Maternity Care Calendar and Guidelines: Screening for Gonorrhea

Current MCC Guideline (1998):

Consider screening for gonorrhea by cervical culture
in bold font
listed under "Investigations" for early pregnancy
if high risk: repeat screening for gonorrhea in third trimester
in plain font
listed under "Investigations" between 20 and 40 weeks

Literature Search:
Not done

Summary of Evidence:
Canadian Task Force on Preventive Health Care (CTFPHC):

There is good evidence to screen individuals at high risk including people under age 30 with at least 2 sexual partners in the past year or age < 16 years at first intercourse, prostitutes, sexual contacts of individuals known to have an STD (A recommendation) ¹
Fair evidence not to screen the general population (D recommendation)

Notes:

The report does not specifically deal with the issue of screening in pregnancy
The report found fair evidence to provide counselling or educational materials to prevent the spread of gonorrhea (B recommendation)
IM ceftriaxone, oral quinolones, cefuroxime axetil are options for therapy. (oral quinolones are contraindicated in pregnancy). Treatment against chlamydia should be initiated at the same time because of the high frequency of co-infection.

U.S. Preventive Services Task Force (USPSTF)

Routine screening for gonorrhea is recommended at the first prenatal visit for pregnant women at high risk of infection (B Recommendation) ² High risk group include commercial sex workers, women with a history of repeated episodes of gonorrhea, women under age 25 with 2 or more sex partners in the previous year and possibly sexually active young women in areas of high prevalence.
An additional test in the third trimester is recommended for those at continued risk of acquiring gonorrhea.
There is insufficient evidence to recommend for or against universal screening of pregnant women (C recommendation)

Recommendations of Others:

Recommendations from the Centers for Disease Control and Prevention: The CDC released STD treatment guidelines in 2002, stating that a test for Neisseria gonorrhoeae should be performed at the first prenatal visit for women at high risk or women living in an area of high prevalence. ³ A repeat test should be performed during the 3rd trimester for those at continued risk.

Notes

Pregnant women should not be treated with a quinolone or tetracyclines. Infected women should be treated with a cephalosporin or a single 2 g dose of spectinomycin IM.

American College of Obstetricians and Gynecologists (ACOG):

Pregnant women with risk factors or symptoms for gonorrhea should be cultured for Neisseria gonorrhoeae at an early prenatal visit. A repeat culture should be obtained in the third trimester for women at increased risk for gonorrhea and other STDs. ⁴

Society of Obstetricians and Gynaecologists of Canada (SOGC):

Screening of high risk populations by cervical culture at the first visit and if symptomatic (cervicitis). ⁵

Conclusions:
The new guideline on the MCC will be as follows:

Screen women at high risk for gonorrhea
It will be listed in bold font
It will be listed under "Investigations' suggested for the first prenatal visit consistent with the USPSTF and CDC recommendations (although screening may also be appropriate at the preconception visit)

If high risk: repeat screening for gonorrhea in third trimester
The recommendation will be in plain font as the optimal frequency and timing of gonorrhea screening has not yet been defined.
It will be listed under "Investigations" to be considered in later pregnancy (20-40 weeks)

Reviewer: Colleen Kirkham, January 2003

1/30/03 11:29 AM

¹ Beagan BL, Wang EEL. Prevention of gonorrhea. In: Canadian Task Force on the Periodic Health Examination. Canadian Guide to Clinical Preventive Health Care. Ottawa: Health Canada, 1994;720-29.
² U.S. Preventive Services Task Force. Guide to clinical preventive services, 2nd ed. Baltimore: Williams & Wilkins, 1996. (http://www.ahcpr.gov/clinic/uspstfix.htm)
³ Centers for Disease Control and Prevention. Sexually transmitted disease treatment guidelines 2002. MMWR 2002;51 (No. RR-6):1-84 (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5106a1.htm)
⁴ Guidelines for Perinatal Care, Fourth Edition. American Academy of Pediatrics, The American College of Obstetricians and Gynecologists. 1997
⁵ SOGC Clinical Practice Guidelines. No 71. Healthy Beginnings: guidelines for care during pregnancy and childbirth. 1998 (http://www.sogc.org/sogcnet/sogc%5Fdocs/common/guide/doorway/68.html)