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. 2015 Oct;109(6):290–299. doi: 10.1179/2047773215Y.0000000033

Prevalence of genital Chlamydia trachomatis in Iran: a systematic review and meta-analysis

Mohammad Hossein Ahmadi 1, Akbar Mirsalehian 1, Abbas Bahador 1,✉
PMCID: PMC4727584  PMID: 26343285

Abstract

Objective

To determine the overall prevalence of Chlamydia trachomatis in Iranian males and females and to find out the effect of this bacterium on fertility potential and its association with urogenital symptoms.

Methods

We searched both English and Persian electronic databases using keywords ‘Chlamydia’, ‘Chlamydia trachomatis’, ‘prevalence’, ‘incidence’, ‘frequency’, ‘epidemiology’ and ‘Iran’. Finally, after some exclusion, 34 studies from different regions of Iran were included in our study, and a meta-analysis was performed to determine pooled prevalence estimates for each group.

Results

C. trachomatis prevalence for women and men was high and ranged from 0 to 32.7% and 0 to 23.3%, respectively (95% CI). The pooled prevalence of the bacterium in the female population was 12.3% (95% CI: 10.6–14.2%) and in men was 10.9% (95% CI: 7.6–15.4%). A high level of heterogeneity was seen for both men (I = 77.4%; P < 0.001) and women (I = 77.5%; P < 0.001); but in men and not in women, some evidence for publication bias was observed [Egger's test (two-tailed P = 0.013); Begg's test (two-tailed P = 0.025)]. In females analysis of symptomatic/infertile group with asymptomatic/fertile group in females, the overall OR was above 1 and the overall P-value was below zero.

Conclusions

This bacterium may play a role in female infertility or be associated with clinical manifestations; thus, planning national programmes for adequate diagnosis of genital infections caused by this pathogen is necessary. Furthermore, screening strategies, particularly for asymptomatic individuals, and treatment of infected people can reduce consequent complications.

Keywords: Chlamydia trachomatis, Prevalence, Infertility, Urogenital Symptoms, Iran

Introduction

C. trachomatis is one of the most common pathogens that cause sexually transmitted infections (STIs).1 Although as much as two-thirds of women and 50% of men who are infected with this organism develop asymptomatic infections,2 in the remaining population, this bacterium can cause a broad spectrum of genitourinary infections, such as non- and post-gonococcal urethritis, epididymitis and prostatitis in males3 and cervicitis, salpingitis and pelvic inflammatory disease (PID) in females, which particularly in the chronic form may lead to ectopic pregnancy or exert negative effects on fertility. Furthermore, in vitro co-incubation of C. trachomatis with human spermatozoa can impair sperm motility and kill spermatozoa likely because of the bacterium lipopolysaccaride,4 although the role of this pathogen in male infertility remains controversial.3–5 However, symptomatic or asymptomatic infections by this pathogen have a profound impact on the female reproductive system;6 ascending infections can cause PID, which may lead to infertility or ectopic pregnancy.7,8

As mentioned above, most genital chlamydial infections are usually asymptomatic, which are capable of transmitting to sexual partner(s);9 therefore, screening is necessary to identify these infections10 and to know the relative frequencies of these agents in different populations.6 This involves screening programmes, which have been established in some industrialised countries to prevent reproductive complications.11–13

In Iran, to date, several studies have reported the frequency of C. trachomatis infections in males and/or females, in which the frequency of this pathogen varies significantly in different studies. However, most of these studies are local and limited to an individual hospital or a special province, and a comprehensive analysis of the overall prevalence of this bacterium, as well as its association with infertility and urogenital symptoms, which may be useful to set up control programmes for the prevention of STIs, has not yet been performed.

Thus, the present study was designed to determine the prevalence of C. trachomatis infection, its impact on fertility potential, and its association with urogenital symptoms in the Islamic Republic of Iran (I.R.Iran) using a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.14

Methods

Search strategy

Electronic databases, including OVID databases, PubMed, Web of Science, Scopus and Google Scholar, were searched for the prevalence of C. trachomatis infections in Iran from November 1998 to January 2015. The search was restricted to original articles published in English that present the prevalence, frequency or incidence of C. trachomatis infections in Iranian males or females using the following keywords with the help of Boolean operators (AND, OR): ‘Chlamydia’, Chlamydia trachomatis’, ‘prevalence’, ‘incidence’, ‘frequency’, ‘epidemiology’ and ‘Iran’. In addition to articles published in English, we also looked for relevant articles in Persian published and indexed in Iranian databases, such as Scientific Information Database (SID) [http://www.sid.ir/], Magiran [http://www.magiran.com/], Irandoc [http://www.irandoc.ac.ir/], Regional Information Center for Science and Technology (RICST) [http://en.ricest.ac.ir/] and Iranian National Library [http://www.nlai.ir/], with similar strategies and related and appropriate Persian keywords. References from reviewed articles were also searched for more information.

