Assessing Partner Management and Counseling in Prenatal Care of Women Diagnosed With Sexually Transmitted Infections.

Abstract

Background: Testing for sexually transmitted infections (STIs) is a routine component of prenatal care. Treating partners is challenging and the inconsistency contributes to maternal reinfection and neonatal morbidity. This study evaluated documentation of partner treatment among pregnant women diagnosed with different STIs.

Methods: This retrospective cohort study included pregnant women who received care at 2 safety-net hospitals in Harris County, TX, between 2019 and 2022. Electronic health records were reviewed for documented partner treatment among patients with chlamydia, gonorrhea, coinfection of both chlamydia and gonorrhea, hepatitis B infection (HBV), or syphilis during pregnancy. Patients with chlamydia and gonorrhea are typically offered expedited partner therapy by physicians, whereas the local health department coordinates partner treatment of HBV and syphilis. Gaps in hospital and health department records were supplemented through brief patient interviews. Multivariable Poisson regression models with robust error variance examined associations between STI and physician counseling on partner treatment, adjusting for age, race and ethnicity, marital status, preferred language, and substance use. Adjusted relative risk with 95% confidence intervals were calculated. P <0.05 was considered statistically significant.

Results: Among 369 eligible patients, physician documentation of partner treatment was highest for patients with chlamydia only (54%), followed by gonorrhea only (46%), syphilis (43%), and lowest for HBV (1%). Documented barriers to partner treatment included lack of partner contact (gonorrhea only 75%, chlamydia only 43%, syphilis 34%) and partner refusal (HBV 43%). Physician counseling on partner treatment was documented for ≥80% of patients with STIs except HBV (56%, adjusted relative risk = 0.68, compared to chlamydia only, 95% confidence interval: 0.51-0.91). Sufficient prenatal care was associated with higher partner treatment for chlamydia only (67% vs. 45%, P = 0.023).

Conclusions: Partner treatment and physician counseling vary by STI. Physician reliance on public health-managed partner treatment may hinder completion and sustain high rates of STIs during pregnancy.