Untreated sexually transmitted infections (STIs) in pregnancy can lead to such negative outcomes as spontaneous abortion, preterm birth, low birth weight, congenital infections, and other abnormalities.
Untreated sexually transmitted infections (STIs) in pregnancy can lead to such negative outcomes as spontaneous abortion, preterm birth, low birth weight, congenital infections, and other abnormalities. Moreover, almost half the new cases of STI diagnoses occur in the women aged 15 to 24 years, and the greatest number of cases of C. trachomatis and N. gonorrhoeae has been found in adolescent girls aged 15 to 19 years, with minorities disproportionately affected. Since prenatal care allows clinicians the opportunity to screen such young women, researchers from the department of obstetrics and gynecology at the University of North Carolina, Chapel Hill, and Washington Hospital Center in Washington, DC, sought to determine if prenatal screening was warranted and would prove to be useful in this patient population.
The researchers conducted secondary analysis of a prospective cohort of 125 pregnant adolescents aged 12 to 18 years old who were enrolled in Teen Alliance for Prepared Parenting, a comprehensive adolescent parenting program that provides comprehensive obstetric and postpartum care with integrated social work services. Median age at delivery was 17 years; other patient characteristics can be found in Figure 1. Participants were screened for C. trachomatis and N. gonorrhoeae at entry to prenatal care and again during the third trimester. If an STI was present early in the pregnancy, additional screening was provided at 36 weeks gestation. Patients who received positive results and a diagnosis were treated according to Centers for Disease Control and Prevention guidelines.
Figure 1. Patient characteristics.
According to the data, more than one-quarter of the participants were diagnosed with C. trachomatis and/or N. gonorrhoeae at some point during the study (Figure 2). Furthermore, nearly one-third (31%) of the participants received a diagnosis for at least one of the STIs during pregnancy. A negative test-of-cure was documented in 3 of 9 adolescents with C. trachomatis before receiving a second diagnosis. Similarly, 2 of 3 participants who received a second diagnosis of N. gonorrhoeae infection had documented>negative test-of-cure before reinfection. For those without negative test-of-cure in the medical records, the researchers did find appropriate prescriptions and contact notes in the medical record. Thus, although they acknowledged some of the secondary infections could be a result of persistent infection (and not reinfection), they did not believe this to be the case.
Figure 2. Results of STI screens.
This study further confirmed that sexual risk behavior in urban teens does not decrease after pregnancy, as was evidenced by reinfection in some participants and new cases found later in pregnancy in other participants. Indeed, the authors noted that adolescents without an STI at onset of the program benefitted from the retesting.
“Pregnancy represents an opportune time to intervene for adolescents at risk for STIs. Routine screening at start of prenatal care is an opportunity for counseling on safe sexual behavior, regardless of infection status,” noted the authors. As such, they suggested discussing condom use and making note of sexual partner(s) to further prevent future STI infection as well as to help identify those patients at increased risk for subsequent infections.
“Overall, repeat STI screening for all adolescents may be warranted, given the high prevalence of infection, suspected reinfection, and new diagnosis only on repeat testing,” the researchers concluded. “We encourage prenatal providers to routinely rescreen pregnant adolescents for STIs, even those not infected at entry to prenatal care.”
Berggren EK, Patchen L. Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae and repeat infection among pregnant urban adolescents. Sex Transm Dis. 2011;38(3):172-174.