Postpartum sexually transmitted disease: refining our understanding of the population at risk

Abstract

Background: Scant literature exists on sexually transmitted disease (STD) risk specific to pregnancy and postpartum. The objective of this prospective study is to examine risk factors for incident postpartum STDs among young mothers (ages, 14-25).

Methods: Pregnant women were enrolled at <24 weeks gestation (N = 848). Data were collected via in-depth interviews and STD testing conducted in the second and third trimesters and at 6 and 12 months postpartum. Prevalence and incidence of STD diagnosis in pregnancy and postpartum is described. Logistic and linear regression are used to identify risk factors for postpartum infection.

Results: Forty-four percent of enrolled women never had an STD, 29% had a history of an STD before pregnancy, 28% got an STD during pregnancy, and 27% were diagnosed with an STD postpartum. Incidence of postpartum infection was higher for women who contracted an STD in pregnancy (43%) compared with those with a prior STD (24%) or no STD (19%). In multivariate analysis, STD in pregnancy, having less than high school education, having a new sexual partner, and black race were risk factors for incident postpartum STD.

Conclusion: Prenatal providers should be aware of the significant risk of incident infection among women diagnosed with STDs in pregnancy. Elevated postpartum incidence among those with an STD in pregnancy supports a shift toward more frequent and targeted postpartum STD screening, with implications for clinical care, future research, and interventions.

Figure 1

Rates of STD by History and Timing of Infection