194 Treatment of gonorrhea in pregnancy
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300 SPO Abstracts 193 HEPATITIS B SCREENING IN A NONINDIGENT POPULATION M.MEYER" P.Mead", E.Cape1ess Dept. OB/GYN University of Vermont, Burlington, Vt. The recommendation for universal hepatitis B screening was based on data from inner city obstetric services serving populations that may be different from many other obstetric groups. The purpose of this study was to evaluate a non- indigent obstetric population to test the following hypotheses: (1) the incidence of the HBsAg carrier state is low in this population and (2) HBsAg carriers in this population can be identified by screening high risk groups. The Medical Center Hospital of Vermont serves a population that is 98.6% caucasion. Fifteen percent of the obstetric population had Medicaid or no insurance. Routine antepartum screening for HBsAg was begun one year prior to the study period. An enzyme monoclonal immunoassay was used, with positives confirmed by inhibition assay (AUZYME, Abbott). The study period was 5/89-4/90, during which 2822 mothers were delivered. Statistics sheets completed immediately after delivery were used to obtain HBsAg results. The chart of each patient with a positive screen was reviewed. Screening information from 2696 (95.5%) mothers was available. HBsAg screens were positive in 2 patients (0.07%), negative in 2167 (80.4%) and were not done in 529 (19.6%). One positive patient was from Korea, the other was an admitted IV drug abuser. Of those patients not screened, 97% had private insurance. The cost of screening this population at $13.50/screen was $29,282, with the only positives being in recognized high risk groups. These data support the hypotheses that in our population, over the period studied (1) the incidence of HBsAg carriers is low and (2) HBsAg carriers would have been identified by screening only high risk groups. 194 TREATMENT OF GONORRHEA IN M. Cavenee: R. Ferris,x S. Rawlins,x J. Mayfield, G. Wendel, Dept. Ob/Gyn, Univ. Texas Southwestern Med. Ctr. & Dallas County Health Dept., Dallas, TX An open, randomized, prospective study was undertaken at Parkland Memorial Hospital from 1/1/90 to 8/31/90 to compare the efficacy of the untested 1989 Centers for Disease Control (CDC) guidelines for the treatment of gonorrhea in pregnancy. Gravidas had pretreatment Neisseria gonorrhoeae (NG) cultures of the cervix, rectum, and pharynx. A cervical specimen for direct fluorescent antibody testing for Chlamydia trachoma tis (CT) was also obtained. Patients received one of three regimens (ceftriaxone 250 mg 1M, spectinomycin 2.0 grn 1M, or amoxicillin 3.0 gm p.o. plus probenecid 1 gm p.o.) and had follow-up 4-7 days later. At follow-up, repeat cultures were taken from any prior positive site. Patients were excluded for penicillin allergy, lack of follow-up or negative pretreatment NG cultures. All failures were re-treated with ceftriaxone. 71 of 105 (68%) women enrolled were available. 28% of the women had positive CT testing. Treatment results: Infection # Cured # Treated % Site eftriaxone Amox+Proben pectinomvcin Cervix 21/21 (100) 24/27 (89) 21/22 (95) Pharynx 2/2 (100) 1/1 (100) 2/2 (100) Rectum 3/3 (100) 8/9 (89) 4/4 (100) All subjects 22/22 (100) 24/27 (89) 21/22 (95) p-lactamase 2/2 (100) 2/2 (100) % (-) These preliminary results reveal no significant difference (p>0.05) in the efficacy of the three treatment regimens, and confirm the efficacy of the 1989 CDC guidelines for the treatment of NG in pregnancy. 