High prevalence of chlamydia and Pap-smear abnormalities in pregnant adolescents warrants routine screening.
A prospective cohort of pregnant adolescent patients who planned to deliver at 1 of 3 Perth metropolitan hospitals was studied; 1 subgroup of 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 atypia, but high-grade Bethesda lesions were also diagnosed. In the control group, the prevalence of positive swabs and abnormal Pap-smear reports in those tested was also high (22% and 35% respectively), but significantly 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 significant decrease in the incidence of newborn febrile morbidity (10% versus 25%; p=0.02). In view of the high prevalence of positive results, it is cost-effective to offer universal screening in this setting. Failure to introduce a specific screening policy can result in a significant number of patients being denied the advantages of diagnosis and treatment.
Department of Obstetrics and Gynaecology, University of Western Australia, and King Edward Memorial Hospital, Perth.
J A
JA
Quinlivan
R W
RW
Petersen
L C
LC
Gurrin
D000293:Adolescent; D002584:Cervix Uteri / Q000473:pathology*; D002690:Chlamydia Infections / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008403:Mass Screening; D065006:Papanicolaou Test; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000517:prevention & control; D011253:Pregnancy in Adolescence; D015995:Prevalence; D014626:Vaginal Smears; D014904:Western Australia / Q000453:epidemiology