Chlamydia and Gonorrhea Testing in Pregnancy: Time to Improve Adherence and Update Recommendations

Area of Science:

• Reproductive Health
• Infectious Disease Prevention
• Public Health Surveillance

Background:

• Chlamydia trachomatis and Neisseria gonorrhoeae infections pose risks during pregnancy.
• National guidelines recommend screening and retesting for these infections during pregnancy.
• Suboptimal adherence to guidelines can impact maternal and neonatal health outcomes.

Purpose of the Study:

• To evaluate adherence to national recommendations for Chlamydia and Gonorrhea testing during pregnancy.
• To assess testing for cure/clearance and persistence/reinfection.
• To identify gaps in current testing protocols.

Main Methods:

• Analysis of Chlamydia and Gonorrhea nucleic acid amplification tests (NAATs).
• Data from a major national reference laboratory from January 2010 to July 2022.
• Inclusion of over 3.5 million pregnant individuals and 4 million pregnancies.

Main Results:

• Initial Chlamydia and Gonorrhea positivity rates were 3.7% and 0.4%, respectively.
• Approximately 71% of initially positive Chlamydia cases were retested, with varied timing.
• Over one-third of positive cases lacked late pregnancy retesting, and many had no negative test before delivery.

Conclusions:

• Adherence to current Chlamydia and Gonorrhea testing recommendations during pregnancy is suboptimal.
• Current testing practices may be insufficient to reduce the disease burden.
• Improved adherence to guidelines is crucial for protecting maternal and neonatal health.