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Young adults’ perspectives on chlamydia-related subfertility and a potential predictive subfertility test: A mixed-methods study in the Netherlands

Year: 2026

Type: article

Abstract: BACKGROUND: Chlamydia trachomatis (chlamydia) infection control could be more effective if focused on morbidity- rather than prevalence reduction. A predictive test, identifying those at higher risk for chlamydia-subfertility, could be developed to enhance targeted chlamydia control. However, do young adults with a uterus (hereafter "young adults") want to know their subfertility risk? METHODS: A sequential mixed methods study was conducted among young adults in the Netherlands to explore perspectives on chlamydia, subfertility, and a potential subfertility test. Five focus groups with Sexual Health Center (SHC) visitors were held to identify potential benefits, barriers, and requirements; results were analysed thematically and used to inform a questionnaire. This questionnaire was distributed online via SHCs and social media. Descriptive statistics and modified Poisson regression were used to assess benefits and barriers of learning one's subfertility risk. RESULTS: Nineteen young adults participated in the focus groups, and the resulting themes informed the questionnaire. These included perceived benefits (mental preparation, anticipation, reassurance after a "no increased risk" result), perceived barriers (mental burden of an "increased risk" result, need for blood sampling), and requirements (accuracy, accessibility, follow-up). The questionnaire was completed by 426 participants (median age 22, IQR 20-24). High perceived susceptibility was reported by 11% for chlamydia and 23% for chlamydia‑related subfertility; perceived severity was high for chlamydia and chlamydia-related subfertility, 75% and 88%, respectively. Willingness to use a risk test was 78%. Relief after a "no increased risk" result was expected by 89%, while an increased‑risk result was expected to enhance preparedness (86%) and elicit worry (83%). Additional considerations included motivation for safer sex, negative effects on relationships, and questioning the value of knowing. CONCLUSION: Young adults are concerned about chlamydia‑related subfertility, resulting in high willingness to use a risk test. The expected benefits and barriers should be carefully considered in test development.

Source: PLoS ONE

DOI: 10.1371/journal.pone.0351874