/1186) in controls (relative risk 0.65, 95% confidence interval 0.34 to 1.22). Seven of 74 control women (9.5%, 95% confidence interval 4.7% to 18.3%) who tested positive for chlamydial infection at baseline developed pelvic inflammatory disease over 12 months compared with one of 63 (1.6%) screened women (relative risk 0.17, 0.03 to 1.01). However, most episodes of pelvic inflammatory disease occurred in women who tested negative for chlamydia at baseline (79%, 30/38). 22% (527/2377) of women reported being tested independently for chlamydia during the trial.

Conclusion: although some evidence suggests that screening for chlamydia reduces rates of pelvic inflammatory disease, especially in women with chlamydial infection at baseline, the effectiveness of a single chlamydia test in preventing pelvic inflammatory disease over 12 months may have been overestimated.

Trial registration: ClinicalTrials.gov NCT00115388.

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Contributors

Author: Helen Atherton

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