Most pregnant people are tested for syphilis, HIV, hepatitis B, and hepatitis C at their first prenatal visit. Chlamydia and gonorrhea screening is also standard for those under 25 or anyone with certain risk factors. These tests are part of routine prenatal bloodwork, and many people don’t realize STI screening is included unless they ask.
Tests Given to All Pregnant People
Four infections are screened universally, meaning every pregnant person should be tested regardless of age, sexual history, or symptoms.
- Syphilis. A blood test at the first prenatal visit. Many states now also require a second test between 28 and 32 weeks and again at delivery, driven by a 110% increase in congenital syphilis rates between 2019 and 2023.
- HIV. A blood test at the first prenatal visit using an “opt-out” approach. This means it’s automatically included in your lab panel unless you specifically decline it. No special written consent is required in most states.
- Hepatitis B. A blood test for a protein called HBsAg, ideally in the first trimester. This is done with every pregnancy, even if you’ve been vaccinated or tested before.
- Hepatitis C. A blood test recommended for all pregnant people in nearly all clinical settings. The only exception is areas where the infection rate is extremely low (under 0.1%).
Tests Based on Age or Risk Factors
Chlamydia and gonorrhea screening is routine if you’re under 25. If you’re 25 or older, your provider will test you if any of these apply: a new sexual partner, more than one partner, a partner who has other partners, a current or past STI, inconsistent condom use, or exchanging sex for money or drugs.
In practice, many providers simply run these tests for everyone at the first prenatal visit because the risk factors are common and the consequences of missing an infection are serious. If you’re unsure whether you were tested, ask your provider directly. These are simple urine tests or swabs, and results come back quickly.
Infections Not Routinely Screened
Trichomoniasis is a common STI but is not part of standard prenatal panels. If you have symptoms like unusual vaginal discharge, itching, or irritation, your provider will test for it regardless of how far along you are. Routine screening of pregnant people without symptoms hasn’t been shown to improve outcomes, so it’s only done in specific situations: people living with HIV, those in high-prevalence settings like STI clinics, or those with multiple risk factors.
Bacterial vaginosis, herpes (HSV), and HPV are also not included in standard prenatal STI panels, though your provider may test for them based on your symptoms or history.
When Repeat Testing Happens
A single round of testing in early pregnancy isn’t always enough. New infections can be acquired during pregnancy, and some take time to show up on tests.
Syphilis retesting has become especially aggressive. A growing number of states now mandate testing at three points: the first prenatal visit, the third trimester (28 to 32 weeks), and at delivery. This applies to all pregnant people, not just those considered high risk. The push came after congenital syphilis rates more than doubled in just four years, reaching about 106 cases per 100,000 live births in 2023.
HIV retesting in the third trimester is recommended for people in areas with higher HIV rates or those with risk factors identified during pregnancy. Hepatitis B is also retested at delivery for those at elevated risk. Chlamydia and gonorrhea may be retested in the third trimester if you tested positive earlier and were treated, or if new risk factors emerged.
Why These Tests Matter for the Baby
Each of these infections can cause specific, preventable harm when passed from parent to baby during pregnancy or delivery.
Syphilis poses one of the most severe risks. About 40% of babies born to people with untreated syphilis are stillborn or die shortly after birth. Those who survive can develop bone damage, severe anemia, enlarged organs, blindness, deafness, or intellectual disability. Infants who aren’t treated within the first three months are more likely to have lifelong complications.
Hepatitis B transmission is remarkably efficient. Without preventive treatment after birth, up to 90% of infants born to someone with hepatitis B become infected. Of those, 90% go on to develop chronic infection, and roughly one in four eventually die from liver disease. The good news is that post-birth treatment (a vaccine and antibody injection given within hours) is highly effective at preventing this.
Hepatitis C passes to about 6 in 100 infants born to infected mothers, with the risk climbing higher if HIV is also present. HIV itself can lead to serious disease progression in the first one to two years of life if the infant goes undiagnosed, including brain damage and severe infections. Chlamydia and gonorrhea, if untreated, can cause eye infections in newborns and increase the risk of preterm birth.
Insurance Coverage for Prenatal STI Screening
Under the Affordable Care Act, most private insurance plans and Medicaid expansion programs cover prenatal STI screening with no copay, deductible, or other out-of-pocket cost. This includes HIV screening for all pregnant people and chlamydia and gonorrhea screening for those who meet the age or risk criteria. Hepatitis B and syphilis testing are similarly covered as part of standard preventive prenatal care.
If you’re uninsured, community health centers and local health departments often provide prenatal STI testing on a sliding-fee scale. Some states have specific programs that cover all prenatal care for uninsured pregnant people regardless of immigration status.