Patterns of Screening, Infection, and Treatment of Chlamydia trachomatis and Neisseria gonorrhea in Pregnancy

Goggins, Emily R.; Chamberlain, Allison T.; Kim, Tesia G.; Young, M. R.; Jamieson, Denise J.; Haddad, Lisa

doi:10.1097/aog.0000000000003757

Cited by 13 publications

(23 citation statements)

References 23 publications

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“…Thus, our results could reflect a delay in treatment, which was not recorded, rather than no treatment at all. In similar studies, ~ 30% of records did not have documented treatments for perinatal STIs 18 , 27 . Goggins et al 27 , examined treatment delays reporting that over 50% of patients experienced delayed STI treatment during pregnancy, with an overall range of 0–221 days.…”

Section: Discussionmentioning

confidence: 92%

“…In similar studies, ~ 30% of records did not have documented treatments for perinatal STIs 18 , 27 . Goggins et al 27 , examined treatment delays reporting that over 50% of patients experienced delayed STI treatment during pregnancy, with an overall range of 0–221 days. These delays were primarily due to lack of clinician recognition of positive results and difficulty contacting patients.…”

Section: Discussionmentioning

confidence: 92%

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Sexually transmitted infections and risk of hypertensive disorders of pregnancy

Taylor

Hill

Perez‐Patron

et al. 2022

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Hypertensive disorders of pregnancy (HDP) result in maternal morbidity and mortality but are rarely examined in perinatal studies of sexually transmitted infections. We examined associations between common sexually transmitted infections and HDP among 38,026 singleton pregnancies. Log-binomial regression calculated relative risk (RRs) and 95% confidence intervals (CIs) for associations with gestational hypertension, preeclampsia with severe features, mild preeclampsia, and superimposed preeclampsia. All models were adjusted for insurance type, maternal age, race/ethnicity, and education. Additional adjustments resulted in similar effect estimates. Chlamydia was associated with preeclampsia with severe features (RRadj. 1.4, 95% CI 1.1, 1.9). Effect estimates differed when we examined first prenatal visit diagnosis only (RRadj. 1.3, 95% CI 0.9, 1.9) and persistent or recurrent infection (RRadj. 2.0, 95% CI 1.1, 3.4). For chlamydia (RRadj. 2.0, 95% CI 1.3, 2.9) and gonorrhea (RRadj. 3.0, 95% CI 1.1, 12.2), women without a documented treatment were more likely to have preeclampsia with severe features. Among a diverse perinatal population, sexually transmitted infections may be associated with preeclampsia with severe features. With the striking increasing rates of sexually transmitted infections, there is a need to revisit the burden in pregnant women and determine if there is a link between infections and hypertensive disorders of pregnancy.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 92%

Sexually transmitted infections and risk of hypertensive disorders of pregnancy

Taylor

Hill

Perez‐Patron

et al. 2022

Sci Rep

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“…Our clinical setting, an urban, safety-net hospital, is ideal for understanding the impact of time to chlamydia and gonorrhea treatment in pregnancy, as our hospital cares for predominantly underserved women at high risk for both sexually transmitted infections (STIs) and preterm birth. Patterns of positivity, treatment, and reinfection in this population have been described previously 16 ; however, the impact of the frequent treatment delays on outcomes remains unknown. The primary objective of this study was to determine whether time to treatment of chlamydia and gonorrhea in pregnancy is associated with an increased risk of preterm and early preterm births.…”

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confidence: 72%

“…However, an earlier analysis of these data found a majority of treatment delays (65%) were due to health care provider recognition and follow-up, which is unlikely to be differential by outcome, and that rates of positive test of reinfection were low. 16 Second, we used the date of a positive test result to determine time to treatment, and it is therefore impossible to know the duration of infection before testing. However, time to treatment from a positive test is the more clinically relevant measure.…”

