and prevalence and associated factors among women presenting to a pregnancy termination and contraception clinic, 2009-2019.

Background: Risk of pelvic inflammatory disease associated with and is increased after termination of pregnancy (TOP) and may be increased after insertion of intrauterine devices (IUDs). Screening prior to these procedures is recommended only for . We examined and prevalence and associated factors among women presenting to a pregnancy termination and contraception service over 10 years.

Methods: Retrospective analysis of clinical data collected from 17 573 women aged 15-45 years in 2009-2019 and for 266 . positive women tested for macrolide resistance-associated mutations in 2016-2019.

Results: and prevalence was 3.7% and 3.4%, respectively. In multivariable analyses, shared risk factors were younger age (p<0.001, for both and ), socioeconomic disadvantage (p=0.045 and p=0.008, respectively) and coinfection (p<0.001, for both sexually transmitted infections), with 10.1% of positive women also positive for . Additional risk factors were earlier year of visit (p=0.001) for and for residing outside a major city (p=0.013). The proportion of infections tested between 2016 and 2019 with macrolide resistance-associated mutations was 32.7%.

Conclusions: Given the high level of antimicrobial resistance and the prevalence of coinfection, testing positive women for could be considered in this setting to prevent further spread of resistant infections. Further research is required into the causal link between and pelvic inflammatory disease in women undergoing TOP and IUD insertion.