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Pregnancy and Sexually Transmitted Diseases


Risks and Treatment

CHLAMYDIA
Stats: An estimated 2.8 million new cases of chlamydia are diagnosed each year, making it the most common bacterial infection in the United States. Rates are higher in women younger than 25 years old.
Symptoms:
Though the majority of women with chlamydia do not have any symptoms, there may be painful or frequent urination or vaginal discharge, usually occurring within two days to three weeks of exposure. This may be accompanied by pelvic or abdominal pain during sex, fever or chills, nausea, vomiting, burning or itching in the vaginal area, joint pain, or a sore throat.
Testing:
Identification of chlamydia can be done through a DNA test (which looks for the DNA of the chlamydia organism), a culture test of cervical cells, or a urine sample.
Risk to Mothers:
As many as 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. Chlamydia also increases the risk of an ectopic pregnancy, which occurs when the embryo implants in the fallopian tube instead of in the uterus.

Risk to Babies:
If the bacteria is passed to a baby during delivery, it can cause pneumonia or eye infections such as conjunctivitis. Chlamydia can also cause premature rupture of the membranes, preterm birth, and miscarriage.
Treatment:
Antibiotics.

GONORRHEA
Stats:
The CDC estimates that there are 356,000 cases each year.
Symptoms:
Signs of gonorrhea are the same as those for chlamydia, though half of infections in women do not cause any symptoms.

Testing:
In women, a culture of the cervix is usually taken. Testing for chlamydia and gonorrhea at the same time is common since the two infections often appear together.
Risk to Mothers:
If not treated, gonorrhea can lead to PID in 10 to 20 percent of affected women. It can also cause joint pain, arthritis, and affect the heart and brain.
Risk to Babies:
Gonorrhea can cause miscarriage and, if it infects a newborn's eyes, can lead to blindness.
Treatment:
Antibiotics. Many states recommend precautionary treatment of all newborns' eyes with silver nitrate drops at birth to prevent infection.

HERPES
Stats:
There are 880,000 new herpes infections each year, with an estimated 45 million Americans already infected.

Symptoms:
While as many as 90 percent of people with herpes do not have symptoms, those infected can experience sores (internal or external) that last two to three weeks, itching or burning, vaginal discharge, a feeling of pressure in the abdomen, fever, headache, or pain in the legs, buttocks, or genitals.

Testing:
If you have symptoms, a culture can be taken to confirm or rule out herpes, and blood tests can determine which strain you have  -- Herpes Simplex Virus 1 (HSV-1), which usually causes oral herpes (in the form of cold sores), or Herpes Simplex Virus 2 (HSV-2), which typically causes genital herpes. Without any symptoms, blood tests are available to determine if you have herpes, though false positives can sometimes occur.
Risk to Mothers:
A pregnant woman with long-standing herpes may find that outbreaks are more frequent and severe while she's expecting. Medication to suppress outbreaks is usually administered late in pregnancy, but if a woman has herpes sores at the time of delivery, a cesarean section will likely need to be done.
Risk to Babies:
If a woman acquires herpes before becoming pregnant or early in her pregnancy, the chances of the infection harming her unborn child are small. That's because she has time to build up immunity to the virus and can pass that immunity to her baby. If an expectant mother is first infected with herpes in her last trimester, her baby has the highest chance of contracting neonatal herpes, which can be life-threatening to an infant because the mother has had less time to build up immunity to the virus and pass protective antibodies to her baby. Fortunately, what often appears to be an initial infection during pregnancy is in fact a recurrence and less risky for a baby. Though neonatal herpes is rare, it can cause eye and throat infections in addition to inflammation of the brain, central nervous system damage, developmental delays, and death. Signs of infection (which usually occur two to three weeks later) include sores around the eyes, irritability, lethargy, poor feeding, and seizures.
Treatment:
There's no getting rid of the herpes virus, but outbreaks can be controlled with antiviral medications such as acyclovir. A 15-year pregnancy registry for acyclovir found no elevated risk of birth defects in babies.

HUMAN IMMUNODEFICIENCY VIRUS (HIV)
Stats:
According to a 2006 CDC report, an estimated 9,000 babies are born to HIV-infected mothers each year. In 2004 (the most recent year for which figures are available), fewer than 150 of these babies became infected with the AIDS virus.

Symptoms:
Those infected with HIV usually do not have symptoms because it takes time for the virus to wear down the immune system. In some cases a woman will have a brief, flu-like illness. Untreated over time, HIV depletes immunity, increasing vulnerability to infection and disease.
Testing:
A health care provider can draw blood or take a sample of saliva to test for HIV, or, if you prefer private testing, the FDA-approved Home Access Test is available in pharmacies, online at www.homeaccess.com, or by calling 847/781-2500.
Risk to Mothers:
Most women diagnosed with HIV who receive treatment feel fine during pregnancy. If an HIV-positive expectant mother does not receive medication or begins treatment late in pregnancy, she'll be more likely to have a c-section to reduce her child's exposure to the virus. Because HIV can be passed through breast milk, new mothers with HIV or AIDS shouldn't nurse.
Risk to Babies:
Babies can acquire HIV from their mothers during labor and delivery, or in utero. With the advent of the drug zidovudine (AZT, ZDV, Retrovir), the mother-to-baby transmission rate has been greatly reduced, from approximately 25 percent of babies born to HIV-infected mothers before 1994 to less than 5 percent. Since 1996 when powerful anti-retroviral therapies became largely available fewer children are developing AIDS. Even less are dying. Still, HIV-positive infants and children are at risk for poor growth, serious bacterial infections, pneumonia, neurologic problems, and developmental delays.
Treatment:
Zidovudine helps prevent transmission of the virus from mother to baby. Antiretroviral drugs can also strengthen a woman's immunity and further reduce the risk of transmission. A pregnancy registry is being maintained that will monitor the effects of these drugs on both women and newborns.

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