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Are You Infected?

After sailing through her third pregnancy, Lis, a 37-year-old mother from New York, gave birth to a nine-pound boy, Simon, in January. Five days later, his first checkup was reassuring -- until the pediatrician noticed small bumps on his face, near his eyes. He inspected them, then turned to Lis and her husband and asked if either of them had herpes.

Lis's body went cold. Two years earlier, her husband had been diagnosed with genital herpes. "The doctor told us that my husband could have gotten the virus years before and never had an outbreak," she recalls. "But no one suggested that I get tested. No one ever said, 'You could have herpes and not know it.'" Like up to 90 percent of people with herpes, Lis had never had any symptoms.

After spending three weeks in the hospital being treated for neonatal herpes -- a condition which can result in severe central nervous system damage and even death -- Simon beat the odds and was able to go home. "By some miracle, he was treated soon enough that he never got sick," says Lis. Now, at 7 months, he's thriving.

Sexually transmitted diseases (STDs) are perhaps the most overlooked threat to babies today. According to the Centers for Disease Control and Prevention (CDC), over 65 million Americans are now living with an incurable STD and 19 million more are infected each year. Because these diseases often don't cause noticeable symptoms, many moms-to-be don't find out they have an STD until it's too late. "Pregnant women are more likely to know about the remote risk of contracting toxoplasmosis from changing the kitty litter than about the dangerous ways an STD can affect their baby," says Linda Alexander, Ph.D., former president of the American Social Health Association (ASHA). Untreated, these infections can cause preterm labor, blindness, pneumonia, developmental disabilities, and even death.

Perhaps the greatest tragedy of all is that most STDs can be easily detected and managed -- if not completely cured -- during pregnancy. Your doctor can test you and your partner, but you may need to ask to be screened. Routine tests are offered only for hepatitis B, syphilis, and HIV; your doctor may not screen you for other infections unless she thinks that you're at risk. But the fact is, even married women like Lis are vulnerable. "The single most important message about STDs is that everyone is at risk -- it doesn't matter what your current or past sexual behavior is," says Lyn Finelli, Ph.D., an epidemiologist at the CDC in Atlanta. Here's what you need to know to keep you -- and your baby -- healthy.

Lorie A. Parch is a freelance writer in Scottsdale, Arizona.

Chlamydia

Stats About 3 million new cases are diagnosed each year, making it the most common sexually transmitted bacterial infection.

Symptoms Though 75 percent of affected women don't have symptoms, there may be painful or frequent urination, vaginal discharge, pelvic or abdominal pain during sex, sore throat, fever, or nausea.

Testing A culture of cervical cells, a urine sample, or a test that can detect the DNA of the chlamydia organism.

Risks Up to 40 percent of women with untreated chlamydia will develop pelvic inflammatory disease (PID) -- an infection of the uterus, fallopian tubes, and ovaries -- which can lead to infertility. The bacteria can cause miscarriage, preterm birth, and, if passed to the baby during delivery, infant pneumonia or eye infections.

Treatment Antibiotics.

Gonorrhea

Stats The CDC estimates that there are more than 700,000 cases of gonorrhea each year.

Symptoms Signs are the same as chlamydia, though half of infections don't cause symptoms.

Testing A culture of the cervix. (Get tested for both chlamydia and gonorrhea -- they often appear together.)

Risks Untreated, gonorrhea can cause joint pain, arthritis, affect the heart and brain, and lead to PID in 10 to 20 percent of affected women. It can also cause miscarriage and, if it infects a newborn's eyes, lead to blindness.

Treatment Antibiotics. Many states treat all newborns' eyes with silver nitrate drops to prevent infection.

Herpes (HSV)

Stats There are 1 million new infections each year, with 45 million Americans already infected. It's estimated that one in four pregnant women has herpes.

Symptoms As many as 90 percent of those infected don't have symptoms, but those who do can experience sores (internal or external) that last two to three weeks, itching or burning, vaginal discharge, fever, or headache.

Testing Blood tests can determine which strain you've been exposed to -- Herpes Simplex Virus 1 (HSV-1), which usually causes oral herpes (cold sores), or Herpes Simplex Virus 2 (HSV-2), which causes genital herpes. If you have symptoms, a culture can confirm or rule out herpes.