Section: Discussionmentioning

confidence: 99%

Association of Delayed Treatment of Chlamydial Infection and Gonorrhea in Pregnancy and Preterm Birth

et al. 2021

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Background: Treating chlamydia and gonorrhea in pregnancy has been shown to decrease the associated risk of preterm birth in some studies. Delayed treatment of these infections among nonpregnant patients carries known consequences. It is unclear whether delayed treatment in pregnancy similarly increases adverse outcomes. Methods:We conducted a retrospective cohort study of women who delivered at a safety-net hospital from July 2016 to June 2018. Women with at least one visit who were tested for chlamydia and gonorrhea were included. Women diagnosed after 36 weeks (preterm analysis) or 31 weeks (early preterm analysis) were excluded. We used multivariable logistic regression to examine the association between no infection, timely treatment (<1 week), and delayed treatment (>1 week, not treated) with preterm (<37 weeks) and early preterm (<32 weeks) birth.Results: Among 3154 deliveries, 389 (12%) were preterm. Among 3107 deliveries, 74 (2%) were early preterm. In adjusted models, women with timely (adjusted odds ratio [aOR]; 1.7, 95% confidence interval [CI], 1.0-2.7) and delayed (aOR, 1.7; 95% CI, 1.1-2.5) treatments had increased odds of preterm birth. Similarly, women with timely (aOR, 2.5; 95% CI, 1.0-6.2) and delayed (aOR, 2.4; 95% CI, 1.2-4.9) treatments had increased odds of early preterm birth. Among women who tested positive, multiple infections were not associated with an increase in preterm birth (preterm: 17% vs. 20%, P = 0.53; early preterm: 5% vs. 6%, P = 0.74).Conclusions: Chlamydia and gonorrhea are associated with preterm and early preterm births, regardless of time to treatment. Creative solutions are needed to improve the prevention of these infections in pregnancy.P reterm birth is the major driver of neonatal morbidity and mortality in the United States. 1 Maternal chlamydial infection and From the

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“…[3][4][5] Enthusiasm for EPT stems from its potential to effectively reach underscreened groups, particularly those who are uninsured or underinsured or who live in medically underserved areas. 6 However, EPT implementation has been suboptimal. In 1 study, about 70% of obstetricians and gynecologists and 72% of emergency room health providers surveyed reported never offering EPT to STI patients.…”

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confidence: 99%

A Statewide Mixed-Methods Study of Provider Knowledge and Behavior Administering Expedited Partner Therapy for Chlamydia and Gonorrhea

et al. 2022

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Background: Expedited partner therapy (EPT) refers to the practice of having patients diagnosed with chlamydia or gonorrhea deliver medication directly to their partner(s) to treat them presumptively for infection. Although EPT facilitates timely treatment and prevents reinfection, it remains underused. We used findings from key informant interviews to design and implement a statewide survey to estimate knowledge and utilization of EPT and to identify barriers and facilitators to EPT among Minnesota providers.Methods: From November to December 2020, we carried out 15 interviews with health providers who currently provide EPT and coded interviews by recurring themes. We then conducted a statewide online survey on sexually transmitted infection treatment and barriers to EPT, from December 2020 to March 2021. We disseminated the survey to all licensed Minnesota health providers, and those who reported treating bacterial sexually transmitted infections in the past year were included in the study.Results: Interview themes included the importance of direct provision of partner medication, administrative/pharmacy barriers to treatment, inclusive EPT eligibility, and patient counseling. Of the 623 health providers who completed the online survey, only 70% thought EPT was legal and only 37% currently offer EPT. Of those who did not provide EPT, 78% said they would under certain circumstances. Barriers included concerns about safety/liability of prescribing without a medical examination, administrative concerns about prescriptions, and patient acceptance. Conclusions:Given that over a quarter of respondents did not know expedited partner therapy (EPT)'s legal status, improving provider education may increase EPT provision. More research is needed on system-level barriers and patient acceptance of solutions identified in this study.

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Patterns of Screening, Infection, and Treatment of Chlamydia trachomatis and Neisseria gonorrhea in Pregnancy

Cited by 13 publications

References 23 publications

Sexually transmitted infections and risk of hypertensive disorders of pregnancy

Sexually transmitted infections and risk of hypertensive disorders of pregnancy

Association of Delayed Treatment of Chlamydial Infection and Gonorrhea in Pregnancy and Preterm Birth

A Statewide Mixed-Methods Study of Provider Knowledge and Behavior Administering Expedited Partner Therapy for Chlamydia and Gonorrhea

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