High rates of chlamydia in patients referred for termination of pregnancy: treatment, contact tracing, and implications for screening

Abstract

Aims: To determine the rate of chlamydia and other sexually transmitted infections (STIs), and to describe treatment and factors associated with chlamydia in patients presenting for a termination of pregnancy (TOP).

Methods: A retrospective audit of patients attending one of two TOP clinics from 1 February 2003. (Clinic A, n=500; Clinic B, n=501). Age, ethnicity, marital status, previous pregnancies, contraception, STIs, and treatment were recorded.

Results: Ten percent of patients tested positive for an STI. Chlamydia was most commonly detected, in 7.7% of all patients. Higher rates of chlamydia were observed at clinic B (10.2% vs 5.2%, p=0.005) and in under 25 year olds (11.2% vs 3.6%, p<0.001). Rates of chlamydia in Pacific women were 18.6%, in Maori 12.9%, in Asian 7.3% and 4.4% in New Zealand European women. All patients testing positive for chlamydia were treated prior to TOP but only 41% of partners were treated. Other infections detected included 18 cases of human papillomavirus (HPV), three cases of trichomoniasis, one case of gonorrhoea, and one case of syphilis.

Conclusions: There is a high rate of chlamydia in women presenting for TOP, particularly in under 25 year olds, Pacific, and Maori women. There is an immediate need for policymakers to respond to this increasing burden of chlamydia by instigating targeted education, guidelines, and mandatory chlamydia screening and contact tracing for pregnant women.