ORIGINAL ARTICLES ____________________________________________________________
_____________________________________________________ Evaluation of near patient testing for Chlamydia trachomatis in a pregnancy termination service
Jennifer Hopwood, MB ChB, D(Obst)RCOG, DipVen, MFFP, Senior Clinical Medical Officer, Wirral and West Cheshire Community NHS Trust, Co-ordinator Wirral DH Chlamydia Pilot Scheme, St Catherine’ Hospital, Wirral, UK; Harry Mallinson, PhD, s Principal Microbiologist, University Hospital, Aintree, UK; Toni Gleave, RGN BA (Hons) MSc, Community Health Adviser, St Catherine’ Hospital, Wirral, UK. s s Correspondence: Dr JJ Hopwood, Chlamydia PilotOffice, Evidence Based Practice Centre, St Catherine’ Hospital, Birkenhead, CH44 0LQ.
(Accepted 2nd February 2001)
The Journal of Family Planning and Reproductive Health Care 2001: 27(3): 127-130
Abstract Aim. To identify and evaluate advantages and disadvantages of a near patient test (NPT) for Chlamydia trachomatis, using Clearview Chlamydia MF (Unipath Ltd) in a British PregnancyAdvisory Service (BPAS) clinic. Method. The improved Clearview Chlamydia MF test was used to test endocervical swabs from 400 women attending BPAS clinic for termination of pregnancy. The results were compared with Ligase Chain Reaction (LCR), using Polymerase Chain Reaction (PCR) as the arbiter. Results. Twenty-seven women tested positive by Clearview Chlamydia MF (24 confirmed by LCR) and 32 by LCR.Comment. NPT has potential advantages in specific situations where a quick result is required for optimal management of those testing positive. However, the current technology available for detection of Chlamydial infection results in time constraints, which limited its benefits in this study, where there was a high throughput of clients. A significant number of cases were missed by ClearviewChlamydia MF, though the sensitivity found is within the ranges reported for various enzyme immunoassays (EIA) – currently the most commonly used testing method. The study confirmed the high positivity in those attending for termination, especially in under 25-year-olds. Key message points
A termination service provides an effective health care opportunity for finding chlamydial infection. This studyconfirms that the prevalence of Chlamydia trachomatis in over 25-year-olds is significantly less than in younger women. Twenty-six percent of women would have been especially likely to benefit from near patient testing. Clearview chlamydia MF results were available to be given before discharge from the clinic in 76% of cases. If a designated person can be used, the Clearview chlamydia technique canbe incorporated effectively into a service, but there needs to be adequate time allocated to gain maximum benefit.
Introduction Chlamydial infection is the most common bacterial sexually transmitted infection (STI) and the most common cause of pelvic inflammatory disease (PID). Estimates of the incidence of PID after termination of pregnancy in infected women range from 25% to 63%.1 BPAS is amajor national specialist provider of abortion services, offering diagnosis, information and counselling to women about being pregnant and, where requested and appropriate,
treatment for termination of pregnancy. Founded after the Abortion Act of 1967, the charity now provides counselling and clinical assessment from a network of BPAS centres and conducts treatment in 12 Department of Healthapproved clinics. The interval between assessment and treatment may be only a few days for some clients. Recognising the risk of ascending infection associated with instrumentation, it has always been the policy of BPAS to give prophylactic antibiotics, currently a course of doxycycline. This policy does not address the problem of partners, so for those with the infection re-infection is likely,...