Universal prophylaxis for Chlamydia trachomatis and anaerobic vaginosis inwomen attending for suction termination of pregnancy: an audit of short-term health gains

A previous study of infection and morbidity in 400 women att ending for ter mination of pregnancy (TOP) had shown that 32 (8%) harboured cervical Chlam ydia trachomatis and 112 (28%) had anerobic (bacterial) vaginosis (AV). Fif ty-three per cent of the women with preoperative C. trachomatis had AV. Thi rty of the 32 women with chlamydial infection were followed up and 19 (63%) of these developed post-abortion upper genital tract infection, 7 of whom needed readmission(1). Ln view of the high morbidity in women with chlamydi al infection attending for TOP, anti-bacterial prophylaxis with metronidazo le suppositories and oral oxytetracycline was introduced for women attendin g for suction termination of pregnancy (STOP). An audit of the clinical and financial benefits and/or losses was carried out. The audit of 1951 consec utive patients attending for STOP revealed that 132 (6.8%) had chlamydial i nfection with equivocal results reported in a further 2 patients. One hundr ed and eight of the 134 women responded to recall. Full genital tract infec tion screening was carried out in 105 of the 108 recalled patients of whom 5 had repeat positive cervical swabs for C. trachomatis, one had Trichomona s vaginalis, 24 had candidiasis and 17 had anaerobic vaginosis, none had go norrhoea. Thirteen (12%) of the 108 women had pelvic infection as previousl y defined(1), none of whom required re-admission. At least pound 20,000 has been saved each year in our Trust following the introduction of pre-aborti on chlamydial screening and universal antichlamydial and anti-anaerobe prop hylaxis. The introduction of universal prophylaxis against C, trachomatis and AV has profoundly reduced morbidity in patients attending for TOP and has also re sulted in substantial financial savings.