Screening for Chlamydia trachomatis using self-collected vaginal swabs at a public pregnancy termination clinic in France: results of a screen-and-treat policy.
OBJECTIVE
To assess the prevalence of Chlamydia trachomatis (CT) infection and the risk factors for CT infection among women presenting for abortion at a clinic in France.


METHODS
Women seeking surgically induced abortions were systematically screened by PCR on self-collected vaginal swabs between January 1, 2010, and September 30, 2010. CT-positive women were treated with oral azithromycin (1 g) before the surgical procedure.


RESULTS
Of the 978 women included in the study, 66 were CT positive. The prevalence was 6.7% (95% confidence intervals [CI] 5.1%-8.3%). The risk factors for CT infection were the following: age <30 years (Odds ratio [OR]: 2.0 [95% CI: 1.2-3.5]), a relationship status of single (OR: 2.2 [95% CI: 1.2-4.0]), having 0 or 1 child (OR: 5.2 [95% CI: 2.0-13.0]), not using contraception (OR: 2.4 [95% CI: 1.4-4.1]), and completing 11 weeks or more of gestation (OR: 2.1 [95% CI: 1.3-3.6]). Multiple logistic regression indicated that 4 factors--having 0 or 1 child, a single relationship status, no contraceptive use, and a gestation of 11 weeks or more--were independently associated with CT infection. The rate of postabortion infection among all patients was 0.4% (4/978).


CONCLUSIONS
These results reveal a high prevalence (6.7%) of CT-positive patients among French women seeking induced abortions. Because it is not common practice to screen the general population for CT, screening before induced abortions seems relevant. A cost-effectiveness study is required to evaluate this screen-and-treat policy.
Faculté de Médecine, Université de Rennes 1, Rennes, France. vincent.lavoue@chu-rennes.fr
Vincent
V
Lavoué
Laurent
L
Vandenbroucke
Sophie
S
Lorand
Patrick
P
Pincemin
Estelle
E
Bauville
Laurence
L
Boyer
Daniel
D
Martin-Meriadec
Jacques
J
Minet
Patrice
P
Poulain
Karine
K
Morcel
D000028:Abortion, Induced / Q000706:statistics & numerical data*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017963:Azithromycin / Q000008:administration & dosage*; D002690:Chlamydia Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D005260:Female; D005602:France / Q000453:epidemiology; D006291:Health Policy; D006801:Humans; D008403:Mass Screening; D011247:Pregnancy; D015995:Prevalence; D012017:Referral and Consultation; D012189:Retrospective Studies; D018571:Sentinel Surveillance; D013997:Time Factors
D000900:Anti-Bacterial Agents; D017963:Azithromycin