Pregnant women
Overview
- STIs and blood borne viruses (BBVs) in pregnancy have been associated with significant maternal and foetal morbidity and mortality, including spontaneous abortion, foetal death, premature labour, low birth weight and neonatal infection.
- Women may be unaware of their risks for infection.
- Many STIs and BBVs are asymptomatic.
- Antenatal STI and BBV testing offers the opportunity for early detection; prompt and appropriate management; prevention or reduction of adverse outcomes for the foetus or neonate; prevention of long term sequelae in the mother; informed antenatal care; patient education contact tracing.
Testing advice
| Infection | Consideration |
|---|---|
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If not high-risk, the testing guidelines recommend HBsAg testing only, with further testing with HBeAg and HBV DNA if HBsAg positive. |
| HIV | Testing should be opt-out to ensure all women have access to HIV testing in pregnancy as a routine, however informed consent must be confirmed before testing. Repeat test if patient exposed within previous 12 weeks (window period). |
| Syphilis | If clinical suspicion of syphilis, refer to the syphilis guideline. |
| Chlamydia | Consider Self-collection of samples for NAAT testingVaginal swab: instruct the patient to insert the swab into the vagina like a tampon and then remove and place into the transport tube. Rectal swab: instruct the patient to insert the swab into the anal canal 2-4cms and then remove and place into the transport tube. FPU (First pass urine): Collect approximately 20 ml (1/3 of the standard urine jar) of the first part of the urine stream in a specimen jar at the time you are consulting the patient. The patient does not need to have held their urine for more than 20 minutes prior to specimen collection. A midstream urine (MSU) or early morning specimen (i.e. first void urine) are not required for NAAT. Click here for information on how to describe self-collection technique to a patient. Treatment during pregnancy is recommended. |
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HBsAg – Hepatitis B surface antigen |
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Specimen collection
Clinician collected for NAAT/culture/microscopy
Urethral swabs for microscopy should be collected when the patient has not urinated for at least 1 hour and only if the patient has frank urethral discharge. Squeeze the urethra to express the discharge and collect on urethral swab. It is not necessary to insert the swab into the urethra.
Rectal swabs should be collected by inserting a sterile swab 2-4cms into the anal canal and moving the swab gently side to side for 10-20 seconds.
Pharyngeal swabs should be collected from the tonsils and oropharynx.
High vaginal swab of vaginal discharge smeared onto a glass slide, air dried and sent for microscopy. Swab inserted into transport medium for culture.
Self-collection of samples for NAAT testing
Vaginal swab: instruct the patient to insert the swab into the vagina like a tampon and then remove and place into the transport tube.
Rectal swab: instruct the patient to insert the swab into the anal canal 2-4cms and then remove and place into the transport tube.
FPU (First pass urine): Collect approximately 20 ml (1/3 of the standard urine jar) of the first part of the urine stream in a specimen jar at the time you are consulting the patient. The patient does not need to have held their urine for more than 20 minutes prior to specimen collection. A midstream urine (MSU) or early morning specimen (i.e. first void urine) are not required for NAAT.
Click here for information on how to describe self-collection technique to a patient.
Clinical indicators for testing
- Many tests are conducted as routine antenatal screening, and HIV, syphilis, hepatitis B and chlamydia testing should be seen as part of the routine antenatal screen.
- Bearing in mind sensitive risk indicators may not be revealed in an antenatal setting, testing should be guided by risk assessment where possible; consider also particular at risk groups such as women <30yrs, people who inject drugs (PWID), Aboriginal and Torres Straight Islander people, those with a recent partner change, and local epidemiology.
- Routine screening is not recommended for herpes, human papillomavirus (HPV) or bacterial vaginosis, however management should be considered if clinical suspicion exists, as recommended.
Follow up
If test results are positive, refer to STI management section for advice on:
Test of cure (TOC)
In the event of a positive test result for syphilis or chlamydia, TOC should be considered following treatment. Contact tracing for all sexual partners is essential.
Retesting
Where continued risk is identified during pregnancy, consider retesting prior to delivery (about 36 weeks).
Even if all test results are negative, use the opportunity to:
- Educate about condom use and risk minimisation
- Vaccinate for hepatitis B postnatally
- Discuss vaccination for hepatitis A postnatally
- Discuss and activate reminders for regular testing according to risk, especially if their behaviours indicate the need for more frequent testing.
Auditable outcomes
- 90% of pregnant women <30years have antenatal screening for chlamydia and gonorrhoea.
- 100% of pregnant women tested for HIV and hepatitis B.