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Can risk factor assessment replace universal screening for gonorrhea and Chlamydia in the third trimester?
1Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut 06520, USA.
American Journal of Perinatology
|December 6, 2001
Summary
Risk factor screening effectively identifies women at low risk for gonorrhea and chlamydia in late pregnancy, potentially replacing routine third-trimester testing for these sexually transmitted diseases (STDs). This approach enhances STD screening efficiency in clinic settings.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Public Health
Background:
- Routine third-trimester screening for gonorrhea and chlamydia is standard in prenatal care.
- Risk factor (RF) screening may offer a more targeted approach to identify patients needing further testing.
Purpose of the Study:
- To evaluate the efficacy of risk factor screening as a substitute for routine third-trimester gonorrhea and chlamydia testing in an urban clinic population.
Main Methods:
- Prospective analysis of 542 women in prenatal care over 10 months.
- Combined gonorrhea and chlamydia DNA probe screening at initial visit and third trimester.
- Analysis of risk factors including age, marital status, STD history, drug use, and gestational age at entry.
Main Results:
- 60% of women had at least one risk factor; 35% had a history of STD.
- Third-trimester screening was positive in 4.1% of women.
- Absence of risk factors had a negative predictive value of 99.1% for third-trimester infection.
- Risk factor screening demonstrated 90.9% sensitivity and 40.7% specificity (p = 0.003).
Conclusions:
- Comprehensive risk factor screening is effective in predicting low risk for sexually transmitted diseases in the third trimester among women with an initial negative screen.
- Risk factor screening can potentially optimize STD testing strategies in prenatal care settings.
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