Blackwell A L, Thomas P D, Wareham K, Emery S J
Department of Genito-Urinary Medicine, Singleton Hospital Trust, Swansea, UK.
Lancet. 1993 Jul 24;342(8865):206-10. doi: 10.1016/0140-6736(93)92299-9.
Infection of the upper genital tract after abortion is well recognised, but routine screening for infection before termination is rare, and few centres are aware of the prevalence of post-abortion complications in their population. We undertook a study to assess the prevalence and sequelae of genital-tract infection in patients undergoing termination of pregnancy and to estimate the costs and potential benefits of introducing screening and prophylaxis for the most commonly found organisms. The study in Swansea, UK, was of 401 consecutive patients attending for termination of pregnancy; only 1 patient refused to take part. Immediately before the termination procedure vaginal and cervical swabs were taken for microscopic examination and culture of Trichomonas vaginalis, Neisseria gonorrhoeae, and candida species. We sought Chlamydia trachomatis by enzyme-linked immunosorbent assay. 112 (28%) women had the typical bacterial flora of anaerobic (bacterial) vaginosis, 95 (24%) had candidal infection, 32 (8%) chlamydial infection, 3 (0.75%) trichomonas infection, and 1 (0.25%) gonorrhoea. Postoperative follow-up of 30 of the women with chlamydial infection showed that pelvic infection developed in 19 (63%), of whom 7 were readmitted to hospital. 9 male partners of women with chlamydial (plus gonococcal in 1 case) infection were examined; 8 were symptom-free, 3 had C trachomatis infection, and 1 N gonorrhoeae. Estimated costs of hospital admissions for complications of chlamydial infection were more than double the costs of providing a routine chlamydia screening programme and prophylactic treatment. Screening for chlamydial infection before termination of pregnancy is essential. Prophylactic treatment for both chlamydial infection and anaerobic vaginosis should also be considered. Male partners of women infected with chlamydia are often symptom-free, but they must be traced to avoid reinfections.
流产后上生殖道感染已广为人知，但终止妊娠前进行常规感染筛查的情况很少见，而且很少有中心了解其人群中流产后并发症的发生率。我们开展了一项研究，以评估接受终止妊娠的患者生殖道感染的发生率和后遗症，并估计针对最常见病原体进行筛查和预防的成本及潜在益处。英国斯旺西的这项研究纳入了401例连续前来接受终止妊娠的患者；只有1例患者拒绝参与。在终止妊娠手术前，立即采集阴道和宫颈拭子，用于显微镜检查以及阴道毛滴虫、淋病奈瑟菌和念珠菌属的培养。我们通过酶联免疫吸附测定法检测沙眼衣原体。112名（28%）女性有厌氧菌（细菌性）阴道病的典型菌群，95名（24%）有念珠菌感染，32名（8%）有衣原体感染，3名（0.75%）有滴虫感染，1名（0.25%）有淋病。对30例衣原体感染女性进行术后随访发现，19例（63%）发生盆腔感染，其中7例再次入院。对9例衣原体感染（1例合并淋球菌感染）女性的男性伴侣进行了检查；8例无症状，3例有沙眼衣原体感染，1例有淋病奈瑟菌感染。衣原体感染并发症的住院估计费用是提供常规衣原体筛查计划和预防性治疗费用的两倍多。终止妊娠前筛查衣原体感染至关重要。还应考虑对衣原体感染和厌氧菌阴道病进行预防性治疗。感染衣原体女性的男性伴侣通常无症状，但必须对其进行追踪以避免再次感染。
