Abstract
The prevalence of cervical Chlamydia trachomatis infection in general practice populations ranges between 2% and 12%. Untreated infection can cause pelvic inflammatory disease, tubal infertility and ectopic pregnancy. These risks are increased by cervical invasive procedures, especially termination of pregnancy. However, most women with chlamydia infection have no symptoms. General practitioners and practice nurses carrying out pelvic examinations should have facilities for taking endocervical specimens for chlamydia. Routine chlamydia screening, should be considered if the local prevalence of infection is over 6%. Otherwise chlamydia testing should be offered to women requesting termination of pregnancy and to those who have risk factors: aged less than 25 years, absence of barrier contraception, recent change of sexual partner, vaginal discharge, friable cervix or sterile pyuria. Women found to have chlamydia infection need appropriate antibiotics, advice about contact tracing and referral to a genitourinary medicine clinic. Good communication between general practitioners and genitourinary physicians is essential. Both general practitioners and practice nurses have an important role to play in reducing the prevalence of cervical chlamydia infection and its potentially devastating consequences.
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- Addiss D. G., Vaughn M. L., Ludka D., Pfister J., Davis J. P. Decreased prevalence of Chlamydia trachomatis infection associated with a selective screening program in family planning clinics in Wisconsin. Sex Transm Dis. 1993 Jan-Feb;20(1):28–35. doi: 10.1097/00007435-199301000-00006. [DOI] [PubMed] [Google Scholar]
- Arnott M. A., Bennett N. D., Cairns D., Hay J. Selective effects of pentamidine on cytosolic and granule-associated enzyme release from zymosan-activated human neutrophilic granulocytes. J Pharm Pharmacol. 1994 May;46(5):394–396. doi: 10.1111/j.2042-7158.1994.tb03824.x. [DOI] [PubMed] [Google Scholar]
- Avonts D., Sercu M., Heyerick P., Vandermeeren I., Piot P. Sexually transmitted diseases and Chlamydia trachomatis in women consulting for contraception. J R Coll Gen Pract. 1989 Oct;39(327):418–420. [PMC free article] [PubMed] [Google Scholar]
- Bevan C., Ridgway G. L. Pelvic inflammatory disease. Br J Obstet Gynaecol. 1992 Dec;99(12):944–945. doi: 10.1111/j.1471-0528.1992.tb13693.x. [DOI] [PubMed] [Google Scholar]
- Blackwell A. L., Thomas P. D., Wareham K., Emery S. J. Health gains from screening for infection of the lower genital tract in women attending for termination of pregnancy. Lancet. 1993 Jul 24;342(8865):206–210. doi: 10.1016/0140-6736(93)92299-9. [DOI] [PubMed] [Google Scholar]
- Bro F., Juul S. Predictors of Chlamydia trachomatis infection in women in general practice. Fam Pract. 1990 Jun;7(2):138–143. doi: 10.1093/fampra/7.2.138. [DOI] [PubMed] [Google Scholar]
- Buhaug H., Skjeldestad F. E., Halvorsen L. E., Dalen A. Should asymptomatic patients be tested for Chlamydia trachomatis in general practice? Br J Gen Pract. 1990 Apr;40(333):142–145. [PMC free article] [PubMed] [Google Scholar]
- Burney P., Marson W. S., Evans M., Forsey T. Chlamydia trachomatis and lower urinary tract symptoms among women in one general practice. Br Med J (Clin Res Ed) 1983 May 14;286(6377):1550–1552. doi: 10.1136/bmj.286.6377.1550. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cates W., Jr, Wasserheit J. N. Genital chlamydial infections: epidemiology and reproductive sequelae. Am J Obstet Gynecol. 1991 Jun;164(6 Pt 2):1771–1781. doi: 10.1016/0002-9378(91)90559-a. [DOI] [PubMed] [Google Scholar]
