Patterns of Screening, Infection, and Treatment of Chlamydia trachomatis and Neisseria gonorrhea in Pregnancy
Patterns of Screening, Infection, and Treatment of Chlamydia trachomatis and Neisseria gonorrhea in Pregnancy
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DOI：
10.1097/aog.0000000000003757
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发表时间：
2020-04-01
影响因子：
7.2
通讯作者：
Haddad, Lisa B.
中科院分区：
文献类型：
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作者：
Goggins, Emily R.;Chamberlain, Allison T.;Haddad, Lisa B.
目的：描述孕期沙眼衣原体和淋病奈瑟菌感染未检出及检出阳性的相关因素，描述再感染的治疗方式和检测方法。方法：我们对2016年7月1日至2018年6月30日在某城市教学医院分娩的产妇进行了一项回顾性队列研究。至少有一次产前护理或分诊的妇女被纳入其中。该指数包括了多次分娩的女性。我们使用Logistic回归分析了与未进行检测相关的因素，并在怀孕期间检测这些感染呈阳性。用COX比例风险模型检验与治疗时间和再感染试验相关的因素。我们查阅了医疗记录，以确定延迟治疗超过1周的原因。结果：在3265例符合条件的分娩中，有3177例(97%)的孕妇在孕期接受了检测。其中，370人(12%)检测为阳性(287人衣原体感染，35人淋病，48人同时感染)，15%有重复感染。产前护理充分性和保险状况是未进行测试的风险因素。年龄、种族和民族、饮酒和性传播感染史与检测阳性有关。治疗时间从0天到221天不等，大多数(55%)患者的延迟时间超过1周。延误的常见原因包括缺乏临床医生对异常结果的认识和跟进(65%)，以及难以联系患者(33%)。结论：传统危险因素与孕期感染风险增加有关。产前护理的充分性和保险状况与接受检测的可能性有关。延误治疗和再感染检测是很常见的。应探索护理点检测和快速伴侣治疗，以此作为改善对妊娠期间这些感染的管理的方法。
OBJECTIVE: To describe factors associated with not being tested for Chlamydia trachomatis and Neisseria gonorrhea infection during pregnancy and for testing positive and to describe patterns of treatment and tests of reinfection. METHODS: We conducted a retrospective cohort study of women who delivered at an urban teaching hospital from July 1, 2016 to June 30, 2018. Women with at least one prenatal care or triage visit were included. The index delivery was included for women with multiple deliveries. We used logistic regression to analyze factors associated with not being tested and for testing positive for these infections in pregnancy. Cox proportional hazards models were used to examine factors associated with time to treatment and tests of reinfection. We reviewed medical records to determine reasons for delays in treatment longer than 1 week. RESULTS: Among 3,265 eligible deliveries, 3,177 (97%) women were tested during pregnancy. Of these, 370 (12%) tested positive (287 chlamydia, 35 gonorrhea, 48 both), and 15% had repeat infections. Prenatal care adequacy and insurance status were risk factors for not being tested. Age, race and ethnicity, alcohol use, and sexually transmitted infection history were associated with testing positive. Time to treatment ranged from 0 to 221 days, with the majority (55%) of patients experiencing delays of more than 1 week. Common reasons for delays included lack of clinician recognition and follow-up of abnormal results (65%) and difficulty contacting the patient (33%). CONCLUSION: Traditional risk factors are associated with increased risk of infection during pregnancy. Prenatal care adequacy and insurance status were associated with the likelihood of being tested. Delays in treatment and tests of reinfection were common. Point-of-care testing and expedited partner therapy should be explored as ways to improve the management of these infections in pregnancy.