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Genital infection and termination of pregnancy: Are patients still at risk?
  1. Caroline D Smith, MB BS, DFFP, Senior House Officer1,
  2. Elizabeth M Carlin, DFFP, FRCP, Consultant1,
  3. Judy Heason, BSc, Health Advisor1,
  4. David TY Liu, MD, FRCOG, Consultant2,
  5. Imtyaz Ahmed Jushuf, MB ChB, FRCP, Consultant3 and
  6. Robert H Hammond, FRCS, FRCOG, Consultant4
  1. Department of Genitourinary Medicine, Nottingham City Hospital, Nottingham, UK
  2. Department of Obstetrics and Gynaecology, Nottingham City Hospital, Nottingham, UK
  3. Department of Genitourinary Medicine, Nottingham City Hospital, Nottingham, UK
  4. Department of Obstetrics and Gynaecology, Queen's Medical Centre, Nottingham, UK
  1. Correspondence Dr EM Carlin, Consultant Physician, Department of Genitourinary Medicine, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK. Tel: 0115 962 7746, Fax: 0115 962 7684

Abstract

Objectives To identify the treatment patterns and early complication rates in women identified with a genital infection prior to a termination of pregnancy (TOP) and to re-assess our earlier work on contact attendance and treatment. The aim was to refine current prophylactic measures to provide the most efficient and effective way of reducing post-termination complications.

Method Six-month retrospective analysis of all women with genital Chlamydia trachomatis or Neisseria gonorrhoeae identified prior to TOP. Data on the timing of positive results and treatment in relation to the TOP were recorded. Clinical signs of pelvic infection and the success of contact tracing and treatment were noted.

Results Forty women were identified with infection, 31 (78%) proceeded to TOP; only five were treated adequately in the peri-TOP period. Twenty-six (84%) of the women undergoing TOP attended the genitourinary medicine (GUM) department after the TOP and received antimicrobial therapy where necessary. In total, four women (10%) were untreated. Approximately two thirds of results were reported prior to, or on the day of, the TOP. The majority of TOPs (71%) were carried out at 5 days or less from the initial assessment. Clinical signs of post-TOP pelvic inflammation developed in seven (28%) women with chlamydial infection. Contact tracing was successful in 24 (69%) of the 35 women who attended the GUM department.

Conclusion The debate about the best option for the most effective management of women undergoing TOP continues. The options with respect to C. trachomatis include universal prophylaxis, screening and treating as necessary, or a 'belt and braces' approach of screening all and treating all. Fundamental is the continuation of active contact tracing and GUM remains integral to this.

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