Of notiiable STDs, infections caused by Neisseria gonorrhoeae are the second most common. The incidence of gonorrhea in the United States has continued to rise since 2009, and in 2015, the rate was 124 cases per 100,000 persons (Centers for Disease Control and Prevention, 2016c). he highest rates in women of any ethnicity were in those aged 15 to 24 years. In pregnant women, its prevalence approximates 0.6 percent (Blatt, 2012). In most pregnant women, infection is limited to the lower genital tract-the cervix, urethra, and periurethral and vestibular glands. Acute salpingitis is rare in pregnancy. But, pregnant women account for a disproportionate number of disseminated gonococcal infections (Bleich, 2012).
Gonococcal infection can have deleterious efects in any trimester. Untreated gonococcal cervicitis is associated with septic abortion as well as infection after voluntary abortion (Burkman, 1976). Preterm delivery, prematurely ruptured membranes, chorioamnionitis, and postpartum infection are more frequent in women with gonococcal infection (lger, 1988; Johnson, 2011).
Vertical transmission of gonorrhea is predominantly due to fetal contact with vaginal infection during birth. he predominant sequela is gonococcal ophthalmia neonatorum, which can lead to corneal scarring, ocular perforation, and blindness. Transmission rates are high and approximate 40 percent (Laga, 1986). Accordingly, as discussed in Chapter 32 (p. 613), ocular prophylaxis is provided to newborns (Mabry-Hernandez, 2010).
Pregnant women who live in high-prevalence areas or who are at risk for gonorrhea should undergo irst-trimester screening. Risk factors include age �25 years; prior gonococcal infection; other STDs; prostitution; new or multiple sexual partners; drug abuse; black, Hispanic, or American Indian or laska Native ethnicity; and inconsistent condom use (American Academy of
Pediatrics, 2017). For women who test positive, screening for syphilis, chlamydial infection, and HIV should precede treatment, if possible. Gonococcal infection is a marker for concomitant chlamydial infection. Thus, if chlamydial testing is unavailable, presumptive chlamydial therapy is given to women treated for gonorrhea.
Screening for gonorrhea in women is by culture or nucleic acid ampliication tests (NAATs). NAATs have replaced culture in most laboratories, and kits are available for specific collection from the vagina, en do cervix, or urine. Of these, vaginal or cervical samples are preferred, as urine collection may detect up to 10 percent fewer infections (Papp, 2014). If used, the initial urine stream, not midstream, is collected. NAATs are also recommended for diagnosis of rectal or pharyngeal disease, but participating laboratories must be CLIA (Clinical Laboratory Improvement Amendments) compliant with required test modifications. Culture is also available for these anatomical sites. Rapid POC tests for gonorrhea, although available, do not yet reach the sensitivity or specificity of culture or NAAT and have not been rigorously studied in pregnant women (Herbst de Cortina, 2016).