Sexually Transmitted Diseases And Pregnancy: What You Need To Know

Couples who are planning to get pregnant often take many steps to ensure they are in good health and both mentally and physically prepared to have a baby. You may be losing weight, improving your diet, taking folic acid and quitting birth control.

Do not overlook the possibility of having a sexually transmitted disease, or perhaps several. Many STDs do not manifest with obvious symptoms, or at least not for a long time - you might have normal vaginal discharge, no pain, and even your test might be negative for STDs. Sexually transmitted diseases are not merely the domain of the promiscuous — you may be affected, even if you have been monogamous for many years. If you are trying to conceive, knowing about STDs is crucial.

How Sexually Transmitted Diseases Affect Pregnancy

Sexually transmitted diseases are still, unfortunately, a taboo topic for many. Though we don't talk about diseases that are spread through sexual contact much, they are a very real risk. Practically any person who has ever had unprotected sex can be at risk. STDs are not just for gay men, prostitutes, or people who have one-night stands. Many sexually transmitted diseases are (initially) silent, so you could be at risk if either you or your partner previously had unprotected sex with another partner — even if you have now been monogamous for many years and have never had any suspicious symptoms. 

Any couple who would like to start trying to conceive should see their family doctor for a complete health check-up first. Such an examination can detect chronic health problems and nutritional deficiencies. You may also benefit from advice about lifestyle changes, or genetic counseling. Checking for STDs should also be part of this check-up. 

STD screening is a normal part of all pregnant women's prenatal care as well. There is a very good reason for this. Many sexually transmitted diseases are harder to treat during pregnancy, and they can often be very dangerous to unborn babies. STD screening has a place in a prenatal care regime, since up to half of all pregnancies are unplanned. Still, any couple who is planning a pregnancy should definitely get tested before they stop using their chosen birth control method.

STD testing is not embarrassing. It is responsible behavior. In fact, every sexually active person should ideally get tested for sexually transmitted diseases annually as an integral part of their routine healthcare. As long as we take a Victorian attitude toward STDs, we give them the opportunity to thrive.

We'll now take a closer look at some of the more common sexually transmitted diseases in the United States. Knowing their symptoms, treatment options, and how these diseases can affect both the mother and her unborn baby during a pregnancy, you will be running to get tested immediately!

Bacterial STDs And Pregnancy

Chlamydia

The bacterial infection chlamydia is the most reported STD in the US. Up to 80 percent of infected women have no symptoms, so many women have chlamydia without knowing it. Symptoms of chlamydia can include abnormal vaginal discharge, pain or burning during urination, general pelvic pain, bleeding in between periods and heavier periods. If symptoms do show up, they'll do so within weeks after infection.

Untreated chlamydia can lead to Pelvic Inflammatory Disease (PID) in the long run. PID — which comes with its own set of symptoms, mostly pelvic pain — rages through a woman's reproductive system, leaving scar tissue and blockages. This can easily render a woman infertile, and it also increases the risk of ectopic pregnancies greatly.

Risks During Pregnancy

During pregnancy, chlamydia can lead to preterm labor and infections of the amniotic sac and fluid. Chlamydia does not cross the placenta, but it can be passed on to the baby during a vaginal delivery. This happens in around 50 percent of mothers who have an untreated chlamydia infection at the time they go into labor. Newborn chlamydia infections can lead to eye problems and, in five to 20 percent of cases, pneumonia during the newborn period. Women who have chlamydia are also at a higher risk of developing a uterine infection after giving birth.

Treatment

Chlamydia is easily treated both before and during pregnancy — unless the woman already developed PID. Like many STDs, chlamydia is most easily treated in the beginning stages. A course of antibiotics will do it — usually azithromycin or doxycycline. There are antibiotics available that can treat chlamydia and that are compatible with pregnancy, like amoxicillin.

Gonorrhea

Gonorrhea is a bacterial infection that has quite a lot in common with chlamydia, but it is harder to treat and has more dangerous consequences. Gonorrhea is very easily transmitted, and women who have the disease do not experience any symptoms in about 50 percent of cases. Women who do have symptoms would would typically notice pelvic pain or discomfort, pain during intercourse or urination, and altered menstrual cycles. Gonorrhea can lead to Pelvic Inflammatory Disease, just like chlamydia. But it can also cause heart problems, meningitis, and joint problems. Scary stuff!

Risks During Pregnancy

Gonorrhea carries all the same risks that chlamydia does, and then some. Gonorrhea during pregnancy is associated with a higher miscarriage rate, uterine and amniotic fluid infections, preterm labor, and uterine infection during the postpartum period. In infants, a gonorrhea infection can cause joint problems and meningitis. Antibiotic eye drops for all newborns are compulsory in most hospitals, because the eye infections caused by gonorrhea can easily make a baby blind (note — these eye drops do not protect the baby's eyes from chlamydia).

Treatment

A newborn whose mother had an untreated gonorrhea infection when she gave birth will need systemic antibiotics, to avoid the risk of joint problems and meningitis. It is, of course, much better to treat gonorrhea before pregnancy wherever possible. The disease is quite adaptable and has become resistant to many antibiotics that were previously very successful — penicillin, tetracycline and fluoroquinolones. Ceftriaxone is now the most effective treatment, and this is also used for pregnant women who have the infection.

Viral STDs And Pregnancy

HPV And Genital Warts

HPV, the human papilloma virus, is a very common sexually transmitted virus. Around half of all sexually active people will end up with some of the 40 strains of genital HPV. Only a few of these are associated with genital warts or an increased risk of cervical cancer. Many people who carry a strain that can cause genital warts have no symptoms, though warts can show up even years after infection — especially during times when the immune system is weakened, like during pregnancy. It is probably safe to assume that everyone knows what warts look like. Genital warts can be big or small, and often appear in clusters. In women, they can appear on the vulva, in the vagina, on the cervix and near the anus. 

Risks During Pregnancy

Women who have genital warts during pregnancy have a few things to consider. Genital warts can be small, but can grow so large that they obstruct the birth canal in rare cases. Some doctors prefer to perform a c-section on women who have genital warts around their due date to prevent transmitting HPV to the baby. This has not been proven to be effective, however — vertical transmission is possible even if a pregnant woman with genital warts has a cesarean, and it is not currently clear how this transmission happens. 

There is a small risk that a baby born to a mother who had genital warts during pregnancy can end up with genital warts, though this chance is very small. Genital warts can affect an infant's throat, potentially causing breathing problems.

Treatment

Some of the topical medications that are used to destroy genital warts are not compatible with pregnancy, because they can lead to birth defects. Laser surgery or cryotherapy (freezing) are the best options for treating genital warts during pregnancy. The growths may recur, however, necessitating repeat treatment.

Genital Herpes

Herpes is caused by herpes simplex viruses. There are two main types: HSV-1 and HSV-2. HSV-1 typically results in cold sores on the mouth, while HSV-2 is usually responsible for genital sores. It is interesting to note that both types can cause sores either near the mouth, or on the genitals.

Risks During Pregnancy

Studies show that one in four pregnant women carry genital herpes, though they may not be aware of it. It is the primary outbreak, after the virus was first caught, that is most dangerous. Up to half of all women who first acquire genital herpes during pregnancy would transmit the virus to their baby during a vaginal birth. In rare cases, herpes is also transmitted to the baby in utero.

Newborn herpes is extremely dangerous. The virus can affect the baby's whole body — it can lead to brain infections, and can affect the eyes, liver, kidneys and lungs. In some cases, systemic newborn herpes can be fatal. In other words, this is a disease to take