Many pregnant women with sexually transmitted infections arent getting the treatment they need when they visit emergency rooms, according to a new Michigan State University study that highlights a wholly preventable risk to unborn children and raises questions about current medical guidelines.
About half of the 735 women with gonorrhea or chlamydia who visited the ERs at three hospitals in Grand Rapids, Mich. from 2008 through 2010 did not get treatment there, despite the availability of effective and relatively inexpensive antibiotics. Of the 179 who were pregnant, only 20 percent received treatment in the ER.
The problem is that it takes a few days to get lab results for those infections and many women dont return for medication, said Roman Krivochenitser, a third-year student in MSUs College of Human Medicine and lead author of the paper, published in the American Journal of Emergency Medicine. Ideally, doctors would be able to confirm a diagnosis and treat the patient while shes still in the ER, but such tests arent yet available.
A lot of patients leave a phone number thats disconnected, or they just dont pick up the phone, Krivochenitser says. The doctors are doing everything right. Its just that we dont yet have the technology for on-the-spot testing.
Diagnosing sexually transmitted infections in pregnant women is especially challenging, he added, because the symptoms of infection overlap with the signs of pregnancy.
You could do a very thorough workup to find out whats causing abdominal pain in a pregnant woman, says Krivochenitser. But if youre pregnant, theres a certain amount of abdominal discomfort we expect.
Left untreated, the infections raise the risk of preterm delivery and low birth weight, and can be passed on to the baby. The infections also can cause serious complications in the mother, such as pelvic inflammatory disease, raising the risk of infertility and dangerous ectopic pregnancy.
Such complications are rare, Krivochenitser says, but theyre also avoidable.
This is something we as health professionals can easily prevent with antibiotics, he adds.
Krivochenitser says it may be time to re-evaluate guidelines from the Centers for Disease Control and Prevention for treating sexually transmitted infections in emergency rooms, where many patients go when they dont have insurance or a family physician. The CDC has safeguards in place to prevent doctors from overprescribing antibiotics, which can breed drug-resistant organisms.
Still, if were looking at the risks and benefits, theres a more immediate risk of a pregnant patient having gonorrhea or chlamydia because it can have serious effects on the baby, Krivochenitser says. When someone visits their family physician, there may be more time to weigh those risks, but things in the emergency department move twice as fast. We have to make very quick decisions.
Krivochenitsers co-authors were MSU professor of emergency medicine and Spectrum Health physician Jeffrey Jones; David Whalen, a physician with Saint Marys Health Care; and Cynthia Gardiner, a registered nurse at the Helen DeVos Childrens Hospital.