Sexually transmitted infections (STIs) can go undetected and untreated during pregnancy due to asymptomatic presentation, clinician assumptions about patient risk, and fragmented access to prenatal care, according to Damian Alagia, III, MD, MS, MBA, FACS, Chief, Hospital and Health Systems, and Senior Medical Director, Advanced Diagnostics / Women’s Health, Quest Diagnostics.
Alagia emphasized that risk-based assumptions fail because most infections produce no symptoms.
Most of these sexually transmitted infections are asymptomatic. They are silent. Patients did not go looking for an STI. They may be in a committed relationship, but their partner may not be in a committed relationship, Alagia said.
Alagia noted that the American College of Obstetricians and Gynecologists (ACOG) is now moving to testing 3 times during pregnancy, at the first trimester, 28 weeks, and then when they deliver, in a non-judgmental way.
ACOG is implementing this testing protocol as standard care during pregnancy, which includes testing at the first trimester, 28 weeks when patients are coming in for their glucose test, and then when they deliver.
Detection alone is insufficient, Alagia noted, citing a study he coauthored with researchers from Quest Diagnostics and the University of Alabama, published in Journal of Lower Genital Tract Disease.
The analysis identified 4,077,212 pregnancies across the United States from January 2010 through July 2022.
Only a third of the patients who tested positive for STI during pregnancy had follow-up, so these babies were possibly delivered with chlamydia, gonorrhea, or syphilis, Alagia said.
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Untreated congenital syphilis can carry severe, long-term consequences, and undiagnosed chlamydia and gonorrhea can result in severe pulmonary infection or blindness.
According to the published findings, 35.1% of patients who tested positive for chlamydia and 36.9% of those who tested positive for gonorrhea did not receive a follow-up negative test before delivery, suggesting they may not have been treated or cured, or were treated and later reinfected.
Alagia described tiers of care that leave many patients without a consistent point of contact, including urgent care and emergency rooms.
There is urgent care where patients come into the emergency room for some other issue, and it could be an eye infection or a pulmonary infection, Alagia said. He noted that urgent care is not set up to do STI testing, and the emergency room has limited time and resources, and patients are not connected to care.
He attributed the gap to systemic design rather than individual clinical decisions, stating that it is the failure of the system to provide consistent care and access to patients when they get pregnant.
Alagia’s study emphasizes the importance of non-judgmental testing and follow-up care for STIs during pregnancy.
Patients who are struggling with alcohol withdrawal may also face unique challenges in accessing prenatal care.
