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STDs common in women seeking EC, pregnancy tests.

SANTA FE, N.M. -- Nearly one in five women seeking emergency contraception or urine pregnancy testing in an urban outpatient clinic tested positive for either Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis.

The findings suggest that routine STD screening with noninvasive methods such as urinalysis or vaginal swabs should be considered in this patient population, Dr. Sara Sakamoto said at the meeting.

"Even though routine screening for STDs is advocated by the Centers for Disease Control and Prevention and by the American College of Obstetricians and Gynecologists, based on age and risk factor guidelines, there are still significant barriers to screening," said Dr. Sakamoto of the University of Pittsburgh. "Women may fear the pelvic exam. We know that the majority of STD infections may be asymptomatic, so women may not be prompted to seek care. Once they get to the office, some physicians may not be adhering to standard national guidelines for screening. For every patient that I diagnose with an STD, there are probably two women out there who are not diagnosed. Considering all this, we really need to find new ways to target high-risk groups."

In an effort to determine the prevalence of chlamydia, gonorrhea, and T. vaginalis infections in women seeking emergency contraception or urine pregnancy testing, Dr. Sakamoto and her associates conducted a cross-sectional study of 305 women aged 15 years and older who presented to the Magee-Womens Hospital outpatient clinic between November 2009 and April 2010 specifically for emergency contraception or urine pregnancy testing--a population potentially at increased risk for STD exposure. The investigators excluded patients who had been diagnosed and treated for an STD within 4 weeks of study enrollment.

Patients filled out a questionnaire that ellicited information about demographics, social history, and vaginal symptoms, as well as gynecologic, STD, and sexual history. The residual urine samples from routine pregnancy testing were evaluated for chlamydia and gonorrhea with GenProbe's transcription-mediated amplification testing, while testing for T. vaginalis was conducted with GenProbe's proprietary analyte-specific reagent primers. Study participants were notified of their positive chlamydia and gonorrhea results and were treated accordingly. The local health department was notified of positive results.

Of the 305 patients recruited, 4 were excluded because they had a recent STD and 1 was excluded for a loss of the urine sample, leaving a total of 300 participants with a mean age of 23 years. More than two-thirds (67%) were African American, 24% were white, and the rest were from other ethnic backgrounds. The majority (82%) presented for walk-in pregnancy testing, while 18% presented for emergency contraception. More than three-quarters (81%) were single.

Overall, 55 patients (18.3%) were infected by at least one STD pathogen. There were 28 cases of chlamydia (9.3%), 3 cases of gonorrhea (1.0%), and 32 cases of T. vaginalis (10.7%). Women who tested positive for an STD were more likely to be younger than 21 years of age (24% vs. 13% among those 21 and older) and African American (23% vs. 7% among those from other ethnicities), but infections were not related to reported condom use, having multiple sexual partners, or having a new sexual partner. Only 6% of women who tested positive for an STD reported any vaginal symptoms.

Disclosures: The study was supported by an investigator-initiated grant from GenProbe. Dr. Sakamoto said she had no relevant financial disclosures to make.


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Author:Brunk, Doug
Publication:OB GYN News
Date:Sep 1, 2010
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