From the Research
Yes, a patient who has delivered without prenatal care should receive STI testing postpartum. The recommended tests include screening for gonorrhea, chlamydia, syphilis, HIV, and hepatitis B. These tests should be performed as soon as possible after delivery, ideally before discharge from the hospital. For gonorrhea and chlamydia, nucleic acid amplification tests from cervical or vaginal swabs are preferred 1. Syphilis testing should include both nontreponemal (RPR or VDRL) and treponemal tests. HIV and hepatitis B surface antigen testing should also be completed. If any tests are positive, appropriate treatment should be initiated promptly - for example, ceftriaxone 500mg IM for gonorrhea, doxycycline 100mg twice daily for 7 days for chlamydia, or benzathine penicillin G for syphilis, as recommended by the 2021 CDC guidelines 2.
Testing is crucial even after delivery because detecting and treating STIs can prevent complications for the mother and reduce the risk of transmission to the newborn. Some infections like HIV or hepatitis B may require interventions for the newborn even after birth to prevent vertical transmission. Additionally, identifying these infections allows for appropriate follow-up care and partner notification to prevent reinfection. The importance of STI testing is further emphasized by the increasing rates of STIs in the US, with approximately 1 in 5 adults having an STI in 2018 1.
Key considerations for STI testing include:
- Using nucleic acid amplification tests for gonorrhea and chlamydia
- Including both nontreponemal and treponemal tests for syphilis
- Completing HIV and hepatitis B surface antigen testing
- Initiating prompt treatment for positive tests
- Providing appropriate follow-up care and partner notification to prevent reinfection.
By prioritizing STI testing and treatment, healthcare providers can help reduce the morbidity, mortality, and quality of life impacts associated with these infections, as highlighted in recent studies 2, 1.