Canadian Guidelines on Sexually Transmitted Infections

Supplementary statement for recommendations related to the diagnosis, management, and follow-up of Pregnant Women: March 2014

Key Issue

The Gonococcal Infections chapter has been revised in response to emerging antimicrobial resistance. As a result, the 2010 print and online versions of the Pregnancy chapter of the Canadian Guidelines on Sexually Transmitted Infections also require updates.

This statement is intended to inform clinicians of key changes in the management of gonococcal infections in pregnant women until such time as the full chapter revision is available.

Diagnosis

  • Evaluation of pregnant women and the need for clinicians to have a lower threshold for screening for sexually transmitted infections remains the same as outlined in the current chapter with the exception of the following laboratory testing considerations:
    • Detection of N. gonorrhoeae or C. trachomatis may be enhanced by the use of nucleic acid amplification tests (NAAT). Culture for N. gonorrhoeae is strongly recommended to evaluate pregnant women as it allows for antimicrobial susceptibility testing. Consideration should be given to collection of samples for both culture and NAAT.

Treatment

  • In pregnant women who have a suspected or confirmed gonococcal infection, treatment should include combination therapy, in response to increasing antimicrobial resistance.
    • Combination therapy using medications with two different mechanisms of action is thought to improve treatment efficacy as well as to potentially delay the emergence of cephalosporin-resistant gonorrhea.
    • This combination therapy also includes effective treatment for concomitant chlamydia infection, which occurs frequently.
    • Table 2 in the current Pregnancy chapter is out of date and should not be used to guide treatment decisions.
    • Refer to Table 7 in the Gonococcal Infections chapter for treatment recommendations and to the Follow-up section for test of cure recommendations.

Follow-up

  • Those who have confirmed gonococcal infection should be reported to local public health and followed up as per the recommendations in the Partner notification and Follow-up sections of the Gonococcal Infections chapter.
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