Study selection

Included studies were all original articles presenting cross-sectional, case-control, or cohort studies on the prevalence of symptomatic or asymptomatic genital C. trachomatis infections in Iranian males/females in which the methods for diagnoses were molecular amplification techniques, such as polymerase chain reaction (PCR), multiplex PCR and plasmid PCR. Excluded studies were: (1) those that used detection methods other than molecular amplification techniques, including culture or serological methods, such as enzyme-linked immunosorbent assay (ELISA) or immunofluorescence (IF), (2) studies reporting combined prevalence data for male and female participants and (3) those that studied chlamydial infections in organs or body sites other than the genitourinary tract.

Review articles, congress abstracts, studies reported in languages other than English or Persian, meta-analyses or systematic reviews, duplicate publications of the same study and articles available only in abstract form were also excluded.

Data extraction

Variables extracted from each study included first author's name, year of publication, study setting, geographical location, participants, gender, specimen type, number of patients investigated, bacterial species investigated, type of detection method and number of positive samples. The articles were reviewed and relevant data were extracted by two authors independently. Disagreements between reviewers were discussed to obtain consensus.

Statistical analysis

The data were analysed using Comprehensive Meta-Analysis Software Version 2.0 (Biostat, Englewood, NJ, USA). The prevalence was reported by 95% confidence intervals (CIs). Cochrane Q-statistic test and I2 test were performed to estimate heterogeneity between studies, and random effect model was chosen to estimate the average prevalence because of its conservative summary estimate and because in all calculations, I2 was above 50%. To assess the possible publication bias, a funnel plot along with Begg's rank correlation and Egger's weighted regression methods were used. Two-tailed P < 0.05 was considered indicative of a statistically significant publication bias.

Results

A total of 92 articles (64 in English and 28 in Persian) were collected. Through the first screening, 21 articles were excluded on the basis of the title evaluation, as eight of them were duplicate publications of the same study, and 13 have titles irrelevant to our study. After the second assessment, five papers were discarded because they had reported Chlamydial infections in organs or body sites other than the genitourinary tract. Finally, after full-text evaluation, 32 studies were ruled out on the basis of their detection methods (detection methods other than molecular amplification techniques), or status of reported prevalence data (combined prevalence data for males and females) (Fig. 1), and 34 articles (25 in English and nine in Persian) published between 2006 and 2014 were selected and included in our analysis (Table 1).

Figure 1.

Figure 1.

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Flow chart of the literature search, systematic review and study selection. *Studies reporting combined prevalence data for male and female participants.

Table 1.

Studies included in meta-analysis after final evaluation.

