title: Chlamydia public health programs and the epidemiology of pelvic inflammatory disease and ectopic pregnancy.
abstract: BACKGROUND
  Many countries have witnessed a disturbing increase in cases of Chlamydia trachomatis infection despite enhanced control programs. Since the goal of Chlamydia control is to prevent reproductive complications such as pelvic inflammatory disease and ectopic pregnancy, an understanding of recent trends in these conditions is needed to fully evaluate the effect of control efforts.
  
  
  METHODS
  We analyzed 2 provincial, comprehensive health services administrative databases (encompassing hospitalizations and all physician-delivered services) for pelvic inflammatory disease and ectopic pregnancy trends from 1992 through 2009 in women of reproductive age in British Columbia, Canada. Trends were compared to provincial Chlamydia surveillance data by time-series analysis, using the cross-correlation function method and Granger causality testing.
  
  
  RESULTS
  Chlamydia cases substantially increased from 1992 through 2009. Inpatient, outpatient, and total diagnoses of pelvic inflammatory disease and ectopic pregnancy declined from 1992 through 2003. After 2003, pelvic inflammatory disease rates continued to fall, while ectopic pregnancy rates significantly increased. The male Chlamydia urethritis rate increased from 39.4 to 173.6 cases/100,000 from 1996 to 2009.
  
  
  CONCLUSIONS
  In the context of increasing Chlamydia infection rates, the reproductive complications of Chlamydia infection in women are declining overall. A recent increase in rates of ectopic pregnancies is cause for concern.
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada. michael.rekart@bccdc.ca
authors.forename: Michael L
authors.initials: ML
authors.lastname: Rekart
authors.forename: Mark
authors.initials: M
authors.lastname: Gilbert
authors.forename: Rafael
authors.initials: R
authors.lastname: Meza
authors.forename: Paul H
authors.initials: PH
authors.lastname: Kim
authors.forename: Michael
authors.initials: M
authors.lastname: Chang
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Money
authors.forename: Robert C
authors.initials: RC
authors.lastname: Brunham
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001955:British Columbia / Q000453:epidemiology; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D002692:Chlamydia trachomatis / Q000472:pathogenicity*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D010045:Outpatients; D000292:Pelvic Inflammatory Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D011271:Pregnancy, Ectopic / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D011634:Public Health; D014526:Urethritis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D055815:Young Adult