195 January 1991 Am J Obstet G} necol PERINATAL TRANSMISSION OF IUWI IIIIUNOOEFICIENCY VIRUS (HIV) IN TVIN GESTATIONS. RR Viscarello, NJ DeGennaro', L Capobianco', and JC Hobbi ns, Dept. of DB/GYN, Yale Uni versi ty, New Haven. CT. The rate of vertical transmission of HIV from mother to fetus is estimated to be from 24-33%. Can gem tal infection with HIV resul ts ina spectrum of neonatal symptomo logy characteri zed by unusual or recurrent infections. VariabIlity in the clinical manifestations of congenital HIV infection has been reported in discordant monozygotic twins. We describe the transmission of HIV infection in 11 twin gestations. All 10 mothers (1 delivered 2 sets) were multIgravidae WIth a mean age of 28 yrs. HIV risk assessment revealed 8 former or current intravenous drug abusers (IVDA) and 2 were heterosexual partners of IVDA. None of the mothers had AIDS; 1 had ARC; and 9 were seropositive but asymptomatic. There were 8 sets of viable. diamniotic/ dIchorionic twins born between 26-39 wks gestation with a mean bi rth wei ght of 1828g. Sex of the infants was concordant in 9 pregnanci es (11: f. 9 :m), unknown in 1. and dl fferent ; n 1 pregnancy. Placental pathology was unavai lable in the 4 remaining cases, including 3 women who delivered previable Infant pairs at 16. 21. & 23 wks. EIght of the mothers delivered vaginally. including 10 NSVD; 4 breech; and 2 low forceps. In 1 pregnancy. twin A was born vaginally and twin B by c/section. The 2 remaining sets were born by c/section. A total of 16 viable Infants were born. One child has died of SIDS at 11 mas. All infants were seropOSItive by Western blot at bi rth. Current 1y 3 sets of twi ns have concordantl y seroreverted (mean follow up = 44 mas); 2 sets are discordant (Ab-pos/Ab-neg) at 86 mas; 1 concordant set who remains weakly positive at 12 mas (twIn A is antigenemic); and 2 sets remaIn seroposit I ve at 4 and 10 mos post-deli very. Three infants are currently symptomatic. while 6 are CDC classification PO WIth a mean duration of follow up of 8 mos. HIV p24 antigen assay was performed inS sets of tWI ns. Ant i gen was detected inane child who was delivered by c/section and has LIP. We observed a 75% concordant rate among twi ns wi th respect to HIV infect ion. All (6 of 6) same-sex twins were concordant for infection. while 50% (1 of 2) opposite-sex twin pairs were discordant. Our results suggest a 25% perinatal transmIssion rate among twin gestations. similar to that of singleton pregnancies. 196 EVALUATION OF TWO RAPID TESTS FOR DETECTION OF GROUP B STREPTOCOCCUS IN LABOR AND DELIVERY PATIENTS M.A. Skoll. B. Mercer, V. BaseIskix, P. GrayX, G. Ryan X , B. Sibai. University of Tennessee, Mempbis. This study compares two tests available for the rapid diagnosis of Group B Streptococcus (GBS) colonization in pregnant patients presenting to the labor and delivery unit. Equate™ Strep B test (BINAX) uses solid phase immunoassay of nitrous acid extracted swabs. Streptex™ (Burroughs Wellcome Co.) uses latex agglutination on protease treated swab extracts. Over a 4 month period, 1062 patients admitted to labor and delivery underwent speculum examination with collection of Culturette IITM vaginal swabs. All samples for culture were rapidly plated on nonselective blood agar. Swabs for rapid tests were refrigerated and hatched for daily runs. Each sample for rapid test was compared to the corresponding culture. A total of 105 patients (9.9'11i) had a positive culture. Rapid test results were : SENSITIVITY SPECIFICITY EQUATE 20/93(21.S'IIi) 947/956(99.1 'IIi) STREl'I'EX 14193(15.1 'IIi) 9621967(99.5 'IIi) 69'11i 92.U 73.7'11i 92.4'J1i Sensitivities of Equate and Streptex were 4.5'11i and O'lli in patients with colonies of GBS and 36.7'11i and 28.5'11i respectively in patients with >50 colonies. We conclude that these tests are not sufficiently sensitive for use in this clinical setting. *Positive predictive value **Negative predictive value
Transcript of 194 Treatment of gonorrhea in pregnancy
300 SPO Abstracts
193 HEPATITIS B SCREENING IN A NONINDIGENT POPULATION M.MEYER" P.Mead", E.Cape1ess Dept. OB/GYN University of Vermont, Burlington, Vt.
