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PLoS One. 2015 Jan 23;10(1):e0115753. doi: 10.1371/journal.pone.0115753. eCollection 2015.

Genital chlamydia prevalence in Europe and non-European high income countries: systematic review and meta-analysis.

Author information

Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, CH-3012, Bern, Switzerland.
HIV & STI Department, National Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom.
Unit of Epidemiology and Surveillance, RIVM/Centre for Infectious Disease Control Netherlands, PO Box 1, 3720 BA, Bilthoven, Netherlands.
University of Amsterdam, 1012 WX Amsterdam, Netherlands and STI AIDS Netherlands, Keizersgracht 390, 1016 GB, Amsterdam, Netherlands.
Infectious Diseases Epidemiology, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom.
Department of Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia.
Department of Clinical Microbiology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden.
Department of Public Health Interventions, Randers Hospital, Skovlyvej, 8900, Randers, Denmark.
Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, PO Box 70032, 3000 LP, Rotterdam, Netherlands.
European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11 A, 17183, Stockholm, Sweden.



Accurate information about the prevalence of Chlamydia trachomatis is needed to assess national prevention and control measures.


We systematically reviewed population-based cross-sectional studies that estimated chlamydia prevalence in European Union/European Economic Area (EU/EEA) Member States and non-European high income countries from January 1990 to August 2012. We examined results in forest plots, explored heterogeneity using the I² statistic, and conducted random effects meta-analysis if appropriate. Meta-regression was used to examine the relationship between study characteristics and chlamydia prevalence estimates.


We included 25 population-based studies from 11 EU/EEA countries and 14 studies from five other high income countries. Four EU/EEA Member States reported on nationally representative surveys of sexually experienced adults aged 18-26 years (response rates 52-71%). In women, chlamydia point prevalence estimates ranged from 3.0-5.3%; the pooled average of these estimates was 3.6% (95% CI 2.4, 4.8, I² 0%). In men, estimates ranged from 2.4-7.3% (pooled average 3.5%; 95% CI 1.9, 5.2, I² 27%). Estimates in EU/EEA Member States were statistically consistent with those in other high income countries (I² 0% for women, 6% for men). There was statistical evidence of an association between survey response rate and estimated chlamydia prevalence; estimates were higher in surveys with lower response rates, (p = 0.003 in women, 0.018 in men).


Population-based surveys that estimate chlamydia prevalence are at risk of participation bias owing to low response rates. Estimates obtained in nationally representative samples of the general population of EU/EEA Member States are similar to estimates from other high income countries.

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