- Cohn M., Stewart P. Prevalence of potential pathogens in cervical canal before termination of pregnancy. BMJ. 1992 Jun 6;304(6840):1479–1479. doi: 10.1136/bmj.304.6840.1479. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Coker D. M., Timmins D. J., O'Mahony C. Chlamydia: one step forward or two backwards? BMJ. 1989 Jan 7;298(6665):51–51. doi: 10.1136/bmj.298.6665.51-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Drife J. O. Tubal pregnancy. BMJ. 1990 Nov 10;301(6760):1057–1058. doi: 10.1136/bmj.301.6760.1057. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dryden M. S., Wilkinson M., Redman M., Millar M. R. Detection of Chlamydia trachomatis in general practice urine samples. Br J Gen Pract. 1994 Mar;44(380):114–117. [PMC free article] [PubMed] [Google Scholar]
- Eynon-Lewis A. Audit of the management of pelvic inflammatory disease in general practice. J R Coll Gen Pract. 1988 Nov;38(316):492–493. [PMC free article] [PubMed] [Google Scholar]
- Faro S. Chlamydia trachomatis: female pelvic infection. Am J Obstet Gynecol. 1991 Jun;164(6 Pt 2):1767–1770. doi: 10.1016/0002-9378(91)90558-9. [DOI] [PubMed] [Google Scholar]
- Fox H. Chlamydial cervicitis: a research study from general practice. J R Coll Gen Pract. 1983 Nov;33(256):721–724. [PMC free article] [PubMed] [Google Scholar]
- Hall M., Barnett L., Melhuish C. Family planning services. Br J Gen Pract. 1993 Aug;43(373):352–352. [PMC free article] [PubMed] [Google Scholar]
- Halvorsen L. E., Skjeldestad F. E., Nordbø S. A., Løge I. Hvilke kvinner bør undersøkes for Chlamydia trachomatis i allmennpraksis? Tidsskr Nor Laegeforen. 1992 Jun 20;112(16):2080–2081. [PubMed] [Google Scholar]
- Handsfield H. H., Jasman L. L., Roberts P. L., Hanson V. W., Kothenbeutel R. L., Stamm W. E. Criteria for selective screening for Chlamydia trachomatis infection in women attending family planning clinics. JAMA. 1986 Apr 4;255(13):1730–1734. [PubMed] [Google Scholar]
- Hay P. E., Thomas B. J., Horner P. J., MacLeod E., Renton A. M., Taylor-Robinson D. Chlamydia trachomatis in women: the more you look, the more you find. Genitourin Med. 1994 Apr;70(2):97–100. doi: 10.1136/sti.70.2.97. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Healy D. L., Trounson A. O., Andersen A. N. Female infertility: causes and treatment. Lancet. 1994 Jun 18;343(8912):1539–1544. doi: 10.1016/s0140-6736(94)92941-6. [DOI] [PubMed] [Google Scholar]
- Kluytmans J. A., Goessens W. H., Mouton J. W., van Rijsoort-Vos J. H., Niesters H. G., Quint W. G., Habbema L., Stolz E., Wagenvoort J. H. Evaluation of Clearview and Magic Lite tests, polymerase chain reaction, and cell culture for detection of Chlamydia trachomatis in urogenital specimens. J Clin Microbiol. 1993 Dec;31(12):3204–3210. doi: 10.1128/jcm.31.12.3204-3210.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lee H. H., Chernesky M. A., Schachter J., Burczak J. D., Andrews W. W., Muldoon S., Leckie G., Stamm W. E. Diagnosis of Chlamydia trachomatis genitourinary infection in women by ligase chain reaction assay of urine. Lancet. 1995 Jan 28;345(8944):213–216. doi: 10.1016/s0140-6736(95)90221-x. [DOI] [PubMed] [Google Scholar]
- Longhurst H. J., Flower N., Thomas B. J., Munday P. E., Elder A., Constantinidou M., Wilton J., Taylor-Robinson D. A simple method for the detection of Chlamydia trachomatis infections in general practice. J R Coll Gen Pract. 1987 Jun;37(299):255–256. [PMC free article] [PubMed] [Google Scholar]
- Malotte C. K., Wiesmeier E., Gelineau K. J. Screening for chlamydial cervicitis in a sexually active university population. Am J Public Health. 1990 Apr;80(4):469–471. doi: 10.2105/ajph.80.4.469. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McCormack W. M., Alpert S., McComb D. E., Nichols R. L., Semine D. Z., Zinner S. H. Fifteen-month follow-up study of women infected with Chlamydia trachomatis. N Engl J Med. 1979 Jan 18;300(3):123–125. doi: 10.1056/NEJM197901183000305. [DOI] [PubMed] [Google Scholar]
