Accuracy of tests used to detect infection with Chlamydia trachomatis in asymptomatic pregnant women: a systematic review

Infection with Chlamydia trachomatis in pregnancy is linked to increased risk of miscarriage, stillbirth, and preterm birth. Currently, PCR or DNA-based tests are the gold standard when detecting the infection; however, they are costly and require access to specialist equipment. The aim of this systematic review was to assess the accuracy of available tests to detect infection in an asymptomatic pregnant population.There was evidence of the superior accuracy of nucleic acid amplification tests to cell culture in nonpregnant asymptomatic women; however, there are multiple commercial nucleic acid amplification tests with varying sensitivities and specificities. There is a gap in current literature on accuracy studies in an asymptomatic pregnant population, particularly within routine antenatal settings.There is a need for a point-of-care test for Chlamydia in pregnancy. Future test accuracy studies for this population should aim to use a universally established reference standard. Further research should provide relevant evidence to guide practice.