Lost opportunity to save newborn lives: variable national antenatal screening policies for Neisseria gonorrhoeae and Chlamydia trachomatis

Abstract

Unfavorable pregnancy outcomes caused by Chlamydia trachomatis or Neisseria gonorrhoeae infection are well known. The first step in addressing antenatal C. trachomatis and N. gonorrhoeae infection is a national policy to screen all pregnant women for C. trachomatis and N. gonorrhoeae, regardless of symptoms. The aim of this study was to inform policy makers on the presence of antenatal screening recommendations for C. trachomatis and N. gonorrhoeae infection. We conducted a three-part study from June 2015 to February 2016. We analyzed English and French language information online on Ministry of Health websites regarding C. trachomatis and N. gonorrhoeae antenatal screening. We referenced both primary official country and regional policy documents. We contacted the Ministry of Health directly if the information on the national antenatal screening was outdated or unavailable. In parallel, we sent a survey to the regional representative from the World Health Organization to help collect country-level data. Fourteen countries have current policies for antenatal screening of C. trachomatis and/or N. gonorrhoeae infection: Australia, the Bahamas, Bulgaria, Canada, Estonia, Japan, Germany, Latvia, New Zealand, Democratic People's Republic of Korea, Romania, Sweden, the United Kingdom, and the United States. Australia, New Zealand, and Latvia and the United States restricted antenatal screening to women ≤25 years old and those of higher risk. Several countries responded that they had policies to treat pregnant women with symptoms. This is the currently recommended WHO guideline but is not the same as universal screening. North Korea had policies in place which were not implemented due to lack of personnel and/or supplies. National level policies to support routine screening for C. trachomatis and N. gonorrhoeae infection to prevent adverse pregnancy and newborn outcomes are uncommon.

Keywords: Chlamydia (Chlamydia trachomatis); gonorrhea (Neisseria gonorrhoeae); prevention; screening; women.

Figure 1.

(a) Thirteen countries have policies to provide laboratory screening for CT among pregnant women (2015). (b) Eight countries have policies to provide laboratory screening for NG among pregnant women (2015).