A new study conducted by Quest Diagnostics in collaboration with the University of Alabama has revealed significant gaps in the testing and treatment of sexually transmitted infections (STIs) among pregnant women in the United States. The study, titled Chlamydia and gonorrhea testing in pregnancy: Time to improve adherence and update recommendations, was published in the ‘Journal of Lower Genital Tract Disease’ and analyzed data from over 4 million pregnancies.
The findings highlight a concerning trend: one in three women who tested positive for chlamydia or gonorrhea during pregnancy were not retested before giving birth. This gap in care suggests that many women may not have been adequately treated, leaving the potential for transmitting these infections to their newborns.
“Our study adds to a troubling body of evidence highlighting inconsistent quality in maternal and child healthcare in the U.S.,” said Damian P. Alagia, MD, co-author of the study and Medical Director of Women’s Health at Quest Diagnostics. “Our analysis shows that improved adherence to existing recommendations, harmonization of guidelines across agencies, and even updated recommendations for STI testing will be critical to ensuring the mothers and babies in the United States receive medically appropriate testing and treatment.”
The study revealed several concerning trends regarding STI testing during pregnancy. Over 4% of women who were screened for chlamydia or gonorrhea during the first trimester tested positive for one or both infections. Among these women, more than one-third—specifically 35.1% for chlamydia and 36.9% for gonorrhea—did not receive a follow-up negative test before delivery, suggesting they may not have been adequately treated or could have been reinfected before giving birth. Additionally, approximately 2% of women who initially tested negative for these STIs later received a positive result during pregnancy, with nearly half of them—53.0% for chlamydia and 49.3% for gonorrhea—still testing positive prior to delivery. These findings indicate a significant gap in the adherence to recommended testing guidelines, which could lead to serious health risks for both mothers and newborns.
These findings underscore the critical need for improved adherence to guidelines for STI testing during pregnancy. Untreated chlamydia and gonorrhea can lead to serious health risks for both mothers and newborns, including infertility, pelvic inflammatory disease, and the transmission of infections to the infant during birth, potentially causing conditions such as conjunctivitis and pneumonia.
The study authors recommend several improvements to current guidelines, noting inconsistencies across various health agencies. For example, while the CDC recommends retesting for cure at four weeks of pregnancy, the U.S. Preventive Services Task Force (USPSTF) suggests retesting before three weeks. Additionally, current guidelines do not recommend screening women over the age of 25 unless they present certain risk factors, a standard based on outdated data from 1998 when women typically married at younger ages.
The study’s large sample size, national representation, and use of objective laboratory data are strengths that add credibility to its findings. However, the lack of clinical follow-up information for positive cases and the study’s focus on only two STIs are noted as limitations. The authors caution that irregular adherence to guideline-based testing in maternal care may extend to other STIs as well.
The Centers for Disease Control and Prevention (CDC) has reported that cases of sexually transmitted diseases are at an all-time high, with more than 2.5 million cases of syphilis, gonorrhea, and chlamydia reported in the United States in 2022. This study highlights the urgent need for better testing and treatment protocols to protect the health of pregnant women and their babies.
