Most people aren't aware of these dangers or of the severity of the STD epidemic. It is a silent -- and potentially deadly -- threat. "Pregnant women are more likely to know about the remote risk of contracting toxoplasmosis from changing the kitty litter during pregnancy than about the dangerous ways an STD can affect their pregnancy and their baby," says Linda Alexander, Ph.D., former president of the American Social Health Association (ASHA), the country's leading clearinghouse for STD information.
Because they are so widespread and often without symptoms, STDs don't discriminate -- even women like Lis, who is in a monogamous marriage, 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," warns Lyn Finelli, Ph.D., a former epidemiologist in the division of STD prevention at the CDC in Atlanta.
Many pregnant women incorrectly assume that they'll be screened for STDs as part of their prenatal care, but the CDC only recommends testing for hepatitis B, syphilis, HIV, chlamydia, and gonorrhea. It’s more likely that a woman will be tested for more diseases, like HPV and herpes, if she has told her doctor that she has more than one sexual partner, a partner who has multiple partners, a history of STD infection or IV drug use, or that she was the victim of a sexual assault.
These screening practices don't go far enough, argues Alexander, who believes that pregnant women should be tested for all STDs or at least educated about them during a prenatal visit. "Women should understand their risk from all infections," she says. "Unfortunately, the stigma of STDs keeps us from dealing with them."
Perhaps the greatest tragedy of all is that most STDs can be easily detected and managed -- if not completely cured -- during pregnancy. If an STD is diagnosed before delivery, the health of both mother and child can almost always be protected: Bacterial diseases such as chlamydia, gonorrhea, and trichomoniasis can be wiped out with antibiotics, while viral STDs like herpes and HPV can be effectively controlled, reducing the likelihood that an infant will contract the condition. And further advances in the prevention, diagnosis, and treatment of STDs are on the horizon. A vaccine to prevent herpes is currently in development. Foams or jellies known as microbicides, which would protect a woman against STDs but still allow her to become pregnant, are being tested as well.
Following are the facts you'll need to understand the effects of STDs and to recognize any noticeable symptoms. Your ob-gyn or midwife can provide STD tests for you and your partner (who should also be tested), but you may need to speak up. "Women will have to be proactive," says James McGregor, M.D., C.M., visiting professor of clinical obstetrics & gynecology at the University of Southern California Keck School of Medicine in Los Angeles. "Talking about STDs is like preparing a birth plan: In order to have it implemented, you have to come in prepared."
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