Many pregnant women may not get STD tests
However, he said, even women who should be screened, based on guidelines, are sometimes not. Of pregnant women ages 16 to 24, 69 percent were tested for gonorrhea, the researchers report in the American Journal of Obstetrics and Gynecology.
Screening plays an important role in catching Chlamydia or gonorrhea because both STDs often have no symptoms, Lieberman pointed out.
“These two infectious diseases are easy to diagnose, and easy to treat and cure,” he said.
But without screening, Lieberman added, many cases will be missed.
STDs You Should Be Tested For During Pregnancy:
HIV : At the first prenatal visit, and then again in the third trimester. Women who were not tested during pregnancy should be rapid tested at the time of delivery. Note: Although these are the CDC guidelines, HIV testing during pregnancy is not yet required in all states.
Syphilis: At the first prenatal visit (all women), during the third trimester (high risk women only), and at delivery (all women).
Hepatitis B: At the first prenatal visit, and then again in the third trimester for high risk women.
Chlamydia: At the first prenatal visit, and then again in the third trimester for high risk women and women <25 years old.
Gonorrhea: At the first prenatal visit for women who live in areas with large numbers of cases. Again during the third trimester for women at high risk.
Bacterial Vaginosis: Some studies suggest that asymptomatic women at high risk for preterm birth should be tested for the sexually associated condition bacterial vaginosis, but the data is controversial. Testing is not supported for asymptomatic women in general.
If left untreated, Chlamydia and gonorrhea can cause pelvic inflammatory disease, which can lead to infertility or an ectopic pregnancy - a dangerous condition in which the fertilized egg grows outside the uterus.
Both STDs can also infect the baby during childbirth. Chlamydia can cause eye infections or pneumonia in newborns, while gonorrhea can lead to joint infections or serious blood infections.
A limitation of the current study is that it’s based on pregnant women who had blood tests done between 2005 and 2008. And during those years, screening guidelines were in flux; the ACOG recommendation came out in 2007, for example.
“Clearly, this is still evolving,” Lieberman said. But, he added, “there’s also no evidence that screening rates have improved.”
A 2009 CDC study, for example, found that only a minority of U.S. women who should be screened for Chlamydia actually had been. Screening is advised not only for pregnant women, but for certain other at-risk groups - like women age 25 or younger (see Reuters story of April 16, 2009).
Exactly why some pregnant women are not tested as recommended is unclear. “Our data don’t speak to that,” Lieberman said.
For some women, access to prenatal care is a hurdle, he noted. But the data in this study all came from women already in prenatal care.
Lieberman suggested pregnant women talk to their doctors if they have not been tested for STDs or are not sure if they have had testing. Other STD tests done during pregnancy include ones for syphilis and HIV.
Sometimes, Lieberman noted, women are put off by the suggestion that they have STD testing. “But doing these tests is not a judgment on them or their behavior,” he said. “We’re just trying to do what needs to be done to make sure you’re healthy and your newborn is healthy.”
According to the CDC, about 100,000 pregnant women in the U.S. are infected with Chlamydia each year. Just over 13,000 have gonorrhea.
SOURCE: American Journal of Obstetrics and Gynecology, online April 30, 2012.
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Chlamydial and Gonococcal Testing during Pregnancy in the United States
During pregnancy, 59% (761,315/1,293,423) and 57% (730,796/1,293,423) women were tested at least once forC. trachomatis or for N. gonorrhoeae, respectively. Of those women tested, 3.5% (26,437/761,315) and 0.6% (4,605/730,796) tested positive for chlamydial and gonococcal infection, respectively, at least once during pregnancy. Of those women initially positive for the given infection, 78.3% (16,039/20,489) and 75.6% (2,610/3,435) were retested, of whom 6.0% (969/16,039) and 3.8% (100/2,610) were positive on their last prenatal test for C. trachomatis and N. gonorrhoeae, respectively.
Conclusion
Many pregnant women are not tested forChlamydia trachomatis andNeisseria gonorrhoeae despite recommendations to test. Follow-up testing to monitor the effectiveness of treatment is also not always performed.
Amy J. Blatt, PhD, Jay M. Lieberman, MD, Donald R. Hoover, PhD, Harvey W. Kaufman, MD