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Sexually Transmitted Infection Screening and Positivity in Pregnant Women Living in Areas with High Social
Gweneth B Lazenby1,2, Jeffrey E Korte3, Ekatrina Pekar4
1From the Departments of Obstetrics and Gynecology.
Objectives:
Pregnant women living in rural areas of the United States are not equitably served by healthcare systems and may be disproportionately affected by sexually transmitted infections (STIs). We examined the impact of location of pregnancy care on STI screening and positivity in a statewide health system.
Methods:
Pregnant women seeking care within a statewide health system during 2021-2022 were categorized by location of care at either the main university hospital (urban) or regional (rural) hospitals. We assessed STI screening and positivity for chlamydia, gonorrhea, and trichomoniasis within each setting and by the Social Vulnerability Index (SVI) assigned to the person's census tract (high ≥0.75 vs low <0.75). We identified 12,921 unique pregnancy episodes: 9051 (70%) within the university hospital and 3870 (30%) in regional hospitals.
Results:
The mean census tract SVI among all women was 0.54 (standard deviation 0.29), and 29% of pregnant women resided in areas with a high SVI. Women in care at a regional hospital were more likely to reside in areas with a high SVI compared with the university hospital (41% v. 23%). In total, 75% of pregnant women were screened for any STI (9727/12,921). Compared with university hospitals, STI screening rates during pregnancy were lower (77% vs 70%) and STI positivity during pregnancy was higher in regional hospitals (chlamydia [3.9% vs 6.4%], gonorrhea [0.6% vs 1.3%], and trichomoniasis [4.6% vs 8%]).
Conclusions:
In a statewide health system, pregnancy care provided in rural regional hospitals was associated with lower STI screening rates and higher STI positivity.
