Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Obstetrics and Gynecology, Parkland Health and Hospital Systems, Dallas, TX.
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Obstetrics and Gynecology, Parkland Health and Hospital Systems, Dallas, TX.
Am J Obstet Gynecol. 2021 Sep;225(3):325.e1-325.e7. doi: 10.1016/j.ajog.2021.04.238. Epub 2021 Apr 22.
Expedited partner therapy for Chlamydia trachomatis has had mixed efficacy in different populations, but limited data exist on the efficacy of the therapy in a pregnant population.
This study aimed to evaluate the real-world effectiveness of establishing a prenatal expedited partner therapy program in eradicating chlamydia before delivery and to examine the maternal and neonatal outcomes between women who received expedited partner therapy for chlamydia and women who received standard partner referral testing and treatment during pregnancy.
An expedited partner therapy program was implemented on August 21, 2019, at a public hospital in a county with high chlamydia prevalence. Pregnant women were provided with single-dose packets of azithromycin to treat partners following a diagnosis of chlamydia infection. We prospectively observed pregnant women treated in the expedited partner therapy program who delivered at our institution in the same year and compared the outcomes with a historic cohort from the previous year that had traditional partner referral testing and treatment. We excluded women with concurrent gonorrhea, HIV, syphilis, or current intimate partner violence. The primary outcome was chlamydia reinfection or no-cure rates at repeat testing in 4 to 6 weeks following treatment or at the 36-week prenatal care screening. Secondary outcomes included obstetrical, maternal, and neonatal outcomes, including premature rupture of membranes, chorioamnionitis, endometritis, neonatal intensive care unit admission, neonatal sepsis, pneumonia, and conjunctivitis.
The rate of chlamydia infection was 3.6% over a 2-year period in our delivered population. In the year following the implementation of the expedited partner therapy, compared with 419 women (mean±standard deviation, 23.4±5.5 years) who were diagnosed with chlamydia infection in the previous year, 471 women (mean±standard deviation age, 23.8±5.3 years) who delivered at our institution were diagnosed with chlamydia infection. There was no difference in race, parity, prenatal care attendance, or concomitant sexually transmitted infections. Compared with the pre-expedited partner therapy group, the rate of reinfection in the post-expedited partner therapy group was not statistically different (60/471 [13%] vs 61/419 [15%]; odds ratio, 0.86 [95% confidence interval 0.58-1.26]). In a per-protocol analysis, 72 women (17%) in the pre-expedited partner therapy group and 389 women (83%) in post-expedited partner therapy group received expedited partner therapy; reinfection was not statistically different between groups (P=.47). There was no difference in secondary outcomes, although a trend toward improved rates of endometritis was noted in the post-expedited partner therapy group (odds ratio, 0.13; 95% confidence interval, 0.02-1.02).
The implementation of a prenatal expedited partner therapy program did not affect the rate of chlamydia reinfection before delivery. Treatment of chlamydia in an inner-city population has multiple factors that lead to successful treatment. Future efforts to reduce sexually transmitted infection and chlamydia reinfection rates in an at-risk population should include exploring patient education and safe sex practices beyond expedited partner therapy alone during pregnancy.
在不同人群中，针对沙眼衣原体的性伴侣治疗的效果不一，但在孕妇人群中，关于该疗法疗效的数据有限。
本研究旨在评估在分娩前建立产前性伴侣治疗方案以消除衣原体的真实世界效果，并研究接受衣原体性伴侣治疗的女性与接受常规性伴侣转诊检测和治疗的女性之间的母婴结局。
2019 年 8 月 21 日，在一个衣原体流行率较高的县的一家公立医院实施了性伴侣治疗方案。为诊断出衣原体感染的伴侣提供单剂量阿奇霉素治疗。我们前瞻性观察了当年在我院分娩的接受性伴侣治疗的孕妇，并将其结果与前一年接受传统性伴侣转诊检测和治疗的历史队列进行比较。我们排除了同时患有淋病、艾滋病毒、梅毒或当前存在亲密伴侣暴力的女性。主要结局是治疗后 4 至 6 周或 36 周产前保健筛查时重复检测的衣原体再感染或未治愈率。次要结局包括产科、母体和新生儿结局，包括胎膜早破、绒毛膜羊膜炎、子宫内膜炎、新生儿重症监护病房入院、新生儿败血症、肺炎和结膜炎。
在我们的分娩人群中，在 2 年期间，衣原体感染率为 3.6%。在实施性伴侣治疗方案的次年，与 419 名（平均±标准差，23.4±5.5 岁）在去年诊断出衣原体感染的女性相比，471 名（平均±标准差年龄，23.8±5.3 岁）在我院分娩的女性被诊断出衣原体感染。种族、产次、产前保健就诊率或同时发生的性传播感染无差异。与性伴侣治疗前组相比，性伴侣治疗后组的再感染率无统计学差异（60/471[13%]比 61/419[15%]；比值比，0.86[95%置信区间 0.58-1.26]）。在一项符合方案分析中，性伴侣治疗前组有 72 名（17%）女性和性伴侣治疗后组有 389 名（83%）女性接受了性伴侣治疗；两组间再感染无统计学差异（P=.47）。次要结局无差异，但性伴侣治疗后组子宫内膜炎发生率呈下降趋势（比值比，0.13；95%置信区间，0.02-1.02）。
在产前实施性伴侣治疗方案并未影响分娩前衣原体再感染率。在城市内人群中治疗衣原体感染有多种因素导致治疗成功。未来减少高危人群中的性传播感染和衣原体再感染率的努力应包括探索在孕期仅进行性伴侣治疗之外的患者教育和安全性行为实践。
