Initial and repeat testing for chlamydia during pregnancy.

OBJECTIVE: This study was done to evaluate the prevalence of chlamydia in late pregnancy after an initial negative test. METHODS: This retrospective cohort study reports prenatal patients entering care between January 1998 and May 2000 at an inner city community based clinic (n = 752). Patients were evaluated if results of initial and late tests (34 weeks gestational age) for chlamydia were known. Charts were abstracted for demographic and pregnancy-related factors. Analysis for categorized data was by chi-squares and odds ratios. Continuous data were analyzed by t-test. Significance was accepted if p < 0.05. RESULTS: The prevalence of chlamydia was 17.8%, with 3.9% having only the second test positive. Treatment failure and/or reinfection were found in 13.3%. Factors correlated with chlamydial carriage include: age 19 years (p < 0.001), gonorrheal carriage (p < 0.001), lower gravidity (p < 0.01), lower parity (p < 0.05), and never having married (p < 0.001). Logistic regression identified gonorrheal carriage and age 19 years as important for both initial and late chlamydial cervicitis. Marital status was important for initial tests only. CONCLUSIONS: In our high-risk population, repeat testing for chlamydia in late pregnancy was found appropriate.

Maternal toxicity and pregnancy complications in human immunodeficiency virus-infected women receiving antiretroviral therapy: PACTG 316.

OBJECTIVE: The purpose of this study was to evaluate rates of maternal toxicity, pregnancy complications, and peripartum morbidity by type and duration of antiretroviral therapy (ART) during pregnancy. STUDY DESIGN: The Pediatric AIDS Clinical Trials Group (PACTG) Protocol 316 (PACTG 316) study evaluated the addition of intrapartum/neonatal nevirapine to background ART to reduce perinatal transmission of human immunodeficiency virus-1 (HIV-1). For this secondary analysis, women were categorized into one of six groups on the basis of ART during pregnancy (monotherapy [monoRx], combination without protease inhibitor [PI], combination with PI), and start time (early: before or during first trimester; late: second or third trimester). RESULTS: One thousand four hundred seven women were included: 288 monoRx late, 34 monoRx early, 327 combo, no PI late, 175 combo, no PI early, 320 combo, PI late, and 263 combo, PI early. Symptoms and laboratory abnormalities of moderate grade or more occurred in less than 5% of women. Only gestational diabetes (highest in combo PI early) varied significantly by therapy group. CONCLUSION: In HIV-infected women receiving prenatal care and ART, adverse events were uncommon.

Initial and repeated screening for gonorrhea during pregnancy.

BACKGROUND AND GOAL: Late pregnancy rescreening is advised for at-risk patients, but data supporting this recommendation are lacking. The intent of this study was to determine the value of a late-pregnancy test for gonorrhea after a negative initial test at the beginning of prenatal care. STUDY DESIGN: A retrospective chart review of clinic records over a 29-month period identified patients with a positive DNA direct assay for gonorrhea either initially or at 34 weeks. RESULTS: Of 751 women, 38 (5.1%) had gonorrhea diagnosed at their first testing; 19 women (2.5%) were positive only at their second screening. For one patient, both tests were positive. CONCLUSION: Repeating screening for gonorrhea at 34 weeks in a high-prevalence population is warranted.