The recommendation for universal hepatitis B screening was based on data from inner city obstetric services serving populations that may be different from many other obstetric groups. The purpose of this study was to evaluate a nonindigent obstetric population to test the following hypotheses: (1) the incidence of the HBsAg carrier state is low in this population and (2) HBsAg carriers in this population can be identified by screening high risk groups. The Medical Center Hospital of Vermont serves a population that is 98.6% caucasion. Fifteen percent of the obstetric population had Medicaid or no insurance. Routine antepartum screening for HBsAg was begun one year prior to the study period. An enzyme monoclonal immunoassay was used, with positives confirmed by inhibition assay (AUZYME, Abbott). The study period was 5/89-4/90, during which 2822 mothers were delivered. Statistics sheets completed immediately after delivery were used to obtain HBsAg results. The chart of each patient with a positive screen was reviewed. Screening information from 2696 (95.5%) mothers was available. HBsAg screens were positive in 2 patients (0.07%), negative in 2167 (80.4%) and were not done in 529 (19.6%). One positive patient was from Korea, the other was an admitted IV drug abuser. Of those patients not screened, 97% had private insurance. The cost of screening this population at $13.50/screen was $29,282, with the only positives being in recognized high risk groups. These data support the hypotheses that in our population, over the period studied (1) the incidence of HBsAg carriers is low and (2) HBsAg carriers would have been identified by screening only high risk groups.
194 TREATMENT OF GONORRHEA IN PREG~CY. M. Cavenee: R. Ferris,x S. Rawlins,x J. Mayfield, G. Wendel, Dept. Ob/Gyn, Univ. Texas Southwestern Med. Ctr. & Dallas County Health Dept., Dallas, TX
An open, randomized, prospective study was undertaken at Parkland Memorial Hospital from 1/1/90 to 8/31/90 to compare the efficacy of the untested 1989 Centers for Disease Control (CDC) guidelines for the treatment of gonorrhea in pregnancy. Gravidas had pretreatment Neisseria gonorrhoeae (NG) cultures of the cervix, rectum, and pharynx. A cervical specimen for direct fluorescent antibody testing for Chlamydia trachoma tis (CT) was also obtained. Patients received one of three regimens (ceftriaxone 250 mg 1M, spectinomycin 2.0 grn 1M, or amoxicillin 3.0 gm p.o. plus probenecid 1 gm p.o.) and had follow-up 4-7 days later. At follow-up, repeat cultures were taken from any prior positive site. Patients were excluded for penicillin allergy, lack of follow-up or negative pretreatment NG cultures. All failures were re-treated with ceftriaxone. 71 of 105 (68%) women enrolled were available. 28% of the women had positive CT testing. Treatment results: Infection # Cured # Treated % Site eftriaxone Amox+Proben pectinomvcin Cervix 21/21 (100) 24/27 (89) 21/22 (95) Pharynx 2/2 (100) 1/1 (100) 2/2 (100) Rectum 3/3 (100) 8/9 (89) 4/4 (100) All subjects 22/22 (100) 24/27 (89) 21/22 (95) p-lactamase 2/2 (100) 2/2 (100) % (-) These preliminary results reveal no significant difference (p>0.05) in the efficacy of the three treatment regimens, and confirm the efficacy of the 1989 CDC guidelines for the treatment of NG in pregnancy.
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January 1991 Am J Obstet G} necol
PERINATAL TRANSMISSION OF IUWI IIIIUNOOEFICIENCY VIRUS (HIV) IN TVIN GESTATIONS. RR Viscarello, NJ DeGennaro', L Capobianco', and JC Hobbi ns, Dept. of DB/GYN, Yale Uni versi ty, New Haven. CT.
