Andrey Nailor, M.D.·Published 17 May 2012·7 min read
Key points
Despite recommendations that pregnant women have tests for certain sexually transmitted diseases, many may not be getting them, a new study suggests.
Some STDs, such as genital herpes and bacterial vaginosis, are quite common in pregnant women in the United States.
HIV : At the first prenatal visit, and then again in the third trimester.
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.
Despite recommendations that pregnant women have tests for certain sexually transmitted diseases, many may not be getting them, a new study suggests.
Researchers found that of nearly 1.3 million U.S. women who had blood work done during pregnancy, only 59 percent were tested for Chlamydia - a common STD that can cause pregnancy complications or be passed on to newborns.
That's despite the fact that experts generally recommend pregnant women be screened for Chlamydia.
In addition, 57 percent of women in the study were screened for gonorrhea - a test recommended for some pregnant women.
The U.S. Centers for Disease Control and Prevention (CDC) says that all pregnant women should be tested for Chlamydia at their first prenatal visit. The American College of Obstetricians and Gynecologists (ACOG) has said the same since 2007.
As for gonorrhea, the CDC and other groups recommend screening for pregnant women who are at increased risk. That includes women younger than 25 and those living in areas of the country where gonorrhea is common.
Can pregnant women become infected with STDs? Yes, women who are pregnant can become infected with the same sexually transmitted diseases (STDs) as women who are not pregnant. Pregnancy does not provide women or their babies any protection against STDs. The consequences of an STD can be significantly more serious, even life threatening, for a woman and her baby if the woman becomes infected with an STD while pregnant. It is important that women be aware of the harmful effects of STDs and know how to protect themselves and their children against infection.
How common are STDs in pregnant women in the United States?
Some STDs, such as genital herpes and bacterial vaginosis, are quite common in pregnant women in the United States. Other STDs, notably HIV and syphilis, are much less common in pregnant women. The table below shows the estimated number of pregnant women in the United States who are infected with specific STDs each year.
"As our study shows, there's a significant gap between the recommendations and actual practice," said Dr. Jay M. Lieberman, who is medical director for infectious diseases at Quest Diagnostics Inc. and worked on the study.
Quest is a diagnostic testing provider that operates labs throughout the U.S. The company offers STD testing and funded the new study.
Written and revised by
Andrey Nailor, M.D.
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How can chlamydia affect my pregnancy? Women who have chlamydia during pregnancy tend to have higher rates of infection of the amniotic sac and fluid, preterm birth, and preterm premature rupture of the membranes (PPROM), although prompt treatment may reduce the risk of these problems. Some studies have linked chlamydia to an increased risk of miscarriage, although other studies have found no connection.
An untreated chlamydia infection also makes you more susceptible to HIV and some other sexually transmitted infections (STIs) if you're exposed to them. It also raises your risk of a uterine infection after you have your baby.
What's more, if you have a chlamydia infection when you go into labor, there's a chance that you'll pass the bacteria to your baby. In fact, up to half of babies born vaginally to mothers with untreated chlamydia (and even some babies born by c-section) will contract the infection.
Between 25 to 50 percent of these babies will develop an eye infection (conjunctivitis) a few days to a few weeks after birth. (The medicated drops or ointments put in your baby's eyes soon after birth to prevent gonorrheal conjunctivitis don't prevent chlamydial eye infections.) And 5 to 20 percent of babies who contract chlamydia during delivery develop pneumonia a few weeks to several months after birth.
Although these infections can be very serious, babies who are treated promptly with antibiotics generally do well. Of course, it's best to get treated before delivery to prevent your baby from becoming infected in the first place.
Since not all pregnant women are advised to have gonorrhea testing, it's difficult to tell whether the 57-percent rate in this study is appropriate or not, according to Lieberman.
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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.
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
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