Sexually Transmitted Diseases Do Not Discriminate; First Trimester Vaginal Bleeding is not Always a Threatened Abortion

Abstract

Objective: To determine the prevalence of sexually transmitted diseases during the first trimester of pregnancy in women who presented to the emergency department with complaint of vaginal bleeding. Secondary measure: To determine the prevalence of gonorrhea, Chlamydia, bacterial vaginosis and trichomonas in women who presented to the emergency department with any gynecological complaints during their first trimester of pregnancy. Methods: Prospective study of consecutive women who presented to the ED at an urban tertiary referring hospital, level II trauma center. Study subjects included all women who presented during an eight month period, that were 16 years of age or older, first trimester of pregnancy with gynecologic complaints. Cognitively impaired and incarcerated women were excluded. PCR for gonorrhea and Chlamydia and wet mounts for bacterial vaginosis and trichomonas were obtained on all subjects during the pelvic exam. Results: Study population of 122 subjects. The prevalence for a STD in our study population was 52.4% (64/122); 10/122 (8.2%) for gonorrhea, 36/122 (29.5%) for Chlamydia, and 18/122 (14.8%) for bacterial vaginosis or trichomonas. The prevalence of gonorrhea or Chlamydia in a subset of women with vaginal bleeding was 65.7%. Women who had vaginal bleeding had an OR of 7.05 for having a concomitant infection with chlamydia or Gonorrhea. Conclusion: To our knowledge, our study is the first to demonstrate the prevalence and the clinical relevance of STD during the first trimester of pregnancy in women presenting with vaginal, in the ED.