Early detection and treatment of sexually transmitted disease in pregnant adolescents of low socioeconomic status.

ABSTRACT

PIP: Maternal sexually transmitted disease (STD) is an important and preventable cause of infant morbidity and mortality. The early identification and treatment of STDs could, however, reduce the number of premature deliveries, low-birthweight infants, and neonatal deaths. Sexually active adolescents of low socioeconomic status (SES) are at increased risk for perinatal morbidity and mortality due to their substantially higher STD rates compared to adult women. Despite these facts, many primary care providers simply diagnose pregnancies with urine tests, then refer adolescents to a prenatal program for a thorough evaluation, including a screen for STDs. This practice means that young women infected with STDs at the diagnosis of pregnancy will most likely remain infected until they return to begin prenatal care and are subsequently diagnosed and treated for the problem. This study followed a group of pregnant adolescents from the initial diagnosis of pregnancy at a primary pediatric care clinic (PPCC) until the initial prenatal clinic visit. The study was undertaken to document the frequency of STD in adolescents presenting at such a PPCC for pregnancy diagnosis and to evaluate the ability to treat the infections once they are identified. 235 pregnancies were identified at the PPCC serving urban adolescents of low SES in Milwaukee, Wisconsin, over the period August 1, 1988, to January 31, 1992. 44 of these patients were seen at other prenatal programs, nine had miscarriages and nine had induced abortions before starting prenatal care, and five met the exclusion criteria, so the study findings pertain to only 168 subjects. 91 subjects were screened at the initial visit to the PPCC for gonorrhea and chlamydia with a pelvic exam and 77 were not. The screened group was of mean age 16.4 years compared to the unscreened group at 15.9 years, while the former also reported more STD-related symptoms than the unscreened group at the time of the initial PPCC visit. 29% of the 91 were positive for gonorrhea, chlamydia, or both. The average delay from pregnancy diagnosis to first prenatal clinic visit was 35.7 days. 53 of the 168 women presenting for prenatal care (32%) had STDs. Patients originally screened at the PPCC for STD, however, had a significantly lower prevalence of infection than the previously unscreened group. 22 of the group screened at the initial PPCC were infected, 12 of whom had been previously negative. The authors stress that primary care providers are missing an important therapeutic opportunity in this adolescent population by failing to identify and treat STDs at the initial diagnosis of pregnancy. The initial diagnosis of pregnancy in adolescents should always include screening for STD, with suspected infections treated immediately rather than waiting for definitive test results. Patients should also be given information on how to protect themselves from acquiring new STDs during pregnancy.