Reproductive tract infections in women seeking abortion in Vietnam

Abstract

BackgroundWomen requesting abortion are at increased risk of developing RTI complications. However, RTI control in many resource-poor countries including Vietnam have been faced with logistical and methodological problems due to lack of standardized definitions of RTIs, lack of well-validated diagnostic criteria, lack of accurate laboratory tests, and lack of diagnostic equipment and skills. This article investigates the prevalence of RTIs among Vietnamese abortion-seeking women, to evaluate the available diagnostic techniques, and to assess antibiotic resistance among aetiological agents of RTI.MethodThe study was conducted in Phu-San hospital (PSH) from December 2003 through April 2004 among 748 abortion clients. A structured questionnaire was used to collect data on socio-economic and reproductive characteristics. Specimens were collected for laboratory analyses of chlamydia, gonorrhoea, trichomoniasis, vaginal candidiasis (VC), bacterial vaginosis (BV) and syphilis. To assess the validity of the obtained results, the study was repeated among 100 women and the duplicate samples were analysed at PSH and Copenhagen University Hospital (CUH).ResultsIn all 54% of the women were diagnosed as having an RTI, including 3.3% with sexually transmitted infections. Endogenous infections were most prevalent (VC 34% and BV 12%) followed by chlamydia (1.3%) and trichomoniasis (0.7%). The sensitivity of culture for VC and BV was 30% and 88%, respectively, when tests in PSH were measured against tests in CUH. Antibiotic resistance was common among bacterial isolates.ConclusionRTIs are common among women seeking abortion. The presence of RTIs is associated with an increased risk of developing iatrogenic infections, routine administration of prophylactic antibiotic to all women undergoing abortion should be considered. However, the choice of routine prophylactic antibiotics should be based on relevant surveillance data of antibiotic resistance. Moreover, since the accuracy of diagnosis is doubtful and to address the problem of under-diagnosed and treated RTIs new investment in diagnostic facilities with simple performed microscopy or improved rapid tests should also be taken into consideration.

Risk of having a sexually transmitted infection in women presenting at a termination of pregnancy clinic in Pretoria, South Africa

“…For trichomoniasis, the trend is similar, in that we found a 12.5% infection rate compared with the 0.3-3.3% from the other studies (Mallinson et al 2002;Rose et al 2005 andHng et al 2009), including 0.5% reported in the antenatal study from Tanzania. However, when comparing the infection rates between these studies one must be cognisant of the different diagnostic methodologies used in each of the studies (Table II).…”

“…For gonococcal infection, the findings of the 4.5% in our study is much higher than the 0-1% reported by the other studies (Mallinson et al 2002;Rose et al 2005;Hng et al 2009;Msuya et al 2009). For trichomoniasis, the trend is similar, in that we found a 12.5% infection rate compared with the 0.3-3.3% from the other studies (Mallinson et al 2002;Rose et al 2005 andHng et al 2009), including 0.5% reported in the antenatal study from Tanzania.…”

“…The commonest organism isolated was C. trachomatis (14.0%), which is much higher than the 8% reported from other countries, i.e. the UK (Mallinson et al 2002), New Zealand (Rose et al 2005) and 1% from Vietnam (Hng et al 2009). A recent study in pregnant women in Tanzania (Msuya et al 2009) reported a 17.5% infection rate, which is similar to the findings of our study.…”

“…the UK, New Zealand and Norway, have made recommendations for the routine screening of sexually transmitted infections (STIs) in women presenting for termination of pregnancy (Blackwell et al 1993;Skjeldestad et al 1988;Rose et al 2005). Women presenting for TOP are at an increased risk of having STIs and therefore screening is recommended to prevent post-abortion infections (Hng et al 2009). STI screening also offers an opportunity to treat infections to prevent serious complications such as ectopic pregnancy (Scholes et al 1996) and pelvic inflammatory disease (Westrom et al 1992;Hillis et al 1993;Mardh 2002), which leads to infertility.…”

“…There are only a few published studies that have reported screening for STIs and especially for chlamydial infection in females presenting for TOP (Mallinson et al 2002;Rose et al 2005;Hng et al 2009). However, in a high HIV prevalence country such as South Africa, no studies have been published.…”