The Proportion of Young Women Tested for Chlamydia Who Had Urogenital Symptoms in Physician Offices.

Using National Ambulatory Medical Care Survey data from 2006 to 2015, we estimated the proportions of young women tested for chlamydia who were symptomatic (urogenital symptoms) or asymptomatic in physician offices. Among women tested for chlamydia, the proportions of women with and without urogenital symptoms were 31.6% and 59.2%, respectively.

Evaluating coverage of maternal syphilis screening and treatment within antenatal care to guide service improvements for prevention of congenital syphilis in Countdown 2030 Countries.

BACKGROUND: Countdown to 2030 (CD2030) tracks progress in the 81 countries that account for more than 90% of under-five child deaths and 95% of maternal deaths in the world. In 2017, CD2030 identified syphilis screening and treatment during antenatal care (ANC) as priority indicators for monitoring. METHODS: Country-reported data in the UNAIDS Global AIDS Monitoring System (GAM) system were used to evaluate four key syphilis indicators from CD2030 countries: (1) maternal syphilis screening and (2) treatment coverage during ANC, (3) syphilis seroprevalence among ANC attendees, and (4) national congenital syphilis (CS) case rates. A cascade analysis for CD2030 countries with coverage data for the number of women attending at least 4 antenatal care visits (ANC4), syphilis testing, seroprevalence and treatment was performed to estimate the number of CS cases that were attributable to missed opportunities for syphilis screening and treatment during antenatal care. RESULTS: Of 81 countries, 52 (64%) reported one or more values for CS indicators into the GAM system during 2016-2017; only 53 (65%) had maternal syphilis testing coverage, 41 (51%) had screening positivity, and 40 (49%) had treatment coverage. CS case rates were reported by 13 (16%) countries. During 2016-2017, four countries reported syphilis screening and treatment coverage of ≥95% consistent with World Health Organization (WHO) targets. Sufficient data were available for 40 (49%) of countries to construct a cascade for data years 2016 and 2017. Syphilis screening and treatment service gaps within ANC4 resulted in an estimated total of 103 648 adverse birth outcomes with 41 858 of these occurring as stillbirths among women attending ANC4 (n = 31 914 408). Women not in ANC4 (n = 25 619 784) contributed an additional 67 348 estimated adverse birth outcomes with 27 198 of these occurring as stillbirths for a total of 69 056 preventable stillbirths attributable to syphilis in these 40 countries. CONCLUSION: These data and findings can serve as an initial baseline evaluation of antenatal syphilis surveillance and service coverage and can be used to guide improvement of delivery and monitoring of syphilis screening and treatment in ANC for these priority countries.

National Trends and Reported Risk Factors Among Pregnant Women With Syphilis in the United States, 2012-2016.

OBJECTIVE: To describe recent syphilis trends among pregnant women and to evaluate the prevalence of reported high-risk behaviors in this population. METHODS: We analyzed U.S. national case report data for 2012-2016 to assess trends among pregnant women with all stages of syphilis. Risk behavior data collected through case interviews during routine local health department investigation of syphilis cases were used to evaluate the number of pregnant women with syphilis reporting these behaviors. RESULTS: During 2012-2016, the number of syphilis cases among pregnant women increased 61%, from 1,561 to 2,508, and this increase was observed across all races and ethnicities, all women aged 15-45 years, and all U.S. regions. Of 15 queried risk factors, including high-risk sexual behaviors and drug use, 49% of pregnant women with syphilis did not report any in the past year. The most commonly reported risk behaviors were a history of a sexually transmitted disease (43%) and more than one sex partner in the past year (30%). CONCLUSION: Syphilis cases among pregnant women increased from 2012 to 2016, and in half, no traditional behavioral risk factors were reported. Efforts to reduce syphilis among pregnant women should involve increasing health care provider awareness of the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists' recommendations, which include screening all pregnant women for syphilis at the first prenatal visit and rescreening high-risk women during the third trimester and at delivery. Health care providers should also consider local syphilis prevalence in addition to individual reported risk factors when deciding whether to repeat screening.

A Comprehensive Evaluation of Obstetrics and Gynecology Residencies' Global Health Training Programs.

OBJECTIVE: To compile a comprehensive summary of obstetrics and gynecology global health training programs and to describe program type, global distribution of work, effect, and reciprocity within programs. METHODS: This cross-sectional observational study identified all U.S. obstetrics and gynecology residencies with global health training programs, described residency and program characteristics, and evaluated the publications resulting from them. Eligible articles included those published in 2011-2016 about work done in a global health training location by global health training faculty. All eligible articles were evaluated for academic effect. The inclusion of host country authors on articles served as a proxy for reciprocity. Article content was assessed to evaluate whether programs addressed Millennium Development Goals. RESULTS: Among 245 obstetrics and gynecology residencies, 196 (80%) had global health training programs. Location and faculty members were identified for 67 (34%) programs, of which 26 (39%) had global health training faculty who had published articles meeting inclusion criteria. Of 698 articles reviewed, 78% addressed at least one Millennium Development Goal, including 39% that addressed improving maternal health (Millennium Development Goal 5). Approximately half (48%) of authors were from host countries. CONCLUSION: Most obstetrics and gynecology residencies are offering global health training. The majority of programmatic work addresses Millennium Development Goals and thus is aligned with global health priorities. The effect and reciprocity of global health training programs varies across institutions. Residencies could benefit from internal analysis of their global health training programs to evaluate whether knowledge gained is being disseminated and to ensure equitable partnerships and the creation of sustainable, influential initiatives.

Outcomes of fetal intervention for primary hydrothorax.

OBJECTIVE: Primary hydrothorax is a rare congenital anomaly with outcomes ranging from spontaneous resolution to fetal demise. We reviewed our experience with fetuses diagnosed with primary hydrothorax to evaluate prenatal management strategies. METHODS: We reviewed the records of patients evaluated for fetal pleural effusions at our Fetal Treatment Center between 1996 and 2013. To define fetuses with primary hydrothorax, we excluded those with structural or genetic anomalies, diffuse lymphangiectasia, immune hydrops, and monochorionic diamniotic twin gestations. RESULTS: We identified 31 fetuses with primary hydrothorax, of whom 24 had hydrops. Hydropic fetuses were more likely to present with bilateral effusions. Of all fetuses with primary hydrothorax, 21 had fetal interventions. Survival without hydrops was 7/7 (100%), whereas survival with hydrops depended on whether or not the patient had fetal intervention: 12/19 (63%) with intervention and 1/5 (20%) without intervention. Premature delivery was common (44%) among those who had fetal intervention. CONCLUSIONS: Fetal intervention for primary hydrothorax may lead to resolution of hydrops, but preterm birth and neonatal demise still occur. Understanding the pathophysiology of hydrops may provide insights into further prenatal management strategies, including targeted therapies to prevent preterm labor.