- Oakeshott P., Chiverton S., Speight L., Bertrand J. Testing for cervical Chlamydia trachomatis infection in an inner city practice. Fam Pract. 1992 Dec;9(4):421–424. doi: 10.1093/fampra/9.4.421. [DOI] [PubMed] [Google Scholar]
- Oakeshott P. Health of the nation and sexually transmitted diseases. Lancet. 1992 Aug 29;340(8818):554–554. doi: 10.1016/0140-6736(92)91754-v. [DOI] [PubMed] [Google Scholar]
- Oakeshott P., Hilton S., Hay P. Treatment and causes of female infertility. Lancet. 1994 Jul 30;344(8918):334–334. [PubMed] [Google Scholar]
- Oakeshott P. Sexual health in teenagers. Lancet. 1995 Sep 2;346(8975):648–649. doi: 10.1016/s0140-6736(95)91489-7. [DOI] [PubMed] [Google Scholar]
- Owen P. A., Hughes M. G., Munro J. A. Study of the management of chlamydial cervicitis in general practice. Br J Gen Pract. 1991 Jul;41(348):279–281. [PMC free article] [PubMed] [Google Scholar]
- Owen P., Munro J., West R. Chlamydia: One step forward or two backwards? BMJ. 1988 Nov 12;297(6658):1267–1267. doi: 10.1136/bmj.297.6658.1267-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Paavonen J., Kiviat N., Brunham R. C., Stevens C. E., Kuo C. C., Stamm W. E., Miettinen A., Soules M., Eschenbach D. A., Holmes K. K. Prevalence and manifestations of endometritis among women with cervicitis. Am J Obstet Gynecol. 1985 Jun 1;152(3):280–286. doi: 10.1016/s0002-9378(85)80210-6. [DOI] [PubMed] [Google Scholar]
- Patton D. L., Kuo C. C., Wang S. P., Halbert S. A. Distal tubal obstruction induced by repeated Chlamydia trachomatis salpingeal infections in pig-tailed macaques. J Infect Dis. 1987 Jun;155(6):1292–1299. doi: 10.1093/infdis/155.6.1292. [DOI] [PubMed] [Google Scholar]
- Pearce J. M. Pelvic inflammatory disease. BMJ. 1990 Apr 28;300(6732):1090–1091. doi: 10.1136/bmj.300.6732.1090. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Phillips R. S., Aronson M. D., Taylor W. C., Safran C. Should tests for Chlamydia trachomatis cervical infection be done during routine gynecologic visits? An analysis of the costs of alternative strategies. Ann Intern Med. 1987 Aug;107(2):188–194. doi: 10.7326/0003-4819-107-2-188. [DOI] [PubMed] [Google Scholar]
- Rahm V. A., Gnarpe H., Odlind V. Chlamydia trachomatis among sexually active teenage girls. Lack of correlation between chlamydial infection, history of the patient and clinical signs of infection. Br J Obstet Gynaecol. 1988 Sep;95(9):916–919. doi: 10.1111/j.1471-0528.1988.tb06580.x. [DOI] [PubMed] [Google Scholar]
- Ridgway G. L., Taylor-Robinson D. Current problems in microbiology: 1. Chlamydial infections: which laboratory test? J Clin Pathol. 1991 Jan;44(1):1–5. doi: 10.1136/jcp.44.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rink E., Hilton S., Szczepura A., Fletcher J., Sibbald B., Davies C., Freeling P., Stilwell J. Impact of introducing near patient testing for standard investigations in general practice. BMJ. 1993 Sep 25;307(6907):775–778. doi: 10.1136/bmj.307.6907.775. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ripa T. Epidemiologic control of genital Chlamydia trachomatis infections. Scand J Infect Dis Suppl. 1990;69:157–167. [PubMed] [Google Scholar]
- Root D. T., Hickner J. M., Nelson T. C. Prevalence and prediction of chlamydial cervical infection in a rural area: an UPRNet project. J Fam Pract. 1991 Oct;33(4):369–374. [PubMed] [Google Scholar]
- Sellors J. W., Pickard L., Gafni A., Goldsmith C. H., Jang D., Mahony J. B., Chernesky M. A. Effectiveness and efficiency of selective vs universal screening for chlamydial infection in sexually active young women. Arch Intern Med. 1992 Sep;152(9):1837–1844. [PubMed] [Google Scholar]
