Physicians should counsel the patient to use condoms and avoid sexual contact until her partner has been treated. Some reports have linked chlamydia to low birth weight and preterm birth, but one study found no such association.
The nucleic acid amplification test NAAT is the preferred test for chlamydia because of its high sensitivity and specificity and its use on specimens obtained noninvasively. Repeat testing three weeks after completion of therapy is recommended for pregnant women. Tetracyclines are contraindicated in pregnancy because of the risk of bone and tooth abnormalities.
Amoxicillin mg orally three times per day for seven days appears to be effective for microbiologic cure, but there are few data on its long-term effectiveness for neonatal infection. Food and Drug Administration pregnancy category B and is recommended as first-line treatment for chlamydia in pregnancy. The risk of transmission from an infected mother to her infant is between 30 and 47 percent. Screening can be performed with a culture on Thayer-Martin media, which is recommended in a population with a low prevalence of infection.
A repeat test is recommended in the third trimester for those at continued risk. A Cochrane review of treatment for gonorrhea in pregnancy concluded that ceftriaxone Rocephin mg intramuscularly and spectinomycin Trobicin 2 g intramuscularly have similar cure rates to oral amoxicillin plus probenecid.
Spectinomycin is rarely used because of the high volume required for the intramuscular dose. The CDC recommends routine screening of all pregnant women for hepatitis B surface antigen HBsAg to detect maternal disease and avoid perinatal transmission.
HBsAg is present in acute and chronic infections. The presence of immunoglobulin M antibody to hepatitis B core antigen is diagnostic of acute or recently acquired infection. HBsAg is the first detectable virologic marker for hepatitis B infection, often appearing before liver transaminases are elevated, but it may become undetectable after one to two months.
Pregnant women seeking STI treatment who have not previously been vaccinated should be vaccinated against hepatitis B. Infants of HBsAg-positive mothers should receive hepatitis B immune globulin as well as hepatitis B vaccine at birth. Routine screening for hepatitis C in pregnancy is not recommended. Herpes simplex virus HSV is an extremely common STI that has potentially devastating effects on perinatally infected neonates.
The risk of transmission is 30 to 50 percent higher among women who acquire genital HSV near the time of delivery. The clinical diagnosis of genital herpes during pregnancy in HIV-infected women may be a risk factor for perinatal HIV infection. Screening is performed clinically by visualization of lesions or by patient history. Diagnosis is by culture or polymerase chain reaction assay of an active lesion.
Routine serologic testing is not recommended. Administration of acyclovir Zovirax or valacyclovir Valtrex starting at 36 weeks' gestation has been shown to significantly reduce the recurrence of herpes simplex lesions and viral shedding at the time of delivery in patients at risk of active lesions, and to reduce the number of cesarean deliveries performed because of genital herpes. The U. Public Health Service and the U. Preventive Services Task Force recommend that all pregnant women in the United States be tested for HIV infection, ideally at the first prenatal visit.
Women who are at high risk e. Testing is done with an enzyme immunoassay for antibodies against HIV. Positive test results are confirmed with a Western blot or an immunofluorescence assay to rule out false-positive results.
Goals of therapy are to control maternal infection and reduce transmission to the fetus. Highly active antiretroviral therapy HAART is used during pregnancy to suppress viral load, 14 , 16 with the exception of efavirenz Sustiva , which is pregnancy category D because of teratogenicity in animal studies.
Elective cesarean delivery at 38 weeks reduces the risk of transmission in women not taking antiretrovirals or taking only zidovudine Retrovir. Because concepts relevant to HIV management evolve rapidly, the recommendations are regularly updated.
Human papillomavirus HPV infection is extremely common and often resolves spontaneously. Testing for HPV is considered useful in triage of women with atypical squamous cells of undetermined significance on Papanicolaou smear.
Treatment is not recommended in women with no cervical squamous intraepithelial lesions or genital warts. Diagnosis of genital warts is made by visual inspection. Biopsy may be needed if the diagnosis is uncertain, if the warts do not respond to standard treatment, or if they are pigmented, ulcerated, fixed, or bleeding.
Because genital warts can proliferate and become friable during pregnancy, many specialists recommend their removal. Treponema pallidum , the cause of syphilis, is highly transmissible, even in the absence of any specific symptoms or clinical findings.
Fetal complications such as fetal syphilis, fetal hydrops, prematurity, fetal distress, and stillbirth also occur. Neonatal complications can include congenital syphilis, neonatal death, and late sequelae.
Screening is performed with a blood test—the rapid plasma reagin or Venereal Disease Research Laboratories test—and confirmed with a fluorescent treponemal antibody serology and T. A single serologic test is insufficient because false-positives occur with other illnesses. If syphilis is diagnosed after 20 weeks' gestation, ultrasonography should be performed to evaluate for fetal syphilis.
Although fetal infection can be cured by treating the mother, treatment failure is much higher in the presence of fetal hepatomegaly, ascites, hydrops, polyhydramnios, and placental thickening, which are signs of fetal syphilis detected on ultrasonography. Treatment has been with benzathine penicillin G. A Cochrane review concluded that although penicillin is effective for the treatment of syphilis in pregnancy and the prevention of congenital syphilis, the optimal treatment regimen is uncertain.
Trichomonas vaginalis , a sexually transmitted vaginal infection, has been associated with preterm delivery and low birth weight. It also causes a chronic inflammatory condition and may facilitate HIV transmission.
Screening for Trichomonas in asymptomatic women is not recommended. Metronidazole Flagyl 2 g orally in a single dose or mg twice per day for seven days is the treatment for trichomoniasis in pregnancy, 1 although many physicians wait until after the first trimester to initiate it.
It is pregnancy category B, but the manufacturer recommends caution in using it in the first trimester. One meta-analysis found no relationship between exposure to metronidazole in the first trimester and birth defects; however, it included only five studies.
The outcome of treating trichomoniasis during pregnancy is uncertain. Bacterial vaginosis is not an STI, but it is more common in sexually active women. Although many studies have shown an association between bacterial vaginosis and preterm birth, premature rupture of membranes, and low birth weight, it is not known whether the bacterial overgrowth causes these complications, or if it is a marker for intrauterine colonization.
Screening for and treating bacterial vaginosis in asymptomatic pregnant women does not appear to reduce the risk of pregnancy complications. Metronidazole Flagyl mg orally two times per day for seven days 1. Azithromycin Zithromax 1 g orally in a single dose 1 , 4 , 5.
Amoxicillin mg orally three times per day for seven days 1. Ceftriaxone Rocephin mg intramuscularly in a single dose 1 , 6 , 8. Cefixime Suprax mg orally in a single dose 1 , 8. It's possible to have an STI without symptoms.
STIs during pregnancy can cause many complications. For example:. Other effects of an STI on your baby can include:. STIs such as chlamydia, gonorrhea and syphilis can be treated and cured with antibiotics during pregnancy. In some cases, antiviral medications can be used to help reduce the risk of transmitting a viral infection to your baby. If you have HIV , you might need to deliver by C-section. There are several ways to reduce your risk of STIs. There is a problem with information submitted for this request.
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