Some Pregnant Women Face Barriers to Crucial STI Testing

Pregnancy is a time of excitement and joy—as well as uncertainty about what exactly is going on in your body. Are you healthy? Is your baby okay? For pregnant people, these questions can linger throughout the nine months.

Thankfully, some of these questions can be answered with regular STI testing. STIs can impact the health of you and your baby, but screenings (both elective and state-mandated) can make the difference.

The importance of STI screening is paramount, but women with limited healthcare access can suffer from untreated infections and the ensuing results.

"There are numerous severe risks that an undiagnosed STI can have both to a woman, but particularly her child during pregnancy," said Monica Grover, D.O., M.S., a double board-certified gynecologist at VSPOT, a medical spa specializing in vaginal health. "These STIs can range from genital herpes, gonorrhea, chlamydia, trichomonas, syphilis, hepatitis and even HIV."

The importance of STI screening is paramount, but women with limited healthcare access can suffer from untreated infections and the ensuing results.

The effects of the STI on the pregnancy, she acknowledged, vary as widely as the STIs themselves. Some, such as gonorrhea, chlamydia and trichomonas (commonly known as trichomoniasis), can lead to premature labor that can compromise fetal development and potentially survivability. Damage to the fallopian tubes—which could affect future pregnancies—is also possible. Other STIs, such as syphilis, can cause neurodevelopmental defects in the fetus.

"Herpes is important to diagnose during pregnancy, as it can cause fetal blindness if there are active lesions during delivery," Grover added.

When should pregnant women get tested for STIs?

That answer gets a little tricky, as across the U.S., individual states require STI testing at different times.

Thankfully, most STIs are easily treated, especially if the main cause of them is bacterial. Pregnant women are generally screened for HIV, hepatitis B, chlamydia and syphilis during their first prenatal visit. In fact, most states require women to be tested for syphilis during the first trimester—with the exception of Iowa, Minnesota, Mississippi, New Hampshire, North Dakota and Wisconsin.

After that, though, state laws get a bit murky. Only seven states require testing during the first and third trimester, and again at delivery, regardless of risk. Whereas Florida, Georgia, Louisiana and Massachusetts require testing during the first and third trimester, and only require it during delivery if a woman is considered high risk. Most states only require testing during the first trimester.

"During the first trimester, fetal organs are developing, and it's important to treat any STIs as quickly as possible," Grover explained. "During the third trimester, screening is important and treatment is as well so deliveries are not complicated nor any harm comes to the fetus during delivery."

Barriers to screening

The rate of testing differs greatly based on a few socioeconomic factors, namely income and race. While there are some state-mandated screenings, sexually active pregnant women in areas with lower levels of screening or limited access to healthcare facilities could be at risk.

One 2018 study specifically looked at the disparity in STIs during pregnancy between Black and white women. What they found was less a disparity between race itself, but rather that the likelihood of an STI diagnosis during pregnancy coincided with racial segregation and income inequality.

That is to say, generally, women living in co-ethnic neighborhoods, across the board, faced fewer issues with STIs during pregnancy. Furthermore, women in the most socioeconomically disadvantaged areas were more prone to STIs during pregnancy, regardless of race.

"In so far as we agree that people in the United States should have a fair opportunity to use their talents to pursue their life plans, then barriers to that opportunity may be considered unjust—particularly if the people facing those barriers are not responsible for them or if the barriers are disproportionately 'erected' for some groups of people. Ill health and a lack of healthcare may be one of those barriers," said Lisa Parker, Ph.D., director of the University of Pittsburgh's Center for Bioethics & Health Law.

Naturally, ill health and a lack of healthcare are more common in disadvantaged areas, meaning mothers living in areas more commonly associated with high rates of STIs during pregnancy also receive fewer treatment options and access to affordable care.

The consequences of untreated STIs during pregnancy can be grave. "Some of the causes of infertility may be related to a lack of access to healthcare to treat conditions that lead to infertility—for example, diabetes and hypertension can affect formation of sperm, while untreated STIs or lack of access to the vaccine for HPV can lead to problems with fertility in women," Parker said.

Women in the most socioeconomically disadvantaged areas were more prone to STIs during pregnancy, regardless of race.

She continued, "Health and healthcare disparities affecting people of color reflect concerns about the justice of conditions leading to health problems, delayed treatment or lack of treatment."

It's easy enough to say you should get regularly tested for STIs if you're sexually active, that you ought to take responsibility for your health and the health of your child—and in a perfect system, these are both true. But our system is not perfect, and for some expectant mothers, access to affordable care that promotes sexual wellness is severely limited, especially as the debate still rages about how much control women have over their bodies and sexuality.

Prices for STI testing vary widely, but can quickly get up into the hundreds of dollars for people without health insurance. Keep in mind, however, those who can't afford insurance likely don't have the spare income to afford regular STI screenings. In conjunction, these unfortunate realities perpetuate an already difficult circumstance for lower-income citizens looking to start a family.

"As the current pandemic has demonstrated quite starkly," Parker said, "access to services...like childcare or after-school programs, are not considered part of the infrastructure necessary for participation in many aspects of American life (like employment)—therefore, it is not surprising that services necessary to start or sustain a family are only available to those with greater wealth."

The biggest factor in STI testing during pregnancy is not individual responsibility or a lack of tools to do the job, it is the massive disparity in access to affordable care among different socioeconomic groups. STIs, if left untreated, can cause serious issues for expectant mothers and their children.

Grover said it would be considered medical malpractice not to test pregnant women for STIs, but the regrettable truth is that until everyone, regardless of wealth or status, has access to affordable, quality healthcare, there are going to be women whose STIs go undiagnosed and untreated, and the consequences affect their children.