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Evaluation of endocervical, first-void urine and self-administered vulval swabs for the detection of Chlamydia trachomatis in a miscarriage population.

Logan S, Browne J, McKenzie H, Templeton A, Bhattacharya S

Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Foresterhill, UK.

OBJECTIVE: To compare, in parallel, different approaches of opportunistically screening women with bleeding in early pregnancy for Chlamydia trachomatis. DESIGN: Prospective observational [corrected] study. SETTING: Early pregnancy assessment unit, University hospital, Scotland, UK. POPULATION: Over 200 consecutive women admitted to an early pregnancy assessment unit were recruited. All had a positive pregnancy test, a history of vaginal bleeding and were less than 24 weeks of gestation. Women with recent antibiotic use, heavy vaginal bleeding and cervical shock excluded. METHODS: Each women provided two or more of the following specimens: a self-administered vulval swab, first-void urine and/or endocervical swab. Following screening, each completed a semi-structured questionnaire assessing the acceptability of each method undertaken. MAIN OUTCOME MEASURE: Subjective rating of the screening methods; prevalence; method performance, including proportion requiring repeat testing. RESULTS: The majority accepted screening, with moderate prevalence rates (95% CI) 3.9% (2.0-7.4%) identified. All positive women were less than 30 years of age. Parallel screening exposed the potential of reduced test performance with urine. Non-invasive sampling was more acceptable, but more likely to require repeat testing. CONCLUSION: Both acceptability and the effect of bleeding on test performance need further assessment before a particular specimen can be recommended for screening this population of women for C. trachomatis.

Published 24 January 2005 in BJOG, 112(1): 103-6.
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