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  • Title: Sexually transmitted diseases and Chlamydia trachomatis in women consulting for contraception.
    Author: Avonts D, Sercu M, Heyerick P, Vandermeeren I, Piot P.
    Journal: J R Coll Gen Pract; 1989 Oct; 39(327):418-20. PubMed ID: 2560023.
    Abstract:
    To study the frequency of genital infections in women consulting their family doctor for contraception, 248 women (median age 23 years) were examined for a range of genital microorganisms. The prevalence of clue cells, Candida albicans and Trichomonas vaginalis were 21.0%, 12.9% and 2.0%, respectively. Neisseria gonorrhoeae was isolated in only one case, whereas Chlamydia trachomatis was found in 6.3% of women. A specific clinical picture for an infection with C. trachomatis in women was not seen. Given the prevalence of over 5% for C. trachomatis and the absence of typical signs and symptoms in infected women, screening for this organism is recommended in women requesting an intrauterine contraceptive device, to prevent complications such as pelvic inflammatory disease and their sequelae. The prevalence of genital micro-organisms was investigated in 248 women who presented to a family practice in Belgium in 1981-84 to obtain contraception. 141 were seeking a new or replacement IUD, while the remaining 107 were oral contraceptive (OC) users. Study participants had no signs or symptoms of a genital infection at the time of screening. The cultures revealed clue cells in 21.0%, Candida albicans in 12.9%, Trichomonas vaginalis in 2%, and Neisseria gonorrhoeae in 0.5%. Chlamydia trachomatis was isolated in 14 women (6.3%); among women requesting an IUD, the prevalence of C trachomatis was 7.5%. A history of 2 or more sex partners in the preceding 3 month period and previous use of OCs each conferred a 2.5 times increased risk of a positive chlamydia finding. Isolation of C trachomatis was not correlated with age at first intercourse, gravidity, an abnormal cervix, or a history of pelvic inflammatory disease (PID), however. 9 of the 14 women infected with chlamydia had nonspecific symptoms of a genital infection, e.g., vulval irritation, odor, or vaginal discharge, and 2 had an abnormal bimanual palpation. Available evidence suggests that IUD linked PID is caused by genital micro-organisms, especially C trachomatis and N gonorrhoeae, that enter the uterine cavity during IUD insertion. Given the 6% prevalence of C trachomatis in the young women presenting for contraception in this study, screening for this micro-organism is urged before an IUD is inserted in order to reduce the complication of PID.
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