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2017 ; 216
(2
): 237-244
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Genital Chlamydia trachomatis Infections Clear More Slowly in Men Than Women, but
Are Less Likely to Become Established
#MMPMID28838150
Lewis J
; Price MJ
; Horner PJ
; White PJ
J Infect Dis
2017[Jul]; 216
(2
): 237-244
PMID28838150
show ga
BACKGROUND: Rigorous estimates for clearance rates of untreated chlamydia
infections are important for understanding chlamydia epidemiology and designing
control interventions, but were previously only available for women. METHODS: We
used data from published studies of chlamydia-infected men who were retested at a
later date without having received treatment. Our analysis allowed new infections
to take one of 1, 2, or 3 courses, each clearing at a different rate. We
determined which of these 3 models had the most empirical support. RESULTS: The
best-fitting model had 2 courses of infection in men, as was previously found for
women: "slow-clearing" and "fast-clearing." Only 68% (57%-78%) (posterior median
and 95% credible interval [CrI]) of incident infections in men were
slow-clearing, vs 77% (69%-84%) in women. The slow clearance rate in men (based
on 6 months' follow-up) was 0.35 (.05-1.15) year-1 (posterior median and 95%
CrI), corresponding to mean infection duration 2.84 (.87-18.79) years. This
compares to 1.35 (1.13-1.63) years in women. CONCLUSIONS: Our estimated clearance
rate is slower than previously assumed. Fewer infections become established in
men than women but once established, they clear more slowly. This study provides
an improved description of chlamydia's natural history to inform public health
decision making. We describe how further data collection could reduce uncertainty
in estimates.