Pregnant women are screened more aggressively for STDs than nonpregnant
women because of the increased risk for adverse outcomes, including
preterm delivery (resulting in low-birth-weight infants) and premature
rupture of membranes (resulting in increased risk for chorioamnionitis).
At the first prenatal visit all women should be screened for chlamydia
and gonorrhea with an NAAT, and blood should be tested for syphilis
(RPR or VDRL). Although HSV-2 antibody screening is not routinely
recommended, a thorough history assessing risk for genital herpes—including
prior episodes of genital ulcer disease, vesicular lesions, or recurrent
urogenital symptoms of burning, pain, or erythema—is strongly
recommended. If a current or prior sex partner has or had genital herpes,
HSV-2 antibody screening is recommended. In most states, pregnant
women must be offered HIV testing with the option to decline (“opt-out” testing).
In asymptomatic pregnant women, evaluation of vaginal fluid for
the presence of trichomoniasis or bacterial vaginosis is recommended
in women who are at increased risk for an adverse pregnancy outcome,
primarily defined as women with a history of preterm delivery. Two
studies have demonstrated no benefit and perhaps harm in asymptomatic
low-risk pregnant women who were screened and treated for bacterial
vaginosis or trichomoniasis.