First author (reference) Published year Province/city Sex Sample(s) Mean age Total number of participants Events number Events rate (95% CI) (%)
Chamani-Tabriz (a)15 2006 Tehran F First-void urine 28.5 1052 129 12.3
Zaeimi-Yazdi16 2006 Tehran F Endocervical swabs 32.7 142 22 15.5
Meidani17 2007 Tehran M First-void urine 32 140 1 0.7
Chamani-Tabriz (d)18 2007 Tehran F First-void urine 28.5 1052 133 12.6
Golshani19 2007 Tehran M Semen 35 200 36 16.3
Hashemi20 2007 Tehran F Endocervical swabs 37.5 123 21 17
Samarbaf-Zadeh21 2007 Ahvaz F Vaginal discharge ND 202 33 16.3
Kalantar22 2007 Yazd F Vaginal discharge 30.2 91 0 0
Chamani-Tabriz (c)23 2007 Tehran F First-void urine 26.1 340 38 11.2
Khalili24 2008 Kerman M Urethral swabs ND 66 8 12.1
F Endocervical swabs ND 64 4 6.3
Chamani-Tabriz(b)25 2008 Tehran F First-void urine 28.8 991 127 12.8
Rashidi (a)26 2009 Tehran F First-void urine 26.8 458 48 10.5
Jenab27 2009 Isfahan F Endocervical swabs 37.5 80 17 21.3
Taheri-Beni (b)28 2010 Ahvaz F Endocervical swabs ND 620 108 17.4
Haghighi29 2011 Sabzevar F First-void urine 31 196 27 13.8
Asgari30 2011 Tehran M First-void urine 32.5 130 3 2.3
Naderi31 2012 Kerman F Fallopian tube tissue ND 129 5 3.9
M First-void urine ND 129 19 14.7
Taheri-Beni (a)32 2012 Isfahan F Endocervical swabs ND 80 17 21.3
Hassanzadeh33 2012 Shiraz F First-void urine 27 210 0 0
Ghazvini34 2012 Mashhad M First-void urine, urethral swabs 38 178 19 10.6
Eslami35 2012 Tehran F Endocervical swabs 27.5 121 16 13.2
Fatholahzadeh (a)36 2012 Tehran F First-void urine 32.5 260 39 15
Mohammadzadeh37 2013 Tehran F Endocervical swabs 33.8 130 6 4.6
Sadrpour38 2013 Tehran M Semen 26.8 120 28 23.3
Ilami39 2013 Yasouj M First-void urine 34.9 28 2 7.1
F First-void urine 30.1 109 3 2.8
Zahirnia40 2013 Tehran F Endocervical swabs 28.6 121 16 13.2
Afrakhteh41 2013 Tehran F First-void urine 28.8 49 16 32.7
Hajikhani42 2013 Tehran F Endocervical swabs 32.5 51 6 11.7
Rashidi (b)43 2013 Tehran F First-void urine 28.3 457 48 10.5
Akya44 2013 Kermanshah F Endocervical swabs 32.6 255 8 3.1
Saeedzadeh45 2013 Shiraz F Endocervical swabs ND 212 17 8
Yeganeh46 2013 Tehran M First-void urine 33.5 200 24 12
Fatholahzadeh (b)47 2013 Tehran M First-void urine 32.5 200 17 8.5
Marashi48 2014 Tehran F Endocervical swabs 24.8 350 61 17.4
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M: males; F: females; ND: not determined

Lower-case letters inside the parentheses indicate the various studies performed by the same author

Of 34 articles included, 24 had studied the prevalence of C. trachomatis in women, seven in men and three in both genders; eight studies (six for women and two for men) were case-control (which investigated fertile-infertile or symptomatic-asymptomatic individuals) and the rest were cross-sectional. The participants of the cross-sectional studies were miscellaneous and varied from asymptomatic and fertile individuals to symptomatic men and women having urogenital infections and complications, such as urethritis, cervicitis, PID, ectopic pregnancy and infertility.

The most commonly collected sample for detection was first-void urine for both men and women, but other samples included semen and urethral swabs for men and vaginal discharge, endocervical swabs and fallopian tube tissue for women. Six papers studied other agents in addition to C. trachomatis, such as Neisseria gonorrhoeae or mycoplasma spp., simultaneously.

Most of the studies were performed in Tehran (n = 21), which is the capital of Iran, in comparison with ones performed in central (n = 7), southwestern (n = 3), northeastern (n = 2) and western (n = 1) Iran. The prevalence of genital infections due to C. trachomatis in different regions of Iran is shown in Fig. 2.

Figure 2.

Figure 2.

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Prevalence of genital infections due to C. trachomatis in different regions (cities) of I.R.Iran. *There was only one study about females in Yazd which had reported no detection of the bacterium; the number of studies in other cities included: Yasouj: one (studied both males and females), Kermanshah: one (females), Sabzevar: one (females), Mashhad: one (males), Shiraz: two (females), Ahvaz: two (females), Kerman: two (each of them studied both males and females), Isfahan: two (females) and Tehran: 21 (15 females and six males); M: males; F: females.

The age for women ranged from 15–66 years (median: 40.5 years) and for men from 14–59 years (median: 36.5 years). Four studies did not report ages of participants, and more than two-thirds of studies had neither age-stratified data nor usable information on patients’ education and occupation.

