Declining Chlamydia and Gonorrhea Diagnoses Among Pregnant Women in South Carolina, 2008 to 2018

Abstract

Background Reported US cases of chlamydia and gonorrhea have increased since 2000, whereas studies in select populations suggest that the prevalence of these diseases has decreased. We sought to determine if these diagnoses are increasing among pregnant women delivering at our center. Methods This is a retrospective study of women delivering at least 1 infant >18 weeks of gestation at the Medical University of South Carolina for 11 years (2008–2018). Using the perinatal information system, we collected maternal race, age, insurer, and chlamydia and gonorrhea screening results during the pregnancy of record. Cochran-Armitage trend analyses were performed to evaluate trends in these diagnoses by delivery year for all women and for age/race subgroups. Results During the study period, there were 24,807 deliveries. The median age of women was 28 years (interquartile range, 23–32 years). Five percent (5.0%) of women were diagnosed with chlamydia and 1.2% with gonorrhea. The percent of women diagnosed decreased for both chlamydia (9.6%–3.4%) and gonorrhea (2.5%–1.1%; P < 0.001, trend analyses for both). A higher percentage of Black women had chlamydia and gonorrhea, and both diagnoses declined over time: 17.4% to 6.9% (P < 0.0001) for chlamydia and 5.8% to 2.1% (P < 0.0001) for gonorrhea. In a subanalysis of race and age, Black women younger than 25 years experienced the most significant decline in chlamydia diagnoses (P < 0.0001). Conclusions We observed declining diagnoses of chlamydia and gonorrhea among pregnant women in our center. Although Black women delivering were more likely to have either diagnoses, they experienced a significant decline in both chlamydia and gonorrhea over time.

Developing Sentinel Surveillance for Chlamydia and Gonorrhea Using Test Results From Routine Screening During Pregnancy

“…Trichomonas positivity in this analysis was also within the range of what we expected (5%). The consistency of results between our previous analysis using data manually extracted from the PINS database and our analysis of EHR data provides additional support for the validity of this method 16,23 …”

“…However, only 2169/4553 (48%) delivered an infant at the university hospital by the end of the study period. The number of deliveries we observed aligns with counts from our previous analysis 16 . We anticipate that persons who did not deliver an infant >20 weeks gestation could have experienced early pregnancy loss (ie, miscarriage, abortion, or ectopic pregnancy) or chose to deliver at another facility.…”

“…Among persons delivering at our center in 2018, 3.4% of persons screened had a positive chlamydia test and 1.1% had a positive gonorrhea test during pregnancy. 16 In our analysis of EHR data from 2021, 4% of tested pregnant persons had a positive chlamydia result and 0.7% had positive gonorrhea result. From previous studies of persons seeking care within our university hospital clinic, we anticipated that 3% to 10% of persons would have a positive Trichomonas test.…”

“…Using EHR system data analytics, we aimed to accurately determine the number of persons tested for STIs and the percentage of positive chlamydia, gonorrhea, and Trichomonas tests during pregnancy. From our previous retrospective evaluation of trends in chlamydia and gonorrhea diagnoses among pregnant persons, we determined age, race/ethnicity, and insurer were associated with infection in our hospital 16 . In this pilot study, we sought to build an analytic code to extract data from the EHR to determine the prevalence of STIs among persons seeking pregnancy care during 2021 and to evaluate characteristics that may influence testing positive for an STI during pregnancy.…”

Sociodemographic Factors Associated With Gonorrhea and Chlamydia Infection in Pregnancy

“…16 Being younger than 25 years of age and non-Hispanic Black race/ethnicity were also significant risk factors associated with gonorrheal and chlamydial infection in pregnancy in a single center from South Carolina. 17 Our analysis provides additional details regarding sociodemographic factors associated with these sexually transmitted infections by further stratifying maternal age groups, including additional racial and ethnic groups, and incorporating educational attainment, which is an important marker of socioeconomic status. Furthermore, Medicaid insurance and inadequate prenatal care were significantly associated with risk of infection in our analysis.…”