September/October - West Virginia State Medical Association

| Scientific Article
Methods
Approval was obtained from
the Institutional Review Board
before beginning our research.
A retrospective chart review
was performed on patients seen
at University Obstetrics and
Gynecology office and the Cabell
Huntington Hospital Obstetrics
and Gynecology clinic from May
2005-November 2007. We included
patients ≤25 years of age tested for
CT using endocervical Gen-Probe at
their initial prenatal visit and again
at 34-36 weeks gestation. Gen-Probe
PACE 2C system is a rapid DNA
probe test which utilizes nucleic
acid hybridization to screen for the
presence of CT. The sensitivity is
92.6 and specificity 99.810. Results
of the CT testing from the initial
visit and the 34-36 week visit were
recorded. Patients were excluded
if they were >25 years old or did
not have both the initial CT testing
as well as the 34-36 week test.
Results
One hundred eighty one (181)
patients were included in the study.
On the initial screen 175 patients
tested negative for CT. Six patients
tested positive for CT on the initial
screen and were treated. At 34-
36 weeks, of the 175 patients that
originally tested negative, 170 tested
negative again and 5 tested positive
for CT. Of the six patients who tested
positive at the initial screen, 5 were
negative and 1 remained positive at
the 34-36 week screen. See figure 1.
A chi squared test of statistical
significance was performed on the
data. P-value was >0.05 meaning that
having a negative initial screen was
not predictive of having a negative
result upon re-testing at 34-36 weeks.
Discussion
The results of our study indicate
that first trimester Chlamydia
trachomatis test results are not
predictive of CT status during
the third trimester. This finding
was contrary to our hypothesis of
re‐screening for CT during the 3rd
trimester is probably of low yield.
The risk of complications in
the newborn due to maternal CT
infection is significant. An infant
born to an infected mother has a
50-70% chance of acquiring the
infection during a vaginal delivery. 4
Neonatal conjunctivitis occurs
in 20-50% of exposed infants. 5
Unrecognized neonatal conjunctivitis
may persist for months and cause
corneal and conjunctival scarring. 8
Pneumonia develops in 10-20%
of exposed infants. 5 This infection
causes fever and cough that interfere
with feeding. Respiratory distress
may also result. If left untreated,
pneumonia caused by CT can result
in chronic pulmonary disease. 4 There
is conflicting evidence regarding the
association of CT with preterm labor. 3
It has been demonstrated that
screening for and treating CT
infections decreases neonatal and
postnatal complications. 6,7 During
the study period, new guidelines
were published that recommended
repeat testing during the 3rd
trimester for all patients ≤25 years
old and those at high-risk of
acquiring CT. 9 The results of our
study support this recommendation.
In light of the significant neonatal
and postnatal complications, as
well as a lack of evidence linking
CT with preterm labor, it is just as
important, if not more important,
to screen for Chlamydia trachomatis
during the third trimester rather
than the first trimester.
References
1. Center for Disease Control. 2006 STD
Surveillance Report.
2. United States Preventative Services Task
Force Guidelines: Screening for chlamydial
infection.
3. Andrews, et al. Midpregnancy
genitourinary tract infection with Chlamydia
trachomatis: association with subsequent
preterm delivery in women with bacterial
vaginosis and Trichomonas vaginalis.
American Journal of Obstetrics and
Gynecology; 2006.194:493.
4. Zar, H.J. Neonatal Chlamydial Infections.
Pediatric Drugs, 2005;7(2):103-10.
5. Remington and Klein. Infectious Disease of
the Fetus and Newborn, 5th edition. 2001.
W.B. Saunders Company. p770.
6. Rours, et al. Sexually Transmitted Infection
2006.
7. Ismail, et al. Role of Chlamydia
trachomatis in postpartum endometritis.
Journal of Reproductive Medicine, 1987
April;32(4):280-4.
8. Forester, et al. Late follow-up of patients
with neonatal inclusion conjunctivitis.
American Journal of Opthomology. 1970;
69:467.
9. American Academy of Pediatrics and
American College of Obstetrics and
Gynecologists. Guidelines for Perinatal
Care. 6th edition. 2007.
10. Gen-Probe PACE 2C System Package
Insert.
11. Weinstock, H, Berman, S, Cates, W, Jr.
Sexually Transmitted Diseases among
American Youth: Incidence and Prevalence
Estimates, 2000. Perspect Sex Reprod
Health, 2004:36(1):6-10.
September/October 2010 | Vol. 106 11