Screening for Chlamydia trachomatis in obstetrics and gynaecology
In 1996, a RCOG Study Group reporting on the prevention of pelvic infection highlighted the considerable role C. trachomatis played in female reproductive morbidity and the potential advantages of DNA based assays. A national screening programme was suggested, as Sweden and the USA had demonstrated that screening women could decrease prevalence and pelvic inflammatory disease rates. In the UK, out with genito-urinary medicine clinics, awareness of the infection and screening was virtually non-existent. Women attending obstetric and gynaecology-affiliated clinics were at increased risk of ascending infection compared to the general public and ideally placed for opportunistic screening. However, patients were TESTED only if symptomatic, by specimens taken from the endocervix for culture or antigen detection assay. It was from this background that the studies commenced. The thesis comprises of: - A questionnaire survey assessing sexually active women’s knowledge of C. trachomatis infection and perceived acceptability of different methods and settings for screening. Women attending induced abortion and family planning clinics in Aberdeen and Leeds were recruited. - A prevalence study, aiming to identify who should undergo screening. Sexually active women attending six different clinical settings in Aberdeen’s Obstetrics & Gynaecology department were screened for Chlamydia. - A study assessing test performance and acceptability of four different screening approaches (enzyme immunoassay of endocervical specimens and ligase chain reaction assay of endocervical, clinician-collected vulva!, and urine specimens) to opportunistically screen pregnant and non-pregnant women, under 25 years of age. - A study evaluating patient-collected vulval swabs, as an alternative to non-invasive screening by urine. Women under 25 years of age attending a family planning clinic were opportunistically screened and test performance and acceptability evaluated. - A study determining whether the measurement of chlamydial IgG antibodies alone or in combination with medical history and/or transvaginal ultrasound can predict tubal infertility in subfertile women.