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In Nottingham all women undergoing a termination of pregnancy (TOP) through the NHS sector are screened for Chlamydia trachomatis and Neisseria gonorrhoeae and receive preoperative antichlamydial prophylaxis. Nottingham has a high level of both chlamydial and gonococcal infection, hence the need to include dual screening.
In order to maximise service capacity and provide sufficient access for women requesting a TOP some procedures are contracted out to external services such as the British Pregnancy Advisory Service (BPAS). Hence, we read with interest the paper by Mallinson and colleagues.1
In our service, to ensure that all patients receive a standard level of care, C trachomatis and N gonorrhoeae screening pre-TOP has been incorporated into the local NHS contract with BPAS. The screening is by nucleic acid amplification from a urine sample. A protocol for referring positive results to the local genitourinary medicine (GUM) clinic with the patient’s permission is incorporated into the programme to allow follow up and partner notification.
Mallinson et al report that only 35% of women would have screening for C trachomatis if they had to pay a supplementary charge for the test, even if this was low, at 20, compared to the private cost of a TOP.
Identification and treatment of genital infection is key to good sexual health and although prophylactic antibiotic therapy will protect against immediate complications of the operative procedure it will not allow for contact tracing and avoidance of re-acquisition, nor will it deal with the community pool of infection.2 For areas with a high prevalence of N gonorrhoeae infection additional screening should be considered.
We believe that all services offering TOP, whether NHS or privately funded, should have screening, treatment, and a contact tracing plan incorporated into the procedure. The costs of screening should be included in the package and not be an optional extra. This is particularly important for women who, at a vulnerable time, may not be aware of the wider health benefits of screening.