Re-audit of referral compliance of chlamydia-positive women from a family planning clinic.

BACKGROUND: Chlamydia infections represent a major public health problem, with a prevalence of 6-10% in family planning clinic (FPC) attendees. There has been recent concern expressed about the management of these patients in terms of treatment and follow-up. OBJECTIVE: An audit was carried out to monitor referral compliance and outcome with care pathways of women attending our FPC who were found to be positive for chlamydia. SETTING: The Palatine Centre FPC and genitourinary medicine (GUM) clinics in Manchester, UK. DESIGN: Analysis of case notes was undertaken of women who tested positive for chlamydia between 1 January 2000 and 31 December 2000. RESULTS: Of the 1935 women who were tested for chlamydia, 5.1% (n = 99) were positive. The age range was 15-41 (mean, 25) years. Treatment was verified in 90% (n = 89) of cases, of which 85% (n = 84) attended a GUM clinic. Despite reasonable efforts, information on outcome was not obtainable for 10 women. The median time between referral and treatment was 5-6 days. Sexual contacts were traced in 57% (n = 56) of cases. CONCLUSIONS: We found our referral compliance and treatment rates to be excellent, demonstrating that GUM and family planning services can work well in partnership from different locations. However, this audit has shown low performance in partner notification and we recommend that more effort be directed to this aspect.

Coil or intrauterine device? Patient preferences for contraceptive terminology.

OBJECTIVE: To discover what terminology women prefer to use when referring to contraceptive methods and to investigate the understanding of and ideas associated with contraceptive names. DESIGN: A self-administered questionnaire was answered by 191 new patients at family planning clinics (FPCs). Women were asked if they understood the terms used by the fpa (Family Planning Association), if they knew of any alternatives and, if so, which they preferred. SETTING: Selected FPCs across the city of Manchester. RESULTS: Patients preferred to use familiar terms, e.g. pill, mini-pill, coil and morning-after pill. There was no difference in preference when the results were compared by age or educational level. A greater proportion of non-Caucasians than Caucasians preferred the precise (fpa) terms. Although precise terms were not widely known or understood, when used they were associated with more information than were the familiar terms. CONCLUSION: All FPC staff should evaluate the language used by individual patients and, where appropriate, introduce precise terminology to help patients to make informed, appropriate choices.

Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomised trial.

BACKGROUND: A single 10 mg dose of mifepristone, and two 0.75 mg doses of levonorgestrel 12 h apart, are effective for emergency contraception. Because no studies had compared the efficacies of both compounds, or investigated a single dose of 1.5 mg levonorgestrel, we undertook this three-arm trial. METHODS: We did a randomised, double-blind trial in 15 family-planning clinics in 10 countries. We randomly assigned 4136 healthy women with regular menstrual cycles, who requested emergency contraception within 120 h of one unprotected coitus, to one of three regimens: 10 mg single-dose mifepristone; 1.5 mg single-dose levonorgestrel; or two doses of 0.75 mg levonorgestrel given 12 h apart. The primary outcome was unintended pregnancy; other outcomes were side-effects and timing of next menstruation. Analysis was by intention to treat, but we did exclude some patients from the final analyses. FINDINGS: Of 4071 women with known outcome, pregnancy rates were 1.5% (21/1359) in those given mifepristone, 1.5% (20/1356) in those assigned single-dose levonorgestrel, and 1.8% (24/1356) in women assigned two-dose levonorgestrel. These proportions did not differ significantly (p=0.83). The relative risk of pregnancy for single-dose levonorgestrel compared with two-dose levonorgestrel was 0.83 (95% CI 0.46-1.50), and that for levonorgestrel (the two regimens combined) compared with mifepristone, 1.05 (0.63-1.76). Side-effects were mild and did not differ greatly between groups, and most women menstruated within 2 days of the expected date. Women who took levonorgestrel had earlier menses than did those who took mifepristone. INTERPRETATION: The three regimens studied are very efficacious for emergency contraception and prevent a high proportion of pregnancies if taken within 5 days of unprotected coitus. Mifepristone and levonorgestrel do not differ in efficacy. A 1.5 mg single levonorgestrel dose can substitute two 0.75 mg doses 12 h apart.