Background: The American College of Obstetricians and Gynecologists recommends prophylactic antibiotics for elective abortions to prevent post-surgical complications from STDs. However, the impact of this recommendation in preventing adverse outcomes depends on the prevalence of STDs in the patient population. Current STD prevalence among women who seek elective abortions in the United States is unknown. We analyzed laboratory testing data to estimate the positivity of chlamydia tests among women who had elective abortions.
Methods: Among women aged 15-44 years who had a chlamydia test performed by a large U.S. commercial laboratory between June 2008 and July 2010, we identified those who had an elective abortion using the International Classification of Diseases, 9th revision (ICD-9) codes (635.xx). Among women seeking an elective abortion who had a chlamydia test, we estimated the positivity by age.
Results: Of 2.3 million women who had a chlamydia test, 3,637 (0.2%) had elective abortion services. Of these 3,637 women, 21.1% were aged 15-19 years, 34.7% aged 20-24 years, 23.7% aged 25-29 years, and 12.7% aged 30-34 years. Overall, chlamydia positivity was 6.0%, and significantly decreased by age (8.5% in 15-19 year olds, 7.8% in 20-24 year olds, 4.8% in 25-29 year olds, 2.8% in 30-34 year olds, and 0.3% in 35-44 year olds (p<0.05)).
Conclusions: Prophylactic antibiotics in women undergoing an elective abortion might not be appropriate for all women. It is important to periodically assess data to update recommendations. Because overuse of antibiotics may lead to microbial resistance, prophylactic regimens might not be the best STD management strategies. Future point-of-care tests may make prophylactic regimens unnecessary, as well. Studies are needed to compare the cost-effectiveness of possible STD management strategies: 1) universal treatment without screening (the current strategy); 2) selective screening and treatment; and 3) universal screening and treatment.