(547) Temporal trends in gonorrhea and chlamydia infections during pregnancy: 2013-2023

Objective: Gonorrhea (GC) and chlamydia (CT) infection during pregnancy is increasing nationally. We evaluated the incidence of GC and/or CT infection in pregnancy as well as risk factors for infection over the past 11 years at single center.

Study Design: Retrospective study of all pregnant patients who delivered between 2013-2023 at large urban tertiary care center in Alabama. The primary outcome was the incidence of infection with GC, CT, or both (GC/CT co-infection) identified during pregnancy by nucleic acid amplification testing; secondary outcomes included rates of treatment, time to treatment, and reinfection rates. Outcomes were compared across the study period with linear regression to assess trends. We secondarily compared baseline characteristics between individuals with and without GC and/or CT infection using multivariable logistic regression. Tests of heterogeneity (interaction p-values) were conducted by year to assess different effects in these risk factors over the study period.

Results:

Over the study period, 40,139 patients were analyzed (no exclusions) - 1.8% had GC, 6.6% CT, and 0.8% both. Rates of infection (GC, CT, and both) significantly decreased over time (Figure, all p< 0.001). Rates of treatment were high (range 58.4%-71.7%), reinfection low (6.2%-12.9%), and did not demonstrate trends across the study period (p >0.05). Of note, time to treatment significantly decreased over the study period from a median of 5 days (IQR 0-10) to 2 days (0-4) (p< 0.001).  Multiple risk factors were associated with infection in multivariable analyses (Table). However, over time, there were only increasing risks of infection based on non-White/Black/Hispanic race/ethnicity (p-interaction=0.02) and government insurance (p-interaction=0.003).  

Conclusion: Contrary to national reports in pregnant individuals, at our urban institution, we describe decreasing rates of GC and/or CT infection. Risk factors in our population are consistent with the literature. Further larger studies to confirm or refute our findings, and identify risk factors in populations with rising infection rates should be performed.