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āFirst Prenatal Visit
(regardless of gestational age)
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- HIV
- Syphilis
- Chlamydia (CT)2
- Gonorrhea (GC)2
- Hepatitis B surface antigen (HBsAg)
- Hepatitis C (HCV) antibody3 with reflex HCV RNA viral load if HCV antibody positive
- Type-specific Herpes Simplex Virus (HSV) serology NOT routinely recommended4
- Cervical cancer screening if age ā„21 years and indicated by national guidelines5
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āThird Trimester
(assuming first prenatal visit has already occurred; if not, see screening recommendations above)
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- HIV if high risk6
- Syphilis (ideally between 28-32 weeks gestation)7
- CT and GC if age <25 years, positive test earlier in pregnancy, or if at an increased risk2
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āDuring Labor & Delivery
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- HIV antigen/antibody combination test with results within the hour if HIV status undocumented
- Syphilis, unless low risk8 AND a documented negative screen in the third trimester
- HBsAG on admission if no prior screening or if at an increased risk9ā
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Recommended vaccinations during pregnancy: Tdap (between 27th and 36th weeks of each pregnancy), influenza (when flu vaccine is available), and COVID-19 (primary series and booster dose[s] when eligible).
1 Local health jurisdictions may have additional screening recommendations during pregnancy. Clinicians should screen according to their local guidelines.
2 CDPH recommends universal GC/CT screening in the first trimester based on the high prevalence of GC/CT among Californians who could become pregnant. The U.S. Centers for Disease Control and Prevention (CDC) recommends screening for GC/CT in the first trimester if age <25 or at increased risk. Both CDC and CDPH recommend screening for GC/CT in the third trimester if age <25 or at increased risk. Risk factors for CT or GC include: prior CT or GC infection (particularly in past 24 months); new or multiple partners; suspicion a recent partner may have had concurrent partners; sex partner diagnosed with an STI; exchanging sex for money or drugs; illicit drug use; history of incarceration; and/or community prevalence of infection.
3 All pregnant people should be screened for HCV except in settings where HCV infection (HCV RNA positivity) is <0.1%. A positive HCV antibody result should reflex to an HCV RNA test to confirm active infection.
4 Routine HSV-2 serologic screening of pregnant patients is not recommended. HSV-2 serologic tests are useful for pregnant patients at risk for HSV infection (e.g., sex partner with HSV).
6 Risk factors for HIV: illicit drug use; new STI diagnosis during pregnancy; new or multiple partners; partner(s) with HIV; live in high HIV prevalence area with signs/symptoms of acute HIV.
8 Risk factors for syphilis in pregnancy and/or congenital syphilis (CS): late or limited prenatal care; new or multiple partners; unstable housing or homelessness; substance use (especially methamphetamine); incarceration within the past 12 months; partner with male or other concurrent partners; new STI diagnosis during pregnancy; sex partner diagnosed with an STI; commercial sex; and living in an area with high CS rates (>8.4 cases per 100,000 live births in at least one of the past three years).
9 Risk factors for hepatitis B: injection drug use; new STI diagnosis in pregnancy; new or multiple partners; or HBsAg-positive partner.