Dr Ayman Ewies - Colposcopy and STI Survey
- 1. Women attending colposcopy are not at increased risk of sexually transmitted infections: a cross sectional survey Background Objectives and Methods The NHS cancer screening programme (NHSCSP)• guidelines for practice in colposcopy (2004) state that there is no indication to routinely test for Chlamydia and other infections in asymptomatic patients when attending colposcopy However, there is suggestion that patients attending• colposcopy unit should be screened for Chlamydia and gonorrhoea prior to colposcopy to minimize post- biopsy pelvic infection (Harel Z,Riggs S. On the need to screen for Chlamydia and gonorrhoea infections prior to colposcopy in adolescents. J Adolesc Health 1997;27:87-90) Within UK C. Trachomatis is a well established cause• of PID. It is also the most common curable sexually transmitted infection 60-80% of infected women will be asymptomatic,• therefore a high number of cases are never diagnosed 2 The numbers of reported cases are increasing (www.• phls.co.uk) In 1998 in many centres in UK routine screening for• C. Trachomatis was introduced for all new colposcopy patients 3 Objectives:• To establish the prevalence of STI within the colposcopy clinic population in order to find out whether implementing a “routine screening policy” is required. Should the referral to GUM be part of the colposcopy clinics policy. Patients and Methods:• Prospective survey of 146 women attended the colposcopy clinic at The Ipswich Hospital NHS Trust from Aug 2006 to January 2007. Women filled in, anonymously, a specially designed questionnaire and participation was voluntary. Dr Fidan ISRAFILBAYLI (UK) Mr Ayman EWIES (UK) Authors: Hospital Protocols There is no current protocol regarding routine• screening for Chlamydia in Colposcopy clinic in Ipswich, UK. Usually patients with inadequate smears and those• with symptoms and signs suggestive of Chlamydial infection are tested for C. Trachomatis in our colposcopy unit. The Chlamydia infection rate in one of the biggest• studies was 3.4% in colposcopy patients, 6.28% in the under 26 years group (total1135 patients) 4 • No protocol exists between departments of GUM• &Gynaecology regarding quick and direct referral to GUM clinic Chlamydia (+) results are sent to GUM irrespective• of collection point. 4 TAYAL, S. An Audit of Chlamydia Screening in coposcopy, International Journal of STD&AIDS, 2005 Conclusion This survey revealed that women attending colposcopy clinic are not at higher risk than normal population to have STI. Our data support the recommendation of The NHS cancer screening programme (NHSCSP) guidelines for practice in colposcopy (2004) that there is no indication to routinely test for Chlamydia and other infections in asymptomatic patients when attending colposcopy. Reasons for Referral PreviouslyScreenedforChlamydia Sexual Partners (last 6 months) Age of Sexual Debut Use of condom….. Screening asymptomatic women not men for Chlamydia is the most cost effective option (Department of Health,• 1998) The cultural and social implications of screening for STIs, especially when screening is specific to one sex, are far from clear• 5 2 major factors have been identified- the perceived link between cervical abnormalities and sexual activity and the• privileged position of men’s sexual behaviour when compared to women. Woman with (+) cervical smears report feelings of contamination which impact on sexual functioning• 6 5 Duncan, B. Sexuality & Health: Hidden cost of screening for Chlamydia, BMJ, 1999 6 Hynie, M & LYDON JE. Women’s perception of female contraception behaviour - experimental evidence of double standard. Psycol Wom Q, 1985 Impact of Cervical screening Sexual Partners (last 6 months)