Introduction: The Natural History and Immunobiology ofChlamydia trachomatisGenital Infection and Implications for Chlamydia Control

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Abstract
Chlamydia trachomatis genital infection is the most common bacterial sexually transmitted infection worldwide [1], and an estimated 3 million cases occur each year in the United States [2]. In women, C. trachomatis genital infection can lead to serious complications, including pelvic inflammatory disease, ectopic pregnancy, tubal infertility, and chronic pelvic pain [3]. Because of this, many countries have implemented chlamydia control efforts that have primarily emphasized enhanced detection and treatment of asymptomatic infection in young women and have achieved varying degrees of screening coverage [4–6]. Early reports from regions that were the first to implement chlamydia control activities (during the late 1980s and early 1990s) revealed that both chlamydia case rates and rates of associated complications were decreasing [7–9]. However, since the mid-1990s, in virtually all countries with substantial investment in chlamydia control, the number of C. trachomatis infection case reports has been increasing in the setting of ongoing control efforts [10–12]. In the United States, regions that had initially shown decreases in chlamydia test positivity (prevalence of chlamydia among tested women) have since shown stable or increasing test positivity [11]. Although there are limitations in using these types of surveillance data to assess burden of disease [13], the substantial and continuing decreases in rates of C. trachomatis infection that were expected after implementation of control programs have not been observed [14], and many chlamydia control programs are currently at a crossroads.

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