Prevalence of Chlamydial Infection in Females Attending Antenatal and Family Planning Clinics in Karachi Pakistan

EDITORIAL COMMENT: We accepted this paper from Pakistan to remind readers that the prevalence of Chlamydia trachomatis infection may be sufficiently great to warrant routine screening even in asymptomatic women such as those attending antenatal clinics and especially those who attend family planning or infertility clinics. The need to screen for infection depends upon the importance of the disease detected to the individual and the community, the prevalence of the disease, and the reliability and cost of the methods available for detection. In this study the prevalence of chlamydial infection in asymptomatic antenatal patients was 2% and was not related to socioeconomic class as defined: in women attending a family planning clinic the rate was 6 times greater as 12% tested positive. In a recent study of 478 unselected patients undergoing pelvic examinations as pan of routine care in Alabama, USA, during a prenatal visit, the prevalence of genitourinary Chlamydia trachomatis infection was 6.1% by cervical culture, 18.2% by ligase chain reaction of cervical swabs and 16.9% by ligase chain reaction of urine (A). This paper compared the sensitivity and specificity of a ligase chain reaction assay of cervical swabs and voided urine with those of cervical swab culture for the detection of genitourinary tract infection with Chlamydia trachomatis in pregnant women. We contacted the directors of 3 large infertility clinics associated with University Hospitals in Melbourne and were informed that in none of them was it routine practice to screen new patients for evidence of genital or urinary tract infections with Chlamydia trachomatis. Moreover women were not tested for this infection before embarking upon GIFT or in vitro fertilization: embryo transfer treatment regimens in any of these centres although this was planned when better technology for testing became available. At the Mercy Hospital for Women routine testing for Chlamydia trachomatis was formerly performed at the colposcopy clinic but was discontinued because so few women tested positive.(A).  Andrews WW. Lee HH, Roden WJ, Mott CW. Detection of Genitourinary Tract Chlamydia trachomatis Infection in Pregnant Women by Ligase Chain Reaction Assay. Ohstel Gynecol 1997: 89: 556–560.Summary: A prospective study was undertaken to investigate the relative prevalence of Chlamydia trachomatis in asymptomatic pregnant women of 2 socioeconomic groups and those attending the family planning clinics. Group I consisted of women attending the antenatal clinics of the Aga Khan University Hospital which caters to the affluent strata of our society (n=100). Group 2 comprised women attending the antenatal clinics of Lady Dufferin Hospital which provides free obstetric care to women belonging to the lower socioeconomic groups of Karachi (n=100). Group 3 consisted of sexually active women attending the family planning clinics of Lady Dufferin Hospital (n=100). Endocervical swabs were taken from women assigned to each group. Chlamydiazyme. an enzyme linked immunoassay, was used to detect chlamydia antigen. The positive samples were retested by using the direct fluorescent monoclonal antibody technique. Chlamydia positive patients and their sexual partners were treated with Erythromycin stearate 500 mg 8‐hourly for 7 days. These patients were retested after antibiotic therapy to assess the efficacy of the therapy. In groups 1 and 2, 2% and in Group 3, 12% of the females tested positive. Selective screening of sexually active women for chlamydial infection is advocated as a cost‐effective public health measure.