Nonviral sexually transmitted infections in pregnancy: current controversies and new challenges

Abstract

Purpose of review This review provides an update of nonviral, curable sexually transmitted infections (STIs) in pregnancy and summarizes our understanding of the current issues and controversies surrounding risk factors, screening, and treatment of STIs in pregnancy primarily in high-income countries (using the United States and the United Kingdom as examples). The infections covered in this review are syphilis, gonorrhea, chlamydia, trichomoniasis, and Mycoplasma genitalium infections. Recent findings Overall, limited modern data is available to update researchers and clinicians on the epidemiology and care of STIs in pregnancy. Though common risk factors can be identified among these STIs, like socioeconomic status and inadequate antenatal care, specific screening and treatment challenges vary by geography and pathogen. Wherever available, surveillance data and research evidence are often limited to nonpregnant patients, leading to imperfect pregnancy-specific risk estimates and obstetric lags in the development and adoption of new guidelines. We have identified three areas of opportunity that may enhance the effectiveness of current approaches and inform new ones: improved data collection and evidence-based screening practices; prompt and comprehensive therapy, including partner services, and evaluations of new treatment modalities; and equitable antenatal and sexual healthcare for all pregnant persons and their partners. Summary These findings highlight the need to revisit standards of screening and management of STIs in pregnancy in high-income countries.

Sexually transmitted infections and risk of hypertensive disorders of pregnancy

“…Much of the data on the association between non-viral STIs and specific adverse pregnancy outcomes is based on outdated studies 3 , most of which lack diversity and do not consider treatment or persistence/recurrence of infections. We found that Chlamydia trachomatis is associated with preeclampsia with severe features and superimposed preeclampsia.…”

“…Suboptimal screening for sexually transmitted infections (~ 60%), delays in treatment (55%), and persistent or recurrent infection (9–14%) are common during pregnancy, particularly in socially disadvantaged populations 3 , 18 . A recent study among 810 women attending clinics in Alabama who were treated with azithromycin for chlamydia had a recurrence rate of 9% and persistence rate of 14% 18 .…”

“…However, these pathogens have been increasing annually since 2014 2 with glaring racial/ethnic disparities. To optimize screening and prevention tactics, research needs to determine the burden of non-viral STIs on specific adverse birth outcomes, particularly in diverse populations 3 . Meta-analyses are limited but studies examining associations between non-viral STIs and adverse pregnancy outcomes are inconsistent and many suffer from confounding, rely on International Classification of Diseases (ICD)-9 codes or birth certificate data 4 , 5 and/or have suboptimal screening in the source population (e.g.…”

Every mother and every fetus matters: A positive pregnancy test = multiple offerings of reproductive risk screening for personal, family, and specific obstetrical‐fetal conditions

“…After evidence‐based screening, perinatal infections require a protocol / algorithm for diagnosis and treatment 114‐116 …”

Disparities in Prenatal Sexually Transmitted Infections among a Diverse Population of Foreign-Born and US-Born Women

“…Differences in STI prevalence have been observed by FB status [ 11 ]; however, few studies have examined the association between FB status and perinatal STIs, particularly for pregnant women. In addition, STIs have been linked to spontaneous abortion, preterm birth, and preeclampsia [ 12 ], yet there is limited literature on the risk of subsequent negative birth outcomes following an STI among FB and US-born mothers.…”