C. trachomatis prevalence for women and men ranged from 0 to 32.7% and 0 to 23.3%, respectively (95% CI). The pooled prevalence of the bacterium in women was 12.3% (95% CI, range: 10.6–14.2%) and in men was 10.9% (95% CI, range: 7.6–15.4%); Figs. 3 and 4 show the forest plot of the meta-analysis of C. trachomatis prevalence for women and men, respectively. The funnel plot for meta-analysis of C. trachomatis prevalence in women suggests no evidence of publication bias (Fig. 5). Neither Egger's test (two-tailed P = 0.053) nor Begg's test (two-tailed P = 0.069) was statistically significant for the publication bias; however, a high level of heterogeneity was observed (I2 = 77.5%; P < 0.001). But, for men, in addition to heterogeneity (I2 = 77.4%; P < 0.001), some evidence for publication bias was observed [Egger's test (two-tailed P = 0.013) and Begg's test (two-tailed P = 0.025)]; the resulting funnel plot is shown in Fig. 6.

Figure 5.

Figure 5.

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Funnel plot of the meta-analysis of C. trachomatis prevalence for women.

Figure 6.

Figure 6.

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Funnel plot of the meta-analysis of C. trachomatis prevalence for men.

Figure 3.

Figure 3.

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Forest plot of the meta-analysis of C. trachomatis prevalence for women.

Figure 4.

Figure 4.

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Forest plot of the meta-analysis of C. trachomatis prevalence for men.

The forest plot for six case-control studies about women is presented in Fig. 7; as seen in the plot, the odds ratios (ORs) for all these studies except one were above 1, P-values for three surveys were below 0.05, the overall OR was 2.3 (95% CI, range: 1.1–4.6), and the overall P-value was 0.02, indicating that the prevalence of C. trachomatis is significantly higher in the case group compared with that in the control group. However, the number of studies was fewer than 10 and insufficient for an accurate conclusion; the corresponding funnel plot is shown in Fig. 8.

Figure 7.

Figure 7.

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Forest plot of the meta-analysis of C. trachomatis prevalence for six case-control studies about women.

Figure 8.

Figure 8.

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Funnel plot of the meta-analysis of C. trachomatis prevalence for six case-control studies about women.

Discussion

The role of C. trachomatis and some other bacteria as primary agents of genital infections and STIs both in men and women is unquestionable.6 Furthermore, a considerable amount of genital infections is asymptomatic and consequently remain undetected and untreated because most infected people do not seek medical care and treatment, thereby transmitting the infection to their sexual partner(s). Thus, implementing national control programmes to interrupt the transmission chain and prevent the subsequent negative impact on the male and female reproductive system is thought to be necessary; in this regard, comprehensive analyses of the overall prevalence of this bacterium, particularly in developing countries (including Iran), may help to accomplish this strategy.

By performing this systematic review and meta-analysis, which is the first such study in Iran, we found that the prevalence and frequency of genital C. trachomatis in men as well as women was greatly variable in various studies. There was also a high grade of heterogeneity in participants’ characteristics and conditions, kinds of samples taken for tests, detection methods, sample sizes and study settings.

Because men and women are distinct populations with different indicators of prevalence, corresponding data about each of them were analysed separately in the present study. Among articles finally included in this analysis, there were no studies conducted either in northern or southern Iran, and most of them were performed in the capital, Tehran, and central Iran; this may relatively suggest some participation bias in generalisation of reported estimates. Another limitation of the present study is that many papers conducted in different regions of the country had to be excluded from the analysis because their methods of detection were culture, or serology (for example, ELISA and IF), which have lower sensitivity and specificity in comparison with molecular techniques.49 Furthermore, different samples were used for detection, and the number of participants in included studies was different and ranged from 28–200 and 49–1052 for men and women, respectively.

We analysed six case-control studies among included articles; all were about females. As seen in Fig. 7, ORs for all these studies26,31,43,47,48 except one27 were above 1, P-values for three surveys were below 0.05,31,47,48 the overall OR was 2.3 (95% CI, range: 1.1–4.6), and the overall P-value was 0.02; indicating that the prevalence of C. trachomatis was significantly higher in the case group (infertile/symptomatic females) compared with that in the control group (fertile/asymptomatic ones); meaning that this bacterium may play a role in female infertility or be associated with clinical manifestations. However, the number of such studies was fewer than 10 and was not enough to perform a good meta-analysis, generalise the results, and make conclusions about them. In addition, more than two-thirds of the studies had reported neither age-stratified data nor usable information on patients’ education and occupation to be analysed and compared with each other. Moreover, there were no randomised, controlled clinical trials assessing the effects of antibiotic therapy for genital Chlamydia on the improvement of infertility due to this bacterium among surveys included in this study.

