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  • Title: A prospective study of Chlamydia trachomatis infection following legal abortion.
    Author: Giertz G, Kallings I, Nordenvall M, Fuchs T.
    Journal: Acta Obstet Gynecol Scand; 1987; 66(2):107-9. PubMed ID: 3618133.
    Abstract:
    In a prospective study, 288 women were tested for Chlamydia trachomatis (CT) in the cervix prior to legal abortion. In the control group (n = 259), CT culturing was carried out only when postoperative infection was suspected. CT was isolated in 14.2% of asymptomatic women. These patients were treated preoperatively with Doxycycline. In this group, no cases of postoperative infection were detected. Among those cases where CT was not detected, 4.9% contracted the infection, while in the control group the rate of infection was 9.7%. In the control group all the infections due to CT gave late symptoms after the operation (1-4 weeks). 500 women under age 25 and undergoing therapeutic abortion between September 1983 and September 1984 were included in this study designed to evaluate whether preoperative Doxycycline treatment given to carriers of "Chlamydia trachomatis" (CT) could reduce the postoperative infections. The patients were randomly distributed into 2 groups. Specimens were taken from the cervix of the patients in group A (n=228) for culture and direct immunofluorescent staining (DFA). In group B (n=259) only a clinical examination was performed. CT culturing (iodine staining) was carried out postoperatively only when signs of infection were found. When a patient in either group A or B showed signs of infection preoperatively, she was excluded from the study. The operation was performed as a vacuum aspiration prior to the 12th week of gestation (9). After the 12th week, a 2-stage procedure was performed with extra- or intra-amniotic instillation of prostaglandin followed by exeresis of the cavum uteri. All cases of postoperative genital infection appearing within 1 month after the abortion were registered. To establish the diagnosis of postoperative PID, a bimanual examination revealing palpation tenderness over the uterus and tubes was required. In group A, 41 of 288 women were CT carriers by any or all diagnostic methods (14.2%). In 32 cases, both culture and DFA revealed the presence of CT. All 41 women received preoperative Doxycycline treatment. None developed a postoperative infection. Among the 247 women with nondetectable CT, 14 developed a postoperative infection (4.9%). In group B, 25 of 259 women (9.7%) contracted a postoperative infection. In 8 of these women, CT was isolated. On dividing the postoperative infections into 2 groups, those with symptoms appearing within 3-4 days after the abortion and those with later symptoms, 9 of the 14 infections were early in group A and 13 of 25 infections were early in group B. With preoperative Doxycycline treatment of CT carriers, the rate of late infections was reduced from 4.6% to 1.7%. Of the infected patients in group B, 4 suffered from salpingitis -- all with a late onset.
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