The rate of vertical transmission of HIV from mother to fetus is estimated to be from 24-33%. Can gem tal infection with HIV resul ts ina spectrum of neonatal symptomo logy characteri zed by unusual or recurrent infections. VariabIlity in the clinical manifestations of congenital HIV infection has been reported in discordant monozygotic twins. We describe the transmission of HIV infection in 11 twin gestations. All 10 mothers (1 delivered 2 sets) were multIgravidae WIth a mean age of 28 yrs. HIV risk assessment revealed 8 former or current intravenous drug abusers (IVDA) and 2 were heterosexual partners of IVDA. None of the mothers had AIDS; 1 had ARC; and 9 were seropositive but asymptomatic. There were 8 sets of viable. diamniotic/ dIchorionic twins born between 26-39 wks gestation with a mean bi rth wei ght of 1828g. Sex of the infants was concordant in 9 pregnanci es (11: f. 9 :m), unknown in 1. and dl fferent ; n 1 pregnancy. Placental pathology was unavai lable in the 4 remaining cases, including 3 women who delivered previable Infant pairs at 16. 21. & 23 wks. EIght of the mothers delivered vaginally. including 10 NSVD; 4 breech; and 2 low forceps. In 1 pregnancy. twin A was born vaginally and twin B by c/section. The 2 remaining sets were born by c/section. A total of 16 viable Infants were born. One child has died of SIDS at 11 mas. All infants were seropOSItive by Western blot at bi rth. Current 1 y 3 sets of twi ns have concordantl y seroreverted (mean follow up = 44 mas); 2 sets are discordant (Ab-pos/Ab-neg) at 86 mas; 1 concordant set who remains weakly positive at 12 mas (twIn A is antigenemic); and 2 sets remaIn seroposit I ve at 4 and 10 mos post-deli very. Three infants are currently symptomatic. while 6 are CDC classification PO WIth a mean duration of follow up of 8 mos. HIV p24 antigen assay was performed inS sets of tWI ns. Ant i gen was detected inane child who was delivered by c/section and has LIP. We observed a 75% concordant rate among twi ns wi th respect to HIV infect ion. All (6 of 6) same-sex twins were concordant for infection. while 50% (1 of 2) opposite-sex twin pairs were discordant. Our results suggest a 25% perinatal transmIssion rate among twin gestations. similar to that of singleton pregnancies.
196 EVALUATION OF TWO RAPID TESTS FOR DETECTION OF GROUP B STREPTOCOCCUS IN LABOR AND DELIVERY PATIENTS M.A. Skoll. B. Mercer, V. BaseIskix, P. GrayX,
G. RyanX, B. Sibai. University of Tennessee, Mempbis. This study compares two tests available for the rapid
diagnosis of Group B Streptococcus (GBS) colonization in pregnant patients presenting to the labor and delivery unit. Equate™ Strep B test (BINAX) uses solid phase immunoassay of nitrous acid extracted swabs. Streptex™ (Burroughs Wellcome Co.) uses latex agglutination on protease treated swab extracts. Over a 4 month period, 1062 patients admitted to labor and delivery underwent speculum examination with collection of Culturette IITM vaginal swabs. All samples for culture were rapidly plated on nonselective blood agar. Swabs for rapid tests were refrigerated and hatched for daily runs. Each sample for rapid test was compared to the corresponding culture. A total of 105 patients (9.9'11i) had a positive culture. Rapid test results were :
SENSITIVITY SPECIFICITY EQUATE 20/93(21.S'IIi) 947/956(99.1 'IIi) STREl'I'EX 14193(15.1 'IIi) 9621967(99.5 'IIi)
~* ~** 69'11i 92.U
73.7'11i 92.4'J1i
Sensitivities of Equate and Streptex were 4.5'11i and O'lli in patients with ~50 colonies of GBS and 36.7'11i and 28.5'11i respectively in patients with >50 colonies. We conclude that these tests are not sufficiently sensitive for use in this clinical setting.
*Positive predictive value **Negative predictive value
