Universal antenatal chlamydia screening by rural midwives.

• Jurisdiction: Australia
• Author: Curran, Glen
• Date: 01 February 2012

Chlamydia trachomatis (chlamydia) is Australia's most notified sexually transmissible infection (STI) and is associated with significant adverse events for pregnant women and neonates.

Rural midwives participated in a reflective narrative study to highlight benefits and harms associated with a unique universal antenatal chlamydia screening process.

In 2004, midwives at a rural Tasmanian hospital commenced universal chlamydia screening in antenatal women. During 2008--2009, they collected 999 urine specimens and detected 32 asymptomatic cases of chlamydia, a rate consistent with other Australian data (Chen et al 2009). All 32 antenatal women were treated with oral Azithromycin and re-tested negative in the third trimester, as 11-15% of women can be re-infected three months after treatment (Peterman et al 2006).

Interestingly, two 33 year old women (2/32 positive chlamydia results) were outside the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (2008) protocol to only screen those who may be at increased risk (eg. less than 25 years), and would not have been normally screened.

Background

Genital chlamydia is a bacterial infection with few symptoms and antenatal women can have the infection for years without knowing (Holmes et al 2008). Chlamydia has been linked to infertility and pelvic inflammatory disease (Pimenta et al 2003), ectopic pregnancy (Egger et al 1998), premature rupture of membranes, prematurity, low birth-weight and postpartum endometritis, while infants are at increased risk of conjunctivitis and pneumonia (US Preventive Services Task Force 2007) (USPSTF).

The sociocultural aspects of chlamydia are huge as it is seen as a "dirty girl" disease, synonymous with women of lower class (Henning et al 2007; Kirkham 2007; Piercy 2007). Barriers to chlamydia screening included stigma, guilt, fear, poor knowledge, embarrassment and problems with informing partners (Anthonisz 2009; Cole and Jasiak 2004).

Reflective Narratives

Reflective narratives provided rich descriptive accounts of antenatal midwives (Taylor 2000). From the interviews in the Tasmanian study with midwives, a number of key themes emerged.

Professional silence about chlamydia

One midwife questioned why chlamydia testing was not present in her professional guidelines (Australian College of Midwives 2006, 2008) and she captured this idea as professional silence. I just completed the midwife emergency course run by the Royal College of Nursing and chlamydia did not come up in preventing premature labour.... It is remiss that chlamydia is also not in the Australian College of Midwives notional midwifery guidelines, when it is clearly an issue. We know chlamydia is one cause of premature labour and my question goes back to the ACM national midwifery guidelines, "Why is chlamydia not there? The silent chlamydia!

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Value for money

Anecdotally, midwives identified the benefits of...