Current legal and policy environment for STI testing in pregnancy

Background: The national regulatory environment has long contained provisions relating to direct testing for sexually transmitted infections (STIs) during pregnancy. Over time, changes have been made to requirements pertaining to specific organisms, provider reporting responsibilities, and timing of testing during pregnancy. Emphasis recently has focused on screening for HIV, with very limited attention to other STIs also associated with adverse pregnancy outcomes. Objectives: To analyze the current law regulating practice with regard to testing and case reporting of STIs during pregnancy. Methods: LEXIS/NEXIS was searched to identify state statutes and regulations relating to testing for STIs during pregnancy Results: Five states have no testing requirements. Four states have opt–in requirements and the rest have some form of opt-out requirement. Most states require only syphilis, hepatitis B and HIV testing. Few require written consent to testing. Eight jurisdictions permit exemption based on religious objections, while four others permit judges or physicians to waive the requirement. Great variability is noted in the time interval to report cases to public health authorities, and few states require that women receive notification of their test results. Conclusions: Findings have implication for targeted regulatory changes to enhance testing practice and expansion of electronic laboratory reporting to improve STI case management in pregnancy.