Prevalence and Determinants of Sexually Transmitted Infections in Women at Risk Undergoing Abortion in a Swiss Primary Care Setting

Abstract

Background: Specific prevalence data are needed to assess the burden of sexually transmitted infections (STIs) in specific settings where data are scant, such as women seeking early termination of pregnancy (TOP). We aimed to investigate the prevalence of STIs and its determinants in women at risk (e.g. pathological cervical swab) undergoing TOP in a primary care setting in Switzerland.Methods: Cross-sectional study of 620 women seeking abortion counselling at a general practice in Zurich, Switzerland.. Patients' characteristics were assessed and in case of pathological cervical swab a PCR-based screening for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG) and Neisseria gonorrhoeae (NG) was initiated to estimate STI prevalence. Bi-and multivariable analysis were used to investigate STI determinants.Results: 585 out of the 620 women presenting for counselling resulted in TOP. 581 (93.7%) cervical specimens were available with 272 having pathological signs (46.8%), thus were considered at risk for STIs. In 192 screened samples 28 STIs (14.6%) (95% CI: 10.3-20.3%) were detected, predominantly CT (17 cases) followed by MG (9 cases) and NG (2 cases).Compared to non-immigrants, immigrants were more likely to have a STI (adjusted OR 2.63; p=0.037) Non-screened women were significantly more often self-payers (31.3%) compared to screened women (8.3%) (p<0.001). Conclusion:We found a high STI prevalence in women presenting for TOP in a Swiss primary care setting. Women with a migration background seemed to be a vulnerable subgroup. Public health efforts are needed to implement cost-effective screening and case management programs in this population at risk for STIs. 2 Ü1 Abbreviations Ü1 IntroductionSexually transmitted infections (STI) are among the most common causes of illness in the world and have far-reaching health, social and economic consequences for many countries.Chlamydia trachomatis (CT), Mycoplasma genitalium (MG) and Neisseria gonorrhoeae (NG) are considered being common sexually transmitted pathogens and can cause genitourinary infections with a wide range of symptoms; in women MG and NG can cause cervicitis, urethritis and endometritis (1-5). The causal connection of MG with salpingitis as well as potentially resulting infertility remains controversial, whereas CT and NG are known to cause salpingitis and have an impact on infertility (1, 4,(6)(7)(8)(9)(10)). An untreated CT infection can also lead to peritonitis, perihepatitis, pelvic inflammatory disease (PID) and ectopic pregnancy (EP) (4, 6, 7). Genital CT and NG infections are asymptomatic or just show mild symptoms in up to 70% and 50% of cases, respectively (4, 11). As a consequence, these infections often remain undetected thus abetting further transmission. Similarly, asymptomatic MG infections have also been described, raising the question whether also asymptomatic subgroups, such as women presenting for early termination of pregnancy (TOP), should be screened for MG (12, 13).International prevalence rates of STIs vary, depe...

Frequency of Chlamydia trachomatis, Mycoplasma genitalium, and Ureaplasma urealyticum Isolated From Vaginal Samples of Women in Kerman, Iran

“…In Iran (Tehran) and Iraq, the rates of 13.25% and 6.4% have been reported, respectively (9, 22). Our result is similar to the reported case from Swiss and higher than those reported from Iran (19).…”

“…for these bacteria are reported. For example, the frequencies of C. trachomatis among women with TOP in Swiss, Sweden, New Zealand, and Poland were 16.37%, 5.4%, 15.7%, and 32%, respectively (16,(19)(20)(21). In Iran (Tehran) and Iraq, the rates of 13.25% and 6.4% have been reported, respectively (9, 22).…”

Der Schwangerschaftsabbruch und sein Stellenwert in der medizinischen Versorgung

“…Bei allen Schwangeren wäre eigentlich eine vollständige STI-Abklärung inklusive HIV-Screening angebracht. In unserer eigenen Praxis wurden bei den für einen SA v oruntersuchten Frauen in 9 % Chlamydia trachomatis [15] und 1 % Neisseria Gonorrhoeae gefunden. Gerade bei besonders vulnerablen Frauen konnten weitere STI-Abklärungen oft nicht durchgeführt werden, unter anderem wegen Finanzierungsschwierigkeiten.…”