Chlamydia in colposcopy clinics: to screen or not to screen?

Abstract

The objective of the study was to assess the prevalence of Chlamydia trachomatis in our colposcopy clinic. A total of 337 consecutive patients newly referred to the colposcopy clinic between May and November 2003 were screened for chlamydia trachomatis. All our patients were referred by their GPs and none of the patients had had a recent chlamydia test performed. Four patients screened positive, overall giving a prevalence of 1.2% [95% CI 0.04-2.36%]. Three of those with positive results were in the 21 - 30 year age group (139 in the group, which equals 2.2% prevalence [95% CI 0 - 4.6%]). The fourth positive result was in the group over the age of 60. None of those screened in the other age groups was positive (< or =20, 31 - 40, 41 - 50, 51 - 60 years). Numbers screened in each of those groups were: 14, 115, 53 and 12, consecutively. Our study, though small in sample size, supports the view that the prevalence of chlamydia is not high in all colposcopy clinic attenders. Women younger than 30 years old are more likely to be infected than older women; hence opportunistic screening should target this age group. The prevalence rate may be low due to the enzyme linked immunosorbent assay giving a poor detection rate for chlamydia screening.

The Colposcopic Examination

“…Condom use may contribute to regression of cervical dysplasia and HPV changes, 37 and has been shown to decrease male‐to‐female transmission of HPV 38 . Educating about and offering screening for sexually transmitted infections should be considered, particularly in high‐risk populations 21 . Women should be reminded to receive recommended follow‐up and to continue to receive cervical cancer screening.…”

“…Some colposcopists may repeat a Pap test during the examination; however, both retrospective and prospective studies have shown limited clinical utility in repeating either liquid‐based or conventional cytology at the time of colposcopy 18–20 . Screening for gonorrhea and chlamydia may be considered in high‐risk populations 21–23 …”

Cervical ectropion. Part 2: assessment of symptomatic women

“…Matiluko et al found a prevalence of chlamydia of 1.2 per cent in a prospective evaluation of 337 patients referred to the colposcopy clinic with abnormal cytology 19. The prevalence of chlamydia was 2.2 per cent in women ≤30 years of age newly attending the clinic.…”

“…The prevalence of chlamydia was 2.2 per cent in women ≤30 years of age newly attending the clinic. Chlamydia was screened for using ELISA in this survey and in the study of Matiluko et al ,19 which was in the same geographic location. While the survey does show the occurrence of chlamydial infection in association with symptomatic cervical ectropion, the suggestion that there is a higher prevalence of chlamydial infection in patients with symptomatic ectropion compared with other women attending the colposcopy unit is limited by the small sample size and the number of positive results, but has been demonstrated by others 20…”