- Smith J. R., Murdoch J., Carrington D., Frew C. E., Dougall A. J., MacKinnon H., Baillie D., Byford D. M., Forrest C. A., Davis J. A. Prevalence of Chlamydia trachomatis infection in women having cervical smear tests. BMJ. 1991 Jan 12;302(6768):82–84. doi: 10.1136/bmj.302.6768.82. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Southgate L. J., Treharne J. D., Forsey T. Chlamydia trachomatis and Neisseria gonorrhoeae infections in women attending inner city general practices. Br Med J (Clin Res Ed) 1983 Sep 24;287(6396):879–881. doi: 10.1136/bmj.287.6396.879. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Southgate L. The diagnosis and management of chlamydial cervicitis: a test of cure. J Fam Pract. 1990 Jul;31(1):33–35. [PubMed] [Google Scholar]
- Southgate L., Treharne J., Williams R. Detection, treatment, and follow up of women with Chlamydia trachomatis infection seeking abortion in inner city general practices. BMJ. 1989 Nov 4;299(6708):1136–1137. doi: 10.1136/bmj.299.6708.1136. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stacey C. M., Munday P. E., Taylor-Robinson D., Thomas B. J., Gilchrist C., Ruck F., Ison C. A., Beard R. W. A longitudinal study of pelvic inflammatory disease. Br J Obstet Gynaecol. 1992 Dec;99(12):994–999. doi: 10.1111/j.1471-0528.1992.tb13705.x. [DOI] [PubMed] [Google Scholar]
- Stacey C., Munday P., Thomas B., Gilchrist C., Taylor-Robinson D., Beard R. Chlamydia trachomatis in the fallopian tubes of women without laparoscopic evidence of salpingitis. Lancet. 1990 Oct 20;336(8721):960–963. doi: 10.1016/0140-6736(90)92418-h. [DOI] [PubMed] [Google Scholar]
- Stergachis A., Scholes D., Heidrich F. E., Sherer D. M., Holmes K. K., Stamm W. E. Selective screening for Chlamydia trachomatis infection in a primary care population of women. Am J Epidemiol. 1993 Aug 1;138(3):143–153. doi: 10.1093/oxfordjournals.aje.a116840. [DOI] [PubMed] [Google Scholar]
- Svensson L. O., Mares I., Olsson S. E., Nordström M. L. Screening for Chlamydia trachomatis infection in women and aspects of the laboratory diagnostics. Acta Obstet Gynecol Scand. 1991;70(7-8):587–590. doi: 10.3109/00016349109007921. [DOI] [PubMed] [Google Scholar]
- Taylor-Robinson D. Chlamydia trachomatis and sexually transmitted disease. BMJ. 1994 Jan 15;308(6922):150–151. doi: 10.1136/bmj.308.6922.150. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Thomas B. J., MacLeod E. J., Taylor-Robinson D. Evaluation of sensitivity of 10 diagnostic assays for Chlamydia trachomatis by use of a simple laboratory procedure. J Clin Pathol. 1993 Oct;46(10):912–914. doi: 10.1136/jcp.46.10.912. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Thompson C., Wallace E. Chlamydia trachomatis. Br J Gen Pract. 1994 Dec;44(389):590–591. [PMC free article] [PubMed] [Google Scholar]
- Trachtenberg A. I., Washington A. E., Halldorson S. A cost-based decision analysis for Chlamydia screening in California family planning clinics. Obstet Gynecol. 1988 Jan;71(1):101–108. [PubMed] [Google Scholar]
- Weinstock H. S., Bolan G. A., Kohn R., Balladares C., Back A., Oliva G. Chlamydia trachomatis infection in women: a need for universal screening in high prevalence populations? Am J Epidemiol. 1992 Jan 1;135(1):41–47. doi: 10.1093/oxfordjournals.aje.a116200. [DOI] [PubMed] [Google Scholar]
- White D., Radcliffe K. Management of chlamydial cervicitis in general practice. Br J Gen Pract. 1991 Oct;41(351):434–435. [PMC free article] [PubMed] [Google Scholar]
- Willard M. A., Edman R. L. Screening for genital chlamydia trachomatis in female patients in a primary care setting. J Fam Pract. 1989 Jan;28(1):97–98. [PubMed] [Google Scholar]