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Pregnancy and Sexually Transmitted Diseases

After sailing through her third pregnancy, Lis, a 37-year-old mother from upstate New York, gave birth to a boy in January. As she held her new son, Simon, he seemed happy and healthy, weighing in at 9 pounds, 1 ounce, and racking up a 9 out of a possible 10 points on the Apgar scale of newborn health. Five days later, his first infant checkup was equally reassuring  -- until the pediatrician noticed small bumps on his face, near his eyes. He inspected them carefully, 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 developed small sores and had unexpectedly 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 ever suggested that I get tested. No one ever said to me 'You could have herpes and not know it.'" Unfortunately, like most people with herpes, Lis didn't know she was infected because she had never had any symptoms. Simon was rushed to a nearby medical center where a DNA spinal tap test confirmed that he had neonatal herpes, a condition which usually results in severe central nervous system damage and often in death. He spent the next three weeks in the hospital, where he underwent another spinal tap and received intravenous doses of acyclovir, an antiviral drug.


Fortunately, Simon beat extraordinary odds and was able to go home. "By some miracle we caught this early and he was treated soon enough that he never got sick," says Lis. Now, at 7 months old, Simon is thriving, doing everything babies his age are meant to do. But his parents wish they could spare others the terrifying experience they had. "We spent the first four weeks of our seemingly healthy baby's life in an intensive care unit because of the devastating effects this virus has on a newborn."


Sexually transmitted diseases (STDs) are perhaps the most overlooked threat to babies today. According to the Centers for Disease Control and Prevention (CDC), 19 million Americans are infected with an STD each year. Countless women have herpes or the human papillomavirus, which can cause genital warts and cervical cancer, or live with curable STDs like chlamydia or gonorrhea but don't know it  -- and don't understand the harm they can pose to a newborn.


Because these diseases often do not cause noticeable symptoms, many pregnant women don't find out they have an STD until it's too late. Untreated, these infections can cause preterm labor and the related complications of low birth weight, in addition to blindness, pneumonia, brain damage, developmental disabilities, and even death. STDs can be hazardous for the mother as well: Many can compromise a woman's fertility or increase the risk of the transmission of HIV, the virus that causes AIDS.


 

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."


Click ahead for Risks and Treatment


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.

Click ahead for more facts on STDs and pregnancy

HUMAN PAPILLOMAVIRUS (HPV)
Stats:
HPV is the most common STD in the U.S., with an estimated 75 percent of the reproductive-age population infected. Twenty million Americans have the genital form of HPV, with 6.2 million new cases diagnosed each year.

Symptoms:
In some people, HPV can cause genital warts.
Testing:
A Pap smear, which can detect changes in cervical cells, can indicate an HPV infection or the early stages of cervical cancer, particularly if the changes are dramatic. For minor Pap changes, a follow-up DNA test can confirm or rule out the presence of HPV. But testing for HPV in pregnancy if genital warts are not present is usually unnecessary because the virus is so prevalent and the risk of transmission is so low, says Thomas Cox, M.D., director of the Gynecology and Colposcopy Clinic at theUniversity of California at Santa Barbara. If you have warts that have not been diagnosed, however, you should see a doctor and be tested.
Risk to Mothers:
A woman previously infected with HPV may get genital warts for the first time during pregnancy or find that her current warts grow significantly. Of the approximately 100 types of HPV, the ones that cause warts (strains 6 and 11) are the least worrisome. Strains 16, 18, 31, and 45 account for 80 percent of all cervical cancers.
Risk to Babies:
The risk of HPV transmission during delivery is very low; less than 1 percent of affected women pass it to their babies. In these infants, there is a slight chance that they will later develop the virus in their larynx (voice box). If a woman has very large genital warts close to her due date, a c-section may be considered.
Treatment:
Several treatments for genital warts that are often given to women who are not pregnant haven't been proven safe for use in pregnancy, says Dr. Cox. It's possible that your OB might freeze or laser the warts or put acid on them since these procedures are safe during pregnancy. Many healthy women appear to get rid of HPV over time or at least to suppress it to the point where it is no longer a threat to them, their partner, or their children.

SYPHILIS
Stats: Approximately 11,500 Americans get syphilis each year, though infection rates are significantly higher in some southern states and in African-Americans. In 1999 there were 420 reported cases of congenital syphilis in infants who acquired the disease from their mothers during pregnancy or delivery.

Symptoms:
The primary stage of syphilis is characterized by a small, firm, round, painless sore (called a chancre) that appears from 10 to 90 days after infection at the place where the bacterium entered the body; the sore lasts one to five weeks. If not treated, the appearance of a non-itching rash on one or more parts of the body indicates the start of the second stage of syphilis. There may be rough, "copper penny" spots on the palms of the hands and bottoms of the feet. Most pregnant women with syphilis are asymptomatic, says Dr. McGregor.
Testing:
In many states, a syphilis screen'a blood test'is the only routine prenatal STD test.
Risk to Mothers:
Third-stage syphilis (called latency) begins to attack the internal organs, eventually leading to blindness, dementia, and lack of muscle coordination, among other complications.
Risk to Babies:
Untreated early syphilis in pregnant women can result in perinatal death in up to 40 percent of cases, and, if syphilis is acquired in the four years preceding pregnancy, it may lead to infect in 80 percent of cases. If a mother-to-be doesn't receive treatment, or receives it too late in pregnancy, there's a 40 to 70 percent chance she'll deliver a syphilitic baby. Signs of an infection include sores, runny nose (sometimes bloody), jaundice, a small head, anemia, a swollen liver, slimy patches in the mouth, and inflammation of the bones in the arms and legs. A newborn may not show signs of infection until 3 to 8 weeks after birth.
Treatment:
Penicillin.

TRICHOMONIASIS
Stats:
The parasite which causes trichomoniasis is responsible for an estimated 7.4 million new cases in men and women each year.

Symptoms:
The condition, often called "trich," 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 health care provider can diagnose trichomoniasis by examining vaginal discharge.
Risk to Mothers:
Trichomoniasis can cause preterm labor.
Risk to Babies:
Preterm labor can cause a baby to have a low birth weight. According to the CDC, mother-to-baby transmission of the parasite is rare, but symptoms in an infected infant include fever, as well as a vaginal discharge in girls.
Treatment:
Antibiotics after the first trimester. (The medicine is not safe for use during the early months of pregnancy.)

The STD epidemic is an undeniable health threat to infants today. Unlike other epidemics, however, it is one that can be easily controlled. If pregnant women insist on being tested for these diseases, in most cases STDs can become what they should be'a nuisance, not a danger. Armed with the right information and a doctor's guidance, a woman with an STD can help keep herself  -- and her baby  

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