Risks A woman with long-standing herpes may find that outbreaks are more severe during pregnancy. Medication to suppress outbreaks is usually given late in pregnancy, but if a woman has sores at delivery, a c-section may be done. If a woman acquires herpes before or early in her pregnancy, the chances of the infection harming her child are small, since there's time to build up and pass protective antibodies to her baby. If a mom-to-be is first infected with herpes in her last trimester, her baby has a 30 to 50 percent chance of contracting neonatal herpes, which, though rare, can cause eye and throat infections, central nervous system damage, developmental delays, and death. Signs of infant infection include sores around the eyes, irritability, lethargy, poor feeding, and seizures.

Treatment Outbreaks can be controlled with antiviral medications such as acyclovir. A 15-year registry for acyclovir found no elevated risk of birth defects.

HIV/AIDS

Stats About 7,000 women with HIV, the virus that causes AIDS, give birth each year.

Symptoms Those infected usually don't have symptoms (though some may have a brief flu-like illness) because it takes time for the virus to wear down the immune system. Untreated, HIV depletes immunity, increasing vulnerability to infection and disease.

Testing Blood or saliva test. If you prefer private testing, the Home Access Test is FDA approved. (Available in pharmacies, at homeaccess.com

Risks Babies can acquire HIV from their mothers in utero, during labor and delivery, or through breast milk. About 20 percent of infected infants develop AIDS in the first year of life and die before the age of 4.

Treatment The drug zidovudine (AZT, ZDV, Retrovir) has reduced the mother-to-baby transmission rate to less than 5 percent. Antiretroviral drugs can strengthen a woman's immunity and further reduce transmission risk.

Human papilloma virus (HPV)

Stats An estimated 75 percent of the U.S. reproductive-age population is infected. symptoms In some people, certain strains of HPV can cause genital warts; others can cause cervical cancer.

Testing A Pap smear, which detects changes in cervical cells, can indicate an infection or the early stages of cancer. A follow-up DNA test can confirm the presence of HPV. Testing in pregnancy if warts aren't present isn't usually necessary because the virus is so prevalent and the risk of transmission is so low.

Risks A woman with HPV may get genital warts for the first time during pregnancy or find that her current warts grow larger. The risk of transmission during delivery is less than 1 percent. In these infants, there is a slight chance that they will later develop the virus in their larynx (voice box). If a woman has large genital warts close to her due date, a c-section may be considered.

Treatment While it's considered safe during pregnancy to freeze or laser the warts or put acid on them, many healthy women appear to get rid of HPV over time.

Trichomoniasis

Stats The condition affects an estimated 5 million women each year.

Symptoms Often called "trich," it can cause a foul-smelling or green vaginal discharge, vaginal itching, or redness within six months of infection. Other symptoms can include painful sexual intercourse, lower abdominal discomfort, and the urge to urinate. Testing A doctor can diagnose trichomoniasis by examining vaginal discharge.

Risks Untreated it can cause preterm labor. Mother-to-baby transmission of the parasite is rare.

Treatment Antibiotics after the first trimester.

Syphilis

Stats Over 32,000 Americans get syphilis each year; infection rates are higher in some southern states and in African-Americans.

Symptoms While most pregnant women don't have any symptoms, the primary stage of syphilis is characterized by a small, firm, painless sore (called a chancre) that appears from 10 to 90 days after infection; the sore lasts one to five weeks. This can be followed by a rash and rough, "copper penny" spots on the palms of the hands and the bottoms of the feet.

Testing In many states, a syphilis screen -- a blood test -- is the only routine prenatal STD test.

Risks Untreated, syphilis can attack the internal organs, causing blindness, lack of muscle coordination, and dementia. A pregnant woman with untreated syphilis has a 50 percent chance of miscarriage and a 40 percent chance of delivering a syphilitic baby. Signs of an infant infection (which can appear up to eight weeks after birth) include sores, runny nose, jaundice, a small head, slimy patches in the mouth, anemia, and a swollen liver.

Treatment Penicillin.

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