As reported by the World Health Organization in 2005, approximately 101 million chlamydial infections are detected annually worldwide, and the prevalence rates of C. trachomatis among adults varies between different countries.50 In a systematic review, 25 studies from several countries were analysed in which the prevalence of urogenital C. trachomatis for women varied from 1.1–10.6% and for men from 0.1 to 12.1%; the prevalence of this bacterium was highly variable between countries and was higher in women than that in men, and the younger age groups ( < 25 years) had the highest prevalence rate.51 The results of our meta-analysis showed that the pooled prevalence of C. trachomatis in males and females was 10.9% (95% CI, range: 7.6–15.4%) and 12.3% (95% CI, range: 10.6–14.2%), respectively; this shows a higher prevalence rate in females rather than that in males and is in the range of the above study.

In a meta-analysis study conducted by Lewis et al. in Australia, the pooled prevalence estimates of C. trachomatis for indigenous women under 25 years was reported to be 22.1% (95% CI: 19.0–25.3; three studies) and for indigenous men under 25 years to be 14.6% (95% CI: 11.5–17.8; three studies). They also reported a high level of heterogeneity among their included studies and a higher prevalence rate in younger populations, indigenous Australians and those attending sexual health centres.52

In another systematic review and meta-analysis survey about females performed in the United Kingdom, healthcare settings had higher prevalence estimates than those in population-based studies because studies performed in general practice surgeries had an overall high chlamydia prevalence of 8.1% (95% CI; range: 6.5–9.9%) compared with 5.0% in population-based studies (95% CI; range: 3.2–7.6%). The authors also declared that age and study setting were variables with the most influence on the prevalence rate of this bacterium.53

As mentioned above, more than two-thirds of studies included in our analysis had not reported age-stratified data; therefore, we could not make a comparison between age groups. However, some variability was seen in prevalence rates reported in different countries, which is perhaps due to differences in detection methods and protocols, types of samples studied, epidemiological aspects (different populations), hygiene issues and existence or non-existence of regular screening, treatment and control programmes, particularly in some of the developing countries, such as Iran, for dealing with this pathogen.

In conclusion, the results of the present study highlight the necessity of planning national programmes for adequate diagnosis of genitourinary infections due to C. trachomatis. Furthermore, our results denote the importance of screening strategies, particularly for asymptomatic individuals, and treating infected people (including sexual partners) to control STIs and their ensuing complications and to maintain fertility and reproductive health.

Disclaimer statements

Contributors

MHA and AB planned the overall study and wrote the protocol. MHA performed the bibliographical searches, identified the studies, extracted data, planned the analyses and produced the first draft of the manuscript. AB reviewed and revised the manuscript. AM participated in data collection and reviewing papers for the study. All authors read and approved the final manuscript.

Funding

None.

Conflict of interest

None declared.

Ethics approval

None.

