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Potential endocervical pathogens before termination.

EDITOR,Mike Cohn and Peter Stewart report the prevalence of potential pathogens in the cervical canal before termination ofpregnancy.' An association between one of these pathogens (Chlamydia trachomatis) and increased morbidity after termination of pregnancy has also been reported.24 We recently conducted an audit of the effect of screening for C trachomatis (MicroTrak, Syva) and treatment in women seeking termination of pregnancy at Taunton and Somerset Hospitals. We studied all women offered termination between January 1990 and June 1991. They were divided into two groups. Those in group 1 (n= 140) had a termination between January 1990 and May 1990, when no screening was done, and those in group 2 (n=306) had a termination between June 1990 and June 1991, when screening was routinely performed before termination. Those in whom C trachomatis was detected were treated postoperatively with doxycycline 100 mg twice daily for 10 days, and instructions for treatment of their sexual partners were given to their general practitioners. C trachomatis was identified in 49 (16 0%) women in group 2. Forty two of these women were single nulliparous women aged 15-24. This represents 45 2% of terminations in this age group. In group 1, 17 (12 1%) patients were readmitted with abdominal pain, vaginal discharge, and fever. C trachomatis was detected in 11 of these patients. Two (0 5%) patients in group 2 were readmitted with fever, lower abdominal pain, and vaginal discharge. C trachomatis was not detected in either, and both responded to clavulanic acid and amoxycillin. The complication rate in group 1 was significantly higher (p<005) than that in group 2. Our findings support those ofCohn and Stewart that C trachomatis is more commonly isolated in single young nulliparous women. The fact that C trachomatis was isolated in only a proportion of our complicated cases also suggests that other pathogens such as Neisseria gonorrhoeae, Mycoplasma hominis, and Ureaplasma urealyticum may be responsible for postoperative infections. We support the suggestion that all women routinely undergoing termination of pregnancy should be screened for potential pathogens. If this is not possible, however, we agree with Cohn and Stewart's suggestion that selective screening of young nulliparous women should be offered.