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  • Title: Health gains from screening for infection of the lower genital tract in women attending for termination of pregnancy.
    Author: Blackwell AL, Thomas PD, Wareham K, Emery SJ.
    Journal: Lancet; 1993 Jul 24; 342(8865):206-10. PubMed ID: 8100930.
    Abstract:
    Infection of the upper genital tract after abortion is well recognised, but routine screening for infection before termination is rare, and few centres are aware of the prevalence of post-abortion complications in their population. We undertook a study to assess the prevalence and sequelae of genital-tract infection in patients undergoing termination of pregnancy and to estimate the costs and potential benefits of introducing screening and prophylaxis for the most commonly found organisms. The study in Swansea, UK, was of 401 consecutive patients attending for termination of pregnancy; only 1 patient refused to take part. Immediately before the termination procedure vaginal and cervical swabs were taken for microscopic examination and culture of Trichomonas vaginalis, Neisseria gonorrhoeae, and candida species. We sought Chlamydia trachomatis by enzyme-linked immunosorbent assay. 112 (28%) women had the typical bacterial flora of anaerobic (bacterial) vaginosis, 95 (24%) had candidal infection, 32 (8%) chlamydial infection, 3 (0.75%) trichomonas infection, and 1 (0.25%) gonorrhoea. Postoperative follow-up of 30 of the women with chlamydial infection showed that pelvic infection developed in 19 (63%), of whom 7 were readmitted to hospital. 9 male partners of women with chlamydial (plus gonococcal in 1 case) infection were examined; 8 were symptom-free, 3 had C trachomatis infection, and 1 N gonorrhoeae. Estimated costs of hospital admissions for complications of chlamydial infection were more than double the costs of providing a routine chlamydia screening programme and prophylactic treatment. Screening for chlamydial infection before termination of pregnancy is essential. Prophylactic treatment for both chlamydial infection and anaerobic vaginosis should also be considered. Male partners of women infected with chlamydia are often symptom-free, but they must be traced to avoid reinfections. Between October 1990 and March 1991, 401 women at Hill House Hospital in Swansea, Wales, undergoing an abortion enrolled in a study to determine the prevalence and sequelae of lower genital tract infection and to assess the costs and potential benefits of screening and of prophylaxis for the most common pathogens. The physicians administered 500 mg oxytetracycline for 10 days for women with uncomplicated chlamydia infection and for 14=21 days for those with chlamydia-related pelvic inflammatory disease (PID). A 5-day course of oral metronidazole (400 mg/2/times/day) treated anaerobic vaginosis and trichomonas infections. 51.7% had at least 1 lower genital tract infection, 28% had anaerobic vaginosis, 24% had candida infection and 32 women (8%) were infected with Chlamydia trachomatis. Some of these women also had anaerobic vaginosis, anaerobic vaginosis and candidosis, Escherichia coli infection, and candidosis (15, 1, 1, and 6 women, respectively). Anaerobic vaginosis was more likely to be present in women with chlamydia infection than in those without chlamydia infection (53% vs. 26%; p .05). 19 of 30 women (63%) with chlamydia infection who could be followed postoperatively developed PID. 7 women had to be readmitted to the hospital. 9 males partners of 26 women also attended the Genito-Urinary Medicine clinic. 8 had not symptoms, but 3 had C. trachomatis infection and 1 had Neisseria gonorrhoea infection. The physicians estimated the costs of hospital admissions for pelvic infection to be 2.4 times more costly than providing routine prophylactic screening and treatment (16,800 vs. 6960 UK pounds). These results showed the need to be screen for chlamydia infection before termination of pregnancy and to provide prophylactic treatment for chlamydia infection and anaerobic vaginosis. The physicians also recommended tracing the male partners of chlamydia-infected women to prevent reinfections.
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