Maternal Sexually Transmitted Infection Trends and Characteristics in the United States: 2018-2022

OBJECTIVES: Sexually transmitted infection (STI) rates continue to increase in the United States (US) annually. STIs during pregnancy can lead to poor pregnancy outcomes and may negatively impact a woman’s reproductive health and ability to conceive. With limited studies on STI prevalence in pregnant patients, this study aimed to report on recent national trends.

METHODS: This was a population-based cross-sectional study using birth certificate data from the US National Vital Statistics System between January 1, 2018 and December 31, 2022. All mothers who were US residents, had a live birth, and available data on chlamydia, gonorrhea, or syphilis infection before or during pregnancy were included. Rates of infection were presented as number of live births with an associated STI per 100,000 live births. Trend significance was assessed using the Cochran-Armitage test. Subgroup analyses for STI rates in 2022 were presented by age group, race, and ethnicity.

RESULTS: This study included 18,422,502 live births (mean [SD] age 29 [5.8] years). When comparing 2018 to 2022 overall rates, gonorrhea (-3%, p=0.0028) and chlamydia (-7%, p=<0.0001) decreased, while syphilis (+140%, p=<0.0001) increased. Syphilis rates continuously increased; whereas, chlamydia and gonorrhea rates peaked in 2019 and 2021 (1,870.5 and 368.1 per 100,000 births), respectively. In 2022, the overall rates of chlamydia, gonorrhea, and syphilis were 1,718.9, 300.0, and 280.4 per 100,000 births, respectively. Rates for all three STIs decreased with increasing maternal age and were highest in patients of Black race and Hispanic ethnicity with the exception of gonorrhea highest in non-Hispanic patients.

CONCLUSIONS: Among US live births, maternal rates for chlamydia and gonorrhea decreased in recent years; however, syphilis rates increased. STIs were disproportionately more common in younger and minoritized groups. Identifying patients with the greatest burden of infection may help in future efforts to lower transmission and target vulnerable populations.