full article:Dear Editor
We would like to draw your readers' attention to the issue of asymptomatic sexually transmitted infection (STI) in women in rural communities. We can report the results of a small study looking at the feasibility of a rural practice-based preventative approach to this important problem.
Chlamydia trachomatis is a common STI1. If the condition is left untreated, it can lead to pelvic inflammatory disease, infertility, ectopic pregnancy, secondary STIs and other complications2. Chlamydia infection is often asymptomatic until serious complications have developed2. A recent study by Ward, Rodger and Jackson has shown that opportunistic screening for this infection could potentially lead to significant healthcare cost savings3. Chlamydia trachomatis can be detected either by a urine test with ligase chain reaction (LCR) assays or polymerase chain reaction (PCR) assays from an endocervical swab. Treatment is usually simple and effective with azithromycin2.
We decided to investigate the prevalence of Chlamydia infection among young women in a Victorian costal town, who presented to a small rural practice for Papanicolaou smear check. We chose PCR, using an endocervical swab, to analyze for Chlamydia infection. Although urine sample analyzed by LCR has a high sensitivity and acceptable specificity, PCR shows less deterioration of the specimen with transportation delay - an important issue for rural clinicians.
Patients who presented to the clinic for a Papanicolaou smear check were invited to participate. Appropriate consultation was conducted and verbal consent obtained. Selection criteria included sexually active women aged 15-35 years, in a current sexual relationship of 12 months or less, presenting for Papanicolaou smear check. Patients excluded from this study were those with previous gynaecological conditions, not giving their consent for the test, and patients symptomatic of STIs.
In all, 67 patients fulfilled the study criteria and were included in our study. Nine were identified as having Chlamydia trachomatis infection, an incidence of 13%. The affected patients were aged between 19 and 25 years with a mean age of 20.5 years. This prevalence rate was similar to a previous study in the UK4 which shared similar socio-economic and demographic status with our region.
The patients were counseled and treated appropriately. A repeat test one month later showed seven patients were clear of infection and two did not return for follow up.
Contact tracing and treatment of sexual partners was a difficult task. Only three patients were willing to comply. Of the three, two had only a vague idea of their previous sexual partners. The other six patients refused to comply and information was forwarded to the Health Department.
Our study, being based in a single rural practice, could only recruit a small number of patients. Nevertheless our findings should alert rural doctors to the high prevalence and importance of this STI, and to the practicability of undertaking a practice-based screening approach to early detection and treatment.
David TW Chiang
Princess Alexandra Hospital
Brisbane, Queensland, Australia
Elaine EL Tan
Brisbane, Queensland, Australia
Warrnambool, Victoria, Australia
1. Hocking J, Fairley CK. Do the characteristics of sexual health centre clients predict chlamydia infection sufficiently strongly to allow selective screening? Sex Health 2005; 2: 185-192.
2. Dayan L. Chlamydia detection and management. Australian Family Physician 2000; 29: 522-526.
3. Ward B, Rodger AJ, Jackson TJ. Modelling the impact of opportunistic screening on the sequelae and public healthcare costs of infection with Chlamydia trachomatis in Australian women. Public Health 2006; 120: 42-49.
4. Tobin C, Aggarwal R, Clarke J, Chown R, King D. Chlamydia trachomatis: opportunistic screening in primary care. British Journal of General Practice 2001; 51(468): 565-566.