Evaluation of endocervical, first-void urine and self-administered vulval swabs for the detection of Chlamydia trachomatis in a miscarriage population

Vaginal self-sampling as a diagnosis tool in low-income countries and potential applications for exploring the infectious causes of miscarriage

Gynecological health is a challenge in low-income countries. Personal opposition to perineal examination has been overcome by the use of vaginal self-sampling. Here, we review the use of this procedure notably in low-income countries and the main infectious causes of miscarriage. Vaginal self-sampling was mainly used for human papillomavirus detection but also to detect microorganisms causing sexually transmitted infections or bacterial vaginosis. 58 studies have been performed in low-resource countries, mainly studies performed to detect human papillomavirus in urban and peri-urban areas and demonstrating excellent acceptability. Several infectious causes of miscarriage could be tested using self-vaginal samples. In the future, such strategies coupled with a rapid-identification point-of-care method could allow the development of screening and treatment programs in rural areas in low-resource countries.

Young pregnant women's views on the acceptability of screening for chlamydia as part of routine antenatal care

Background

In pregnancy, untreated chlamydia infection has been associated with adverse outcomes for both mother and infant. Like most women, pregnant women infected with chlamydia do not report genital symptoms, and are therefore unlikely to be aware of their infection. The aim of this study was to determine the acceptability of screening pregnant women aged 16-25 years for chlamydia as part of routine antenatal care.

Methods

As part of a larger prospective, cross-sectional study of pregnant women aged 16-25 years attending antenatal services across Melbourne, Australia, 100 women were invited to participate in a face-to-face, semi structured interview on the acceptability of screening for chlamydia during pregnancy. Women infected with chlamydia were oversampled (n = 31).

Results

Women had low levels of awareness of chlamydia before the test, retained relatively little knowledge after the test and commonly had misconceptions around chlamydia transmission, testing and sequelae. Women indicated a high level of acceptance and support for chlamydia screening, expressing their willingness to undertake whatever care was necessary to ensure the health of their baby. There was a strong preference for urine testing over other methods of specimen collection. Women questioned why testing was not already conducted alongside other antenatal STI screening tests, particularly in view of the risks chlamydia poses to the baby. Women who tested positive for chlamydia had mixed reactions, however, most felt relief and gratitude at having had chlamydia detected and reported high levels of partner support.

Conclusions

Chlamydia screening as part of routine antenatal care was considered highly acceptable among young pregnant women who recognized the benefits of screening and strongly supported its implementation as part of routine antenatal care. The acceptability of screening is important to the uptake of chlamydia screening in future antenatal screening strategies.

Oral health care patterns and the history of miscarriage

OBJECTIVE

Oral infections can trigger the production of pro-inflammatory mediators that may be risk factors for miscarriage. We investigated whether oral health care patterns that may promote or alleviate oral inflammation were associated with the history of miscarriage in 328 all-Caucasian women.

MATERIALS AND METHODS

Of 328 women in this cross-sectional cohort, 74 had history of miscarriage (HMC). Medical, dental and sociodemographic data were collected through clinical examinations, medical record searches and structured questionnaires.

RESULTS

The multivariate regression analyses indicated that urgency-based dental treatment demonstrated a significant association [odds ratio (OR) = 2.54; 95% confidence interval (CI): 1.21-5.37; P = 0.01] and preventive dental treatment demonstrated a marginally significant inverse association (OR = 0.53; CI: 0.26-1.06; P = 0.07) with HMC. Self-rated poor oral health had a non-significant positive association with HMC (OR 1.60; CI: 0.88-2.90).

CONCLUSION

Our results provide sufficient evidence for hypothesis generation to test whether other precise measures of oral inflammation are associated with adverse birth outcomes.

Chlamydia infection among pregnant women and those seeking termination

A total of 60 women tested positive for chlamydia during the study period. Of these, 75% (n = 45) were pregnant and were divided into those seeking termination (38%) and the antenatal group (62%). Of all pregnant chlamydia-positive women, 35% were teenagers. Most were aged <25 years, but if all test-positive women up to 30 years were included, 100% infections among the termination group and 92% infection among the antenatal group were detected. Of all chlamydia-positive pregnant women, 69% were nulliparous and 15.6% had multiple sexual partners. While 28.6% of the women in the antenatal group were married, in the termination group, none were married (p = 0.02). All women in the termination group were asymptomatic, while 75% of the antenatal chlamydia-positive women were emergency admissions (p < 0.0001). To conclude, opportunistic screening should be offered to pregnant women aged 25 - 29 years, to enhance detection. Testing strategies should focus on testing pregnant women of <19 years.

Chlamydia screening and treatment in patients undergoing evacuation of retained products of conception or vaginal termination of pregnancy: an audit of the Royal College of Obstetricians and Gynaecologists' Guidelines in practice

OBJECTIVE

To assess compliance with the Royal College of Obstetricians and Gynaecologists Guidelines regarding screening for and treatment of Chlamydia trachomatis before vaginal termination of pregnancy (VTOP) and surgical evacuation of retained products of conception (ERPC).

METHODS

Case notes of women undergoing VTOP and ERPC in the authors' department were examined for evidence of the presence of C. trachomatis infection and identification of chlamydia risk factors, and for evidence of curative treatment for women with confirmed infection or prophylactic treatment for women at risk.

RESULTS

In the VTOP group (n = 30) screening and treatment was carried out satisfactorily, aided by an assessment proforma. In the ERPC group (n = 30) there were weaknesses in the identification and treatment of patients at risk.

CONCLUSIONS

We conclude that the use of a proforma helps to achieve effective screening. Adequate risk assessment of women undergoing ERPC seems to be difficult to achieve and so universal administration of prophylactic antibiotics might be a safe and efficient option until the National Chlamydia Screening Programme is established in our area.

A review on infection with Chlamydia trachomatis

Infection with Chlamydia trachomatis accounts for the most common bacterial sexually transmitted infection in the UK. Men between 20 and 24 years and women between 16 and 19 years have the highest prevalence of chlamydial infection. Because the majority of women with chlamydial infection are asymptomatic, a proportion remains untreated and eventually develops pelvic inflammatory disease (PID). PID can result in ectopic pregnancy, infertility and chronic pelvic pain. Screening for chlamydial infection might reduce the incidence of complications of PID. The advent of nucleic acid amplification tests and single-dose therapy for chlamydial infection has made home testing and easy treatment possible.

Urine gonococcal/Chlamydia testing in adolescents

PURPOSE OF REVIEW

This review will highlight the recent literature findings regarding urine-based Chlamydia and gonorrhea testing in adolescents.

RECENT FINDINGS

Rates of Chlamydia trachomatis are increasing, likely due to increased detection efficiency, but have not yet begun to decrease. Neisseria gonorrhoeae is at an all-time low. Urine-based testing for sexually transmitted infections is readily available and convenient but underutilized. Interesting approaches to a more universal screening program, including self-collected, mail-in urine samples, have been shown to be effective.

SUMMARY

In spite of recommendations urging universal screening for C. trachomatis and N. gonorrhoeae and the availability of highly accurate and convenient tests, screening rates for adolescents and young adults remain below the universal recommendations. Strategies to improve screening rates should take advantage of urine-based screening methodologies for sexually transmitted infections because of their cost-effectiveness as well as the convenience for patient and provider.