References

  • 1.Liu J, Wang Q, Ji X, Guo S, Dai Y, Zhang Z, et al. Prevalence of Ureaplasma urealyticum, Mycoplasma hominis, Chlamydia trachomatis infections, and semen quality in infertile and fertile men in China. Urology. 2014;83:795–9. [DOI] [PubMed] [Google Scholar]
  • 2.Gonzales G, Munoz G, Sanchez R, Henkel R, Gallegos-Avila G, Díaz-Gutierrez O, et al. Update on the impact of Chlamydia trachomatis infection on male fertility. Andrologia. 2004;36:1–23. [DOI] [PubMed] [Google Scholar]
  • 3.Gallegos G, Ramos B, Santiso R, Goyanes V, Gosálvez J, Fernández J, Sperm DNA. fragmentation in infertile men with genitourinary infection by Chlamydia trachomatis and Mycoplasma. Fertil Steril. 2008;90:328. [DOI] [PubMed] [Google Scholar]
  • 4.Eley A, Pacey A, Galdiero M, Galdiero F. Can Chlamydia trachomatis directly damage your sperm? Lancet Infect Dis. 2005;5:53–7. [DOI] [PubMed] [Google Scholar]
  • 5.Ouzounova-Raykova V, Ouzounova I, Mitov I. Chlamydia trachomatis infection as a problem among male partners of infertile couples. Andrologia. 2009;41:14–19. [DOI] [PubMed] [Google Scholar]
  • 6.Rodrigues M, Fernandes P, Haddad J, Paiva M, Andrade T, et al. Frequency of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis and Ureaplasma species in cervical samples. J Obstet Gynecol. 2011;31:237–41. [DOI] [PubMed] [Google Scholar]
  • 7.Stamm WE, Holmes KK. Chlamydia trachomatis infections of the adult. Sex Transm Dis. 1999;3:407–22. [Google Scholar]
  • 8.Weström L, Bengtsson L, Mårdh P. Incidence, trends, and risks of ectopic pregnancy in a population of women. Br Med J (Clin Res Ed). 1981;282:15. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Malhotra M, Sood S, Mukherjee A, Muralidhar S, Bala M. Genital Chlamydia trachomatis: an update. Indian J Med Res. 2013;138:303. [PMC free article] [PubMed] [Google Scholar]
  • 10.Torrone E, Papp J, Weinstock H. Prevalence of Chlamydia trachomatis genital infection among persons aged 14-39 years-United States, 2007-2012. MMWR Morb Mortal Wkly Rep. 2014;63:834–8. [PMC free article] [PubMed] [Google Scholar]
  • 11.Berg AO. Screening for chlamydial infection: recommendations and rationale. Am J Prev Med. 2001;20(3):90–4. [PubMed] [Google Scholar]
  • 12.Peipert JF. Genital chlamydial infections. N Engl J Med. 2003;349:2424–30. [DOI] [PubMed] [Google Scholar]
  • 13.Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, Stamm WE. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med. 1996;334:1362–6. [DOI] [PubMed] [Google Scholar]
  • 14.Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–9. [DOI] [PubMed] [Google Scholar]
  • 15.Chamani Tabriz L, Jeddi-Tehrani M, Mosavi-Jarrahi A, Zeraati H, Ghasemi J, Asgari S, et al. The prevalence of Chlamydia trachomatis infection by molecular analysis of urine samples in women attending OB & GYN clinics in Tehran [Persian]. J Reprod Infertil. 2006;7:234–42. [Google Scholar]
  • 16.Yazdi JZ, Khorramizadeh M, Badami N, Kazemi B, Aminharati F, Eftekhar Z, et al. Comparative assessment of Chlamydia trachomatis infection in Iranian women with cervicitis: a cross-sectional study. Iran J Public Health. 2006;35:69–75. [Google Scholar]
  • 17.Meidani M, Chamani Tabriz L, Zeraati H, Razin B, Jamali B, Gachkar L, et al. Molecular assessment on the prevalence of urogenital infection with Chlamydia Trachomatis in asymptomatic men. J Isfahan Med Sch. 2008;25:45–53. [Google Scholar]
  • 18.Chamani-Tabriz L, Tehrani MJ, Akhondi M, Mosavi-Jarrahi A, Zeraati H, Ghasemi J, et al. Chlamydia trachomatis prevalence in Iranian women attending obstetrics and gynaecology clinics. Pak J Biol Sci. 2007;10:4490–4. [DOI] [PubMed] [Google Scholar]
  • 19.Golshani M, Eslami G, Ghobadloo SM, Fallah F, Goudarzi H, Rahbar AS, et al. Detection of Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum by multiplex PCR in semen sample of infertile men. Iran J Public Health. 2007;36:50–7. [Google Scholar]
