So You're Pregnant? Get Tested!

Chlamydia and gonorrhea screenings not frequent enough for pregnant women

(RxWiki News) Not enough pregnant women are being screened for the two most common sexually transmitted diseases in the United States, chlamydia and gonorrhea, putting themselves and their newborns at risk.

A recent study that analyzed lab results for nearly 1.3 million pregnant women revealed that pregnant women are not being screened for chlamydia and gonorrhea at the rates recommended.

Pregnant women should be tested for chlamydia and gonorrhea.

Amy Blatt, PhD, of Quest Diagnostics, led the study with two other Quest researchers and a Rutgers University researcher.

The researchers gathered lab results from Quest Diagnostics for 1,293,423 pregnant women between the ages of 16 and 40 in the U.S. The women's labs were all tested by Quest between 2005 and 2008.

They found that only 59 percent of women were tested at least once for chlamydia, and only 57 percent were tested at least once for gonorrhea. Among women aged 16 to 24, a high risk group for gonorrhea, only 69 percent were tested for the condition.

Chlamydia, the most common sexually transmitted disease in the U.S., infects approximately 100,000 pregnant women annually, according to background information in the article. Gonorrhea is the second most common, found in approximately 13,200 pregnant women a year.

Both chlamydia and gonorrhea can cause a range of health or labor complications for pregnant women or their children if the conditions are untreated.

The infections can cause preterm labor or eye infections or pneumonia in the newborns.

The study's results regarding infection rates and age corresponded to what is already known about lower age groups being at higher risk for both diseases.

Among 16-year-olds in the study group, which reviewed guidelines from the Centers for Disease Control and Prevention and from the American Congress of Obstetrics and Gynecology (ACOG), 16 percent tested positive for chlamydia, though only 3 percent of 26-year-olds and under 1 percent of 40-year-olds did.

Both the CDC and ACOG recommend that all women are screened for chlamydia and that all women aged 24 or younger are tested for gonorrhea. The CDC recommends that women who test positive for chlamydia be tested again three weeks after treatment.

However, the study found that over one-fifth of the women, or 22 percent, did not receive a follow-up screening, and only a third with a positive result were re-tested within six weeks of their diagnosis.

Women aged 25 or younger should be tested for chlamydia again during their third trimester because they are in a high-risk group for contracting the infection, even if their test was negative the first time, according to the CDC.

Yet only 19 percent of women aged 25 and under was tested again in the third trimester if their first screening was a negative test result.

The study also found risks associated with women becoming re-infected with both diseases, likely from their partners. Some women tested positive for one of the diseases later in their pregnancy after having a negative test result earlier in their pregnancy.

In addition, 6 percent of women who tested positive for chlamydia the first time also tested positive for the infection on their last prenatal test. The rate for re-infection with gonorrhea was 3.8 percent.

“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 co-author Jay Lieberman, MD, the medical director of infectious diseases at Quest Diagnostics.

He said the study's evidence supports the rationale behind the CDC and ACOG guidelines, so he hopes more doctors will follow these clinical recommendations and that more women will be tested for both infections.

“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," he said.

The study appeared online May 17 in the American Journal of Obstetrics and Gynecology. The research was funded by Quest Diagnostics. Three of the four study authors are Quest employees.

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May 17, 2012