A randomised comparison of strategies for reducing infective complications of induced abortion

Objectives To determine lower genital tract carriage rates of C. trachomatis, N. gonorrhoeae and bacterial vaginosis among women seeking termination of pregnancy. To compare two clinical management strategies for minimising the risks of infective morbidity after induced abortion. Design Prevalence of infections was assessed by screening women undergoing abortion. Clinical management strategies were compared by a randomised trial. Setting The gynaecology departments of four hospitals in Scotland. Participants 1672 women undergoing induced abortion. Interventions Women randomised to prophylaxis received metronidazole 1 g rectally before abortion plus doxycycline 100 mg twice daily for seven days. Women randomised to screen‐and‐treat received appropriate antibiotics only if screening proved positive for one or more infection. Main outcome measures Prevalences of infections; morbidity in the eight weeks following abortion as assessed by reported symptoms, general practitioner consultation and prescription rates and hospital re‐attendances; costs to the NHS of alternative managements. Results Prevalence rates: C. trachomatis 5.6%; N. gonorrhoeae 0.19%; bacterial vaginosis 17.5%. Overall, women allocated to receive prophylaxis had lower rates of measures of short term infective morbidity than those allocated to screen‐and‐treat. These differences only reached statistical significance for women who were reported negative on screening. The direct costs to the NHS of prophylaxis and screen‐and‐treat were calculated to be £8.17 and £18.34 per woman, respectively. Conclusions Prevalences of lower genital tract infections which have been implicated in increased rates of infective morbidity after abortion are similar to those reported elsewhere. Universal antibiotic prophylaxis is at least as effective as a policy of screen‐and‐treat in minimising the risk of short term infective morbidity and is far more cost efficient.