Which infectious disease screenings are recommended during pregnancy?

Infectious Disease Screening in Pregnancy

All pregnant women should be universally screened for hepatitis B, syphilis, HIV, chlamydia, and gonorrhea at the first prenatal visit, with additional third-trimester and delivery screening for syphilis and gonorrhea/chlamydia in high-risk populations.

Universal Screening Tests (All Pregnant Women)

First Prenatal Visit - Required Screening:

• Hepatitis B Surface Antigen (HBsAg) - Grade A recommendation 1

  • Screen at first prenatal visit regardless of previous vaccination or negative test results
  • Repeat at delivery if unknown status or new risk factors (injection drug use, STD treatment)
  • Sensitivity and specificity >98%
  • Critical for preventing perinatal transmission through immediate postpartum prophylaxis

• Syphilis Serology - Grade A recommendation 2

  • Use nontreponemal tests (VDRL or RPR) initially, followed by confirmatory treponemal test (FTA-ABS or TPPA)
  • Universal screening prevents stillbirth, neonatal death, bone deformities, and neurologic impairment
  • High-risk women require repeat testing at 28 weeks AND at delivery

• HIV Screening - Recommended universally 3

  • Screen at first prenatal visit
  • Screening coverage reaches 82.4% in practice 3

• Chlamydia Screening - Recommended universally 3

  • Screen at first prenatal visit
  • Current screening coverage approximately 80.4% 3

• Gonorrhea Screening - Recommended universally 3

  • Screen at first prenatal visit
  • Current screening coverage approximately 79.5% 3

Risk-Based Screening

• Trichomoniasis - Only for high-risk populations 3
  • Screening coverage is substantially lower (22.4%), reflecting its risk-based rather than universal recommendation

High-Risk Populations Requiring Repeat Testing

Third Trimester (28 weeks) and Delivery Screening:

High-risk criteria include:

• Uninsured women
• Women living in poverty
• Sex workers
• Illicit drug users
• Communities with high STI morbidity
• Southern U.S. residents or certain metropolitan areas
• Hispanic and African-American populations (higher prevalence)
• History of other sexually transmitted diseases
• Injection drug use
• Recent STD evaluation or treatment

For these women, repeat syphilis, chlamydia, and gonorrhea screening at 28 weeks and delivery 2.

Critical Implementation Points

Common Pitfalls to Avoid:

1. Hepatitis B screening must occur in EVERY pregnancy - even if previously vaccinated or tested negative 1
2. Use the same nontreponemal test for syphilis follow-up - ensures comparable titers 2
3. Inadequate prenatal care is the strongest predictor of missed screening 4 - screen at delivery if no prenatal records
4. HIV screening gaps remain significant - only 82.4% coverage despite universal recommendations 3
5. Results must be in labor/delivery records - establish systems for accurate transfer of maternal test results 1

Age-Related Considerations:

Screening rates decline with increasing maternal age for chlamydia, gonorrhea, and trichomoniasis 3, but age should not determine screening - all pregnant women require universal screening for the core infections.

Treatment Implications

• Hepatitis B positive: Infant receives vaccine + hepatitis B immune globulin within 12 hours of birth 1
• Syphilis positive: Parenteral benzathine penicillin G; penicillin-allergic women require desensitization 2
• Unknown status at delivery: Treat as positive until proven otherwise

State Mandates

Most states legally mandate screening for these infections during pregnancy, with many requiring screening at delivery 2. This underscores the public health importance of universal screening.