This document discusses a cross-sectional survey that was conducted to determine the prevalence of sexually transmitted infections (STIs) among women attending colposcopy clinics in order to inform screening policies. The survey found that the women attending colposcopy were not at higher risk of STIs than the general population. Current NHS guidelines state that asymptomatic patients do not need routine STI screening during colposcopy visits. The survey results support these guidelines and suggest that universal STI screening is not required for colposcopy patients.

1. Women attending colposcopy are not
at increased risk of sexually transmitted
infections: a cross sectional survey
Background
Objectives and Methods
The NHS cancer screening programme (NHSCSP)•
guidelines for practice in colposcopy (2004) state that
there is no indication to routinely test for Chlamydia
and other infections in asymptomatic patients when
attending colposcopy
However, there is suggestion that patients attending•
colposcopy unit should be screened for Chlamydia and
gonorrhoea prior to colposcopy to minimize post-
biopsy pelvic infection (Harel Z,Riggs S. On the need
to screen for Chlamydia and gonorrhoea infections
prior to colposcopy in adolescents. J Adolesc Health
1997;27:87-90)
Within UK C. Trachomatis is a well established cause•
of PID. It is also the most common curable sexually
transmitted infection
60-80% of infected women will be asymptomatic,•
therefore a high number of cases are never diagnosed
2
The numbers of reported cases are increasing (www.•
phls.co.uk)
In 1998 in many centres in UK routine screening for•
C. Trachomatis was introduced for all new colposcopy
patients 3
Objectives:•
To establish the prevalence of STI within the colposcopy
clinic population in order to find out whether
implementing a “routine screening policy” is required.
Should the referral to GUM be part of the colposcopy
clinics policy.
Patients and Methods:•
Prospective survey of 146 women attended the
colposcopy clinic at The Ipswich Hospital NHS Trust
from Aug 2006 to January 2007. Women filled in,
anonymously, a specially designed questionnaire and
participation was voluntary.
Dr Fidan ISRAFILBAYLI (UK)
Mr Ayman EWIES (UK)
Authors:
Hospital Protocols
There is no current protocol regarding routine•
screening for Chlamydia in Colposcopy clinic in
Ipswich, UK.
Usually patients with inadequate smears and those•
with symptoms and signs suggestive of Chlamydial
infection are tested for C. Trachomatis in our
colposcopy unit.
The Chlamydia infection rate in one of the biggest•
studies was 3.4% in colposcopy patients, 6.28% in
the under 26 years group (total1135 patients) 4
•
No protocol exists between departments of GUM•
&Gynaecology regarding quick and direct referral to
GUM clinic
Chlamydia (+) results are sent to GUM irrespective•
of collection point.
4 TAYAL, S. An Audit of Chlamydia Screening in coposcopy, International Journal of
STD&AIDS, 2005
Conclusion
This survey revealed that women attending colposcopy
clinic are not at higher risk than normal population
to have STI. Our data support the recommendation
of The NHS cancer screening programme (NHSCSP)
guidelines for practice in colposcopy (2004) that
there is no indication to routinely test for Chlamydia
and other infections in asymptomatic patients when
attending colposcopy.
Reasons for Referral
PreviouslyScreenedforChlamydia
Sexual Partners (last 6 months)
Age of Sexual Debut
Use of condom….. Screening asymptomatic women not men for Chlamydia is the most cost effective option (Department of Health,•
1998)
The cultural and social implications of screening for STIs, especially when screening is specific to one sex, are far from clear• 5
2 major factors have been identified- the perceived link between cervical abnormalities and sexual activity and the•
privileged position of men’s sexual behaviour when compared to women. Woman with (+) cervical smears report
feelings of contamination which impact on sexual functioning• 6
5
Duncan, B. Sexuality & Health: Hidden cost of screening for Chlamydia, BMJ, 1999
6
Hynie, M & LYDON JE. Women’s perception of female contraception behaviour - experimental evidence of double standard. Psycol Wom Q, 1985
Impact of Cervical screening
Sexual Partners (last 6 months)