  • 20.Hashemi FB, Pourakbari B, Yazdi JZ. Frequency of Chlamydia trachomatis in women with cervicitis in Tehran. Iran. Infect Dis Obstet Gynecol. 2007;:1–4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Samarbaf-Zadeh A, Razi MT, Kelishadi M. Prevalence of C. trachomatis infection among Ahvaz females with vaginal discharge. J Fertil Steril. 2007;1:19–22. [Google Scholar]
  • 22.Kalantar SM, Kazemi MJ, Sheikhha MH, Aflatoonian A, Kafilzadeh F. Detection of Chlamydia trachomatis infection in female partners of infertile couples. Int J Fertil Steril. 2007;1:79–84. [Google Scholar]
  • 23.Chamani-Tabriz L, Tehrani M, Zeraati H, Asgari S, Moini M, Rabbani HA. Molecular survey on prevalence of Chlamydia trachomatis infection in pregnant woman attending OB&GY clinics of Tehran [Persian]. Iran J Infect Dis Trop Med. 2007;13:45–50. [Google Scholar]
  • 24.Khalili M, Atapour M, Aali S, Azizollahi G, Azizollahi S. Frequency of Chlamydia trachomatis in genital specimens: kerman city, PCR method [Persian]. Tehran Univ Med J. 2008;66:127–30. [Google Scholar]
  • 25.Chamani-Tabriz L, Tehrani M, Zeraati H, Asgari S, Tarahomi M, Moini M, et al. A molecular survey of Chlamydia trachomatis infection in married women: a cross sectional study on 991 women [Persian]. Tehran Univ Med J. 2008;66:485–91. [Google Scholar]
  • 26.Rashidi BH, Tabriz LC, Haghollahi F, Ramezanzadeh F, Shariat M, Foroushani AR, et al. Prevalence of Chlamydia trachomatis infection in fertile and infertile women; a molecular and serological study [Persian]. J Reprod Infertil. 2009;10:32–42. [Google Scholar]
  • 27.Jenab A, Golbang N, Golbang P, Chamani-Tabriz L, Roghanian R. Diagnostic value of PCR and ELISA for Chlamydia trachomatis in a group of asymptomatic and symptomatic women in Isfahan. Iran. Int J Fertil Steril. 2009;2:193–8. [Google Scholar]
  • 28.Taheri Beni B, Motamedi H, Ardakani MR. Genotyping of the prevalent Chlamydia trachomatis strains involved in cervical infections in women in Ahvaz. Iran. J Med Microbiol. 2010;59:1023–8. [DOI] [PubMed] [Google Scholar]
  • 29.Haghighi HM, Mohammadzadeh M, Bahador A, Fazel N, Rakhshani H, Majnooni A. Prevalence of Chlamydia trachomatis and Mycoplasma genitalium in pregnant women of Sabzevar-Iran. Iran J Microbiol. 2011;3:123. [PMC free article] [PubMed] [Google Scholar]
  • 30.Asgari S, Chamani-Tabriz L, Allami A, Asadi S, Zeraati H, Gachkar L, et al. Urogenital Chlamydia trachomatis infection among prisoner men. Arch Clin Infect Dis. 2011;6:74–7. [Google Scholar]
  • 31.Naderi T, Kazerani F, Bahraminpoor A. Comparison of chlamydia infection prevalence between patients with and without ectopic pregnancy using the PCR method. Ginekol Pol. 2012;83:819–21. [PubMed] [Google Scholar]
  • 32.Taheri Beni B, Jenab A, Roghanian R, Motamedi H, Golbang N, Golbang P, et al. Genotyping of endocervical Chlamydia trachomatis strains and detection of serological markers of acute and chronic inflammation in their host. Int J Fertil Steril. 2012;6:101–6. [PMC free article] [PubMed] [Google Scholar]
  • 33.Hassanzadeh P, Sharifi H, Bazargani A, Khashei R, Emami A, Motamedifar M. Non-detection of Chlamydia trachomatis infection by polymerase chain reaction in pregnant Iranian women. Microbiol Res. 2012;3:e8. [Google Scholar]
  • 34.Ghazvini K, Ahmadnia H, Ghanaat J. Frequency of Chlamydia trachomatis among male patients with urethritis in northeast of Iran detected by polymerase chain reaction. Saudi J Kidney Dis Transpl. 2012;23:316. [PubMed] [Google Scholar]
  • 35.Eslami G, Goudarzi H, Taheripanah R, Taheri S, Fallah F, Moazzami B, et al. Chlamydia trachomatis detection by nested-PCR method on females referred to medical centers of Tehran. Iran. Arch Clin Infect Dis. 2012;7:124–7. [Google Scholar]
  • 36.Fatholahzadeh B, Bahador A, Hasanabad MH, Bazarjani F, Haghighi F. Comparative screening of Chlamydia trachomatis infection in women population in Tehran. Iran. Iran Red Crescent Med J. 2012;14:289. [PMC free article] [PubMed] [Google Scholar]
  • 37.Mohammadzadeh M, Amirmozafari N, Shayanfar N, Ranjbar R, Rahbar M. Prevalence of Chlamydia trachomatis infections in symptomatic women by polymerase chain reaction (PCR) immunofluorescence and Giemsa stain. Afr J Biotechnol. 2013;10:6601–5. [Google Scholar]
