Objective: To determine the outcome of cytologic screening compared to screening for gonorrhea and chlamydia in an indigent population seeking abortion. Methods: Results of screening for cytology, chlamydia, and gonorrhea were tabulated for women seeking abortion at Boston Medical Center during 1998 and 1999. Results: During the 2-year period, there were 2614 abortions. 2537 were outpatient procedures performed at 5-17 menstrual weeks. 77 were induction procedures at 17-20 weeks. There were 24 women with high-grade squamous intraepithelial lesions (HGSIL, 0.9%) and 91 women with low-grade squamous intraepithelial lesions (LGSIL, 3.5%), for an overall rate of SIL of 4.4%. The obstetrics and gynecology clinics overall had a rate of HGSIL of 1.5% and of LGSIL, 4.8%. During the 2-year period, chlamydia incidence among abortion patients decline from 6.3% to 4.3%. Gonorrhea rates declined from 0.6% to 0.2% and routing screening was subsequently discontinued. The number (and rate) of SIL increased slightly fron 51 in 1998 to 64 in 1999. Conclusions: The incidence of SIL, particularly HGSIL, in high in our inner-city population. Abortion patients are not spared. The rate of SIL is now higher than the rate of "traditional" sexually transmitted diseases in our population. In many localities, abortion services are disconnected from obstetrical, gynecological, or public health services for indigent women, and may forego cytologic screening to control costs. In a fragmented system, low-income women who choose abortion may not be able to access screening, although they are at high risk for SIL.
Learning Objectives: 1. The participant will be able to identify local trends in cytologic abnomalities and STI incidence among abortion patients. 2. The participant will be able to reassess screening priorities for abortion patients. 3. The participant will recognize some of the implications of fragmentation of care for abortion patients
Keywords: Abortion,
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: none
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.