Chlamydia screening and prophylactic treatment in termination of pregnancy clinics in the Netherlands and Great Britain: a qualitative study

Abstract

Background: Women having a termination of pregnancy (TOP) have higher rates of Chlamydia trachomatis (CT) than the general population. In this study, we explored CT treatment and prevention in Dutch TOP clinics in comparison to that provided in Great Britain (GB).

Methods: A qualitative study including 14 semi-structured interviews with health care professionals (HCPs) in TOP clinics (the Netherlands: 9, GB: 5). Interviews were recorded, transcribed, and analysed by thematic content analysis.

Results: Prophylactic treatment with azithromycin is routinely prescribed after surgical TOP, but not after medical TOP (‘abortion pill’). Sexually transmitted infections (STI) tests are offered to clients who are considered at high risk of having STI. Uptake varies according to health insurance coverage of STI testing. Some Dutch clinics are able to provide free testing for women under 25 years of age. Sexual health counselling is often limited to discussing birth control. The major difference between the Netherlands and GB is that GB TOP clinics more often offer free STI testing and prophylaxis to their clients.

Conclusion: HCPs in Dutch TOP clinics consider STI testing an important part of their service, but financial barriers prevent testing on location. Dutch TOP clinics should offer STI tests to all women, and collaboration with public health services could improve STI testing and counselling for young people. Furthermore, clinics should treat all TOP clients with prophylactic azithromycin. This could prevent CT and other upper genital tract post-abortion infections.

Chinese abstract

背景: 选择终止妊娠的妇女 (TOP) 比一般人群具有更高的沙眼衣原体 (CT) 感染率。在本研究中, 我们探讨了在荷兰的TOP诊所里CT的治疗和预防, 并与英国 (GB) 提供的数据相比较。

方法: 定性研究。包括对TOP诊所的医疗保健专业人员 (HCPs) 的14个半结构化访谈 (荷兰: 9个, GB: 5个) 。通过专题内容分析记录, 转录和分析访谈。

结果: 通常在人工流产手术后给予阿奇霉素的预防性治疗, 但药物流产后并不常规给予。仅仅对性传播感染 (STI) 的高危人群进行STI的筛查。摄入量根据STI测试的健康保险覆盖率而有所不同。荷兰的一些诊所能够为25岁以下的妇女提供免费检测。性健康咨询通常限于讨论生育控制。荷兰和GB之间的主要区别是, GB的TOP诊所更经常向其客户提供免费的STI检测和预防。

结论: 荷兰TOP诊所的医疗保健专业人员们 (HCPs) 认为STI检测是他们服务的一个重要部分, 但明显受限于财务障碍。荷兰TOP诊所应该向所有妇女提供性传播疾病感染的检测, 与公共卫生服务机构合作可以改善对青少年的性传播感染检测和疾病咨询。此外, 诊所应该用预防性使用阿奇霉素治疗所有TOP客户, 这可以防止CT和其他上生殖道流产后感染。

Keywords:

• STI
• Netherlands
• Great Britain
• abortion clinics
• termination of pregnancy
• Chlamydia trachomatis

Note

Acknowledgements

The authors would like to thank Birgit van Benthem, Silke David, and Marianne van der Sande from the RIVM for helpful discussions and reading of the manuscript. Furthermore, we thank all participating health care professionals from the Dutch and GB termination of pregnancy clinics.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Notes

1. AWBZ: Algemene wet bijzondere ziektenkosten (The Exceptional Medical Expenses Act); a national insurance that covers medical risks that are not covered by personal health insurance. Anyone who lives or works in the Netherlands has insurance and is entitled to reimbursement of AWBZ care, which is paid for by the tax authorities.