  • 38.Sadrpour P, Bahador A, Asgari S, Bagheri R, Chamani-Tabriz L. Detection of Chlamydia trachomatis and Mycoplasma genitalium in semen samples of infertile men using multiplex PCR [Persian]. Tehran Univ Med J. 2013;70:623–9. [Google Scholar]
  • 39.Ilami O, Rahimian SH, Kargar M, Sisakht AJ, Saeedinejad SZ, Hadinia A. Detection of Neisseria gonorrhoeae and Chlamydia Trachomatis in patients with symptomatic urethritis using multiplex PCR, gram stain and urine culture [Persian]. J Mazandaran Univ Med Sci. 2013;23:11–18. [Google Scholar]
  • 40.Zahirnia Z, Eslami G, Goodarzi H, Taheri S, Fallah F, Taheripanah R, et al. Evaluation of the prevalence of infection with Chlamydia trachomatis in spontaneous abortions, by nested PCR method [Persian]. Pejouhesh. 2013;37:67–72. [Google Scholar]
  • 41.Afrakhteh M, Mahdavi A, Beyhaghi H, Moradi A, Gity S, Zafargandi S, et al. The prevalence of Chlamydia trachomatis in patients who remained symptomatic after completion of sexually transmitted infection treatment. Iran J Reprod Med. 2013;11:285. [PMC free article] [PubMed] [Google Scholar]
  • 42.Hajikhani B, Motallebi T, Norouzi J, Bahador A, Bagheri R, Asgari S, et al. Classical and molecular methods for evaluation of Chlamydia trachomatis infection in women with tubal factor infertility. J Reprod Infertil. 2013;14:29. [PMC free article] [PubMed] [Google Scholar]
  • 43.Rashidi BH, Chamani-Tabriz L, Haghollahi F, Jeddi-Tehrani M, Naghizadeh MM, Shariat M, et al. Effects of Chlamydia trachomatis infection on fertility; a case-control study. J Reprod Infertil. 2013;14:67. [PMC free article] [PubMed] [Google Scholar]
  • 44.Akya A. The frequency of Chlamydia trachomatis and Neisseria gonorrhoeae infections among women in Kermanshah. Iran. Asian Biomed. 2013;7:681–5. [Google Scholar]
  • 45.Saeedzadeh A, Hosseinzadeh S, Firouzi R. Genotyping of Chlamydia trachomatis from endocervical specimens in Shiraz. Iran. Iran J Vet Res. 2013;14:203–10. [Google Scholar]
  • 46.Yeganeh O, Jeddi-Tehrani M, Yaghmaie F, Kamali K, Heidari-Vala H, Zeraati H, et al. A survey on the prevalence of Chlamydia Trachomatis and Mycoplasma genitalium infections in symptomatic and asymptomatic men referring to urology clinic of Labbafinejad Hospital. Tehran, Iran. Iran Red Crescent Med J. 2013;15:340. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.Fathollahzadeh B, Bahador A, Majnooni A, Kamalimanesh B, Moshkani S, Haghighi Hasanabad M. Screening of Chlamydia trachomatis infection in men, is it necessary in Iran? Jundishapur J Microbiol. 2013;6:e7782. [Google Scholar]
  • 48.Marashi SMA, Moulana Z, Fooladi AAI, Karim MM. Comparison of genital Chlamydia trachomatis infection incidence between women with infertility and healthy women in Iran using PCR and immunofluorescence methods. Age. 2014;40:4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.El Qouqa IA, Shubair ME, Al Jarousha AM, Sharif FA. Prevalence of Chlamydia trachomatis among women attending gynecology and infertility clinics in Gaza. Palestine Int J Infect Dis. 2009;13:334–41. [DOI] [PubMed] [Google Scholar]
  • 50.Organization WH. Global incidence and prevalence of selected curable sexually transmitted infections – 2008. Geneva: WHO; 2012. [Google Scholar]
  • 51.Dielissen PW, Teunissen DA, Lagro-Janssen TL. Chlamydia prevalence in the general population: is there a sex difference? a systematic review. BMC Infect Dis. 2013;13:534. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 52.Lewis D, Newton DC, Guy RJ, Ali H, Chen MY, Fairley CK, et al. The prevalence of Chlamydia trachomatis infection in Australia: a systematic review and meta-analysis. BMC Infect Dis. 2012;12:113. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Adams E, Charlett A, Edmunds W, Hughes G. Chlamydia trachomatis in the United Kingdom: a systematic review and analysis of prevalence studies. Sex Transm Infect. 2004;80:354–62. [DOI] [PMC free article] [PubMed] [Google Scholar]

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