Check pregnant women for chlamydia, gonorrhea
Check pregnant women for chlamydia, gonorrhea
If your practice includes care of pregnant women, be sure they are being tested for chlamydia and gonorrhea. Results of a new national analysis of laboratory tests of 1.3 million pregnant women indicate just 59% and 57% of pregnant women were tested at least once for chlamydia and gonorrhea, respectively.1
The analysis, conducted by scientists at Quest Diagnostics of Madison, NJ, and Rutgers University of New Brunswick, NJ, examined de-identified results of 1.3 million pregnant women between ages 16-40 who were tested by Quest Diagnostics between 2005 and 2008.
Sexually transmitted infections (STIs) caused by C. trachomatis or N. gonorrhoeae are of special concern in pregnancy. Women with untreated infection can develop pelvic inflammatory disease (PID), which, in turn, can lead to ectopic pregnancy. Chlamydia and gonorrhea also can result in adverse outcomes of pregnancy, including neonatal ophthalmia and in the case of chlamydia, neonatal pneumonia.2
"We were alarmed to find that so many pregnant women in our very large, nationally representative study were not screened for chlamydia and gonorrhea, given the prevalence of these infections and the significant risks they pose for maternal and neonatal health if untreated," said Jay Lieberman, MD, Quest Diagnostics' medical director for infectious diseases, in a statement accompanying the paper. "Testing for chlamydia and gonorrhea is simple and treatment is easy and highly effective, but if you do not screen these women, the infections can go undiagnosed and untreated."
The consequences of such STIs can be significantly more serious, even life-threatening, for a woman and her baby if the woman becomes infected while pregnant, explains Karen Hoover, MD, a medical epidemiologist in the Centers for Disease Control and Prevention' s (CDC) Division of STD Prevention. Chlamydial infection in pregnant women can cause adverse pregnancy effects, postnatal complications in the mother, and chlamydial infection in the baby; a mother also can pass a gonorrhea infection on to her baby, which can cause serious health problems for the infant, she notes.
"For these reasons, all pregnant women should be screened at their first prenatal visit," says Hoover. "Women aged 25 years and younger, and those at increased risk for chlamydia and gonorrhea, should be retested in the third trimester." (Educate your patients by providing them a CDC fact sheet on STDs and pregnancy. It is available.)
Check the results
The current study was designed to estimate the rates of testing, prevalence, and follow-up testing for chlamydial and gonococcal infection in a nationally-based population comparable with the U.S. pregnant population in terms of age and race. Scientists extracted laboratory results for 1,293,423 pregnant women tested over three years.
The analysis shows that during pregnancy, 59% (761,315) and 57% (730,796) of women were tested at least once for Chlamydia trachomatis or for Neisseria gonorrhoeae, respectively. Of those women tested, 3.5% (26,437 of 761,315) and 0.6% (4605 of 730,796) tested positive for chlamydial and gonococcal infection, respectively, at least once during pregnancy. Of those women who were initially positive for the given infection, 78% (16,039 of 20,489) and 76% (2610 of 3435) were retested; 6.0% (969 of 16,039) and 3.8% (100 of 2610) were positive on their last prenatal test for C. trachomatis and N. gonorrhoeae, respectively.1
Study findings indicate that age was strongly associated with infection risk. Sixteen percent of women age 16 tested positive for chlamydia, the highest of any age group. The risk of infection steadily declined with age, reaching 3% of those age 26 and less than 1% of those age 40.1
Check CDC guidance
As Hoover notes, all pregnant women should be routinely screened for Chlamydia trachomatis during the first prenatal visit. Women who are 25 years or younger and those at increased risk for chlamydia (such as those who have a new or more than one sex partner) also should be retested during the third trimester to prevent maternal postnatal complications and chlamydial infection in the infant, CDC guidance notes.3 Women who are found to have chlamydial infection during the first trimester should be retested within about 3–6 months, preferably in the third trimester, the guidance states.
All pregnant women at risk for gonorrhea or living in an area in which the prevalence of Neisseria gonorrhoeae is high should be screened at the first prenatal visit for N. gonorrhoeae. Women less than age 25 are at highest risk for gonorrhea infection; other risk factors for gonorrhea include a previous gonorrhea infection, other STIs, new or multiple sex partners, inconsistent condom use, commercial sex work, and drug use.3
Pregnant women who test positive for gonococcal infection during the first trimester should be retested within about 3-6 months, preferably in the third trimester. Uninfected pregnant women who remain at high risk for gonococcal infection also should be retested during the third trimester, CDC guidance advises.
Testing and treatment are key to reducing disease and infertility associated with undiagnosed STIs. Physicians play an important role, notes Hoover. The CDC recommends chlamydia screening for all sexually active young women age 25 and under to prevent infertility and ectopic pregnancy, and for all pregnant women to protect the health of the mother and infant, she states. However, even with this recommendation, testing rates have been low; one study found that only 38% of sexually active U.S. women reported a chlamydia test in the past year.4
"It is important to increase chlamydia screening coverage to protect the reproductive health of young women," says Hoover.
References
- Blatt AJ, Lieberman JM, Hoover DR, et al. Chlamydial and gonococcal testing during pregnancy in the United States. Am J Obstet Gynecol 2012; Doi: 10.1016/j.ajog.2012.04.027.
- Centers for Disease Control and Prevention. STDs in Women and Infants. Fact sheet. November 2011. Accessed at http://1.usa.gov/rE7p9b.
- Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR 2010; 59(No. RR-12): 9.
- Hoover KW. Self-reported chlamydia testing of women in the United States, 2006-2008. Presented at the 2012 National STD Prevention Conference. Minneapolis; March 2012.
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