HIGH PREVALENCE OF CHLAMYDIA AND PAP-SMEAR ABNORMALITIES IN PREGNANT ADOLESCENTS WARRANTS ROUTINE SCREENING

A prospective cohort of pregnant adolescent patients who planned to de liver at 1 of 3 Perth metropolitan hospitals was studied; 1 subgroup o f this cohort was offered universal screening for cervical chlamydial infection and Pap-smear abnormalities (screened), and the remainder of the cohort were offered screening at the discretion of the attending medical staff (control). High prevalences of both chlamydial infection (27%) and Pap-smear abnormalities (38%) were detected in the screened cohort. The majority of Pap-smear abnormalities were inflammatory aty pia, but high-grade Bethesda lesions were also diagnosed. In the contr ol group, the prevalence of positive swabs and abnormal Pap-smear repo rts in these tested was also high (22% and 35% respectively), but sign ificantly fewer patients were tested (18% and 33% respectively in the control group, compared to 92% and 94% in the screened group; both p<0 .001). Screening and treatment of chlamydia was associated with a sign ificant decrease in the incidence of newborn febrile morbidity (10% ve rsus 25%; p = 0.02). In view of the high prevalence of positive result s, it is cost-effective to offer universal screening in this setting. Failure to introduce a specific screening policy can result in a signi ficant number of patients being denied the advantages of diagnosis and treatment.