One in three women who tested positive for
chlamydia or gonorrhea while pregnant were not retested before
giving birth, despite potential to transmit infections to
newborns
SECAUCUS, N.J., Aug. 12,
2024 /PRNewswire/ -- A new study by researchers from
Quest Diagnostics (NYSE: DGX) and the University of Alabama suggests adherence to
guideline-based laboratory testing and treatment of pregnant women
for two of the most prevalent sexually transmitted infections
(STIs) is suboptimal in the United
States, with potentially dire effects on maternal and
newborn health.
The study, titled Chlamydia and gonorrhea testing in
pregnancy: Time to improve adherence and update
recommendations, was published in the peer reviewed Journal of
Lower Genital Tract Disease, the official journal of the American
Society for Colposcopy and Cervical Pathology. It is based
on deidentified results of lab tests performed by Quest in all 50
states and the District of
Columbia for 4,077,212 pregnancies.
The findings suggest gaps in guideline-based care, intended to
reduce the risk of infection and medical complications. Untreated
chlamydia and gonorrhea can raise risks of infertility and pelvic
inflammatory disease in women. The risk of transmission during
birth is approximately 50%, raising the potential for newborns to
develop infections of the eye (conjunctivitis), lungs (pneumonia)
and other health problems.
"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."
Key findings:
- Over 4% of women who received guideline-based screening for
chlamydia or gonorrhea in pregnancy during the first trimester
received a positive result for one or both infections.
- More than one in three of these women (35.1% chlamydia; 36.9%
gonorrhea) did not receive a follow up negative test before
delivery, suggesting they may not have been treated and cured (or
were treated, cured but then reinfected) before birth.
- About 2% of patients who received a negative test result for
chlamydia or gonorrhea early in pregnancy later received a positive
result, suggesting "an ongoing risk of infection during pregnancy".
Of these, about one in two were still positive prior to delivery.
(53.0% chlamydia and 49.3% gonorrhea).
The authors believe reinfections (or ineffectively treated
initial infections) may result in an increased number of deliveries
while women are positive with one or more STIs, which can impact
both maternal and newborn health.
The authors conclude current guidelines are inconsistent and
they provide several recommendations for improvements. For
instance, the CDC recommends women be retested for cure at 4 weeks
of pregnancy while the USPSTF recommends retesting before 3 weeks.
Current guidelines also do not recommend screening women after the
age of 25 years unless there are risk factors (such as multiple
partners), based on a study from 1998 when women married at younger
ages than today. Guidelines recommend that all women under the age
of 25 be screened, regardless of perceived risk.
The study's strengths include its large size, national
representation, and use of objective laboratory data. Its
limitation is the lack of clinical follow-up information for the
positive cases, as testing was limited to one national clinical
laboratory. While the authors did not evaluate other STIs, such as
syphilis, they caution these patterns of irregular adherence to
guideline-based testing in maternal care may extend to other
conditions.
According to the Centers for Disease Control and Prevention
(CDC), cases of sexually transmitted disease 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.
About Quest Diagnostics
Quest Diagnostics works across
the healthcare ecosystem to create a healthier world, one life at a
time. We provide diagnostic insights from the results of our
laboratory testing to empower people, physicians and organizations
to take action to improve health outcomes. Derived from one of the
world's largest databases of de-identifiable clinical lab results,
Quest's diagnostic insights reveal new avenues to identify and
treat disease, inspire healthy behaviors and improve healthcare
management. Quest Diagnostics annually serves one in three adult
Americans and half the physicians and hospitals in the United States, and our nearly 50,000
employees understand that, in the right hands and with the right
context, our diagnostic insights can inspire actions that transform
lives and create a healthier world. www.QuestDiagnostics.com.
For more Quest Diagnostics Health Trends® reports, visit
www.Newsroom.QuestDiagnostics.com/Health-Trends.
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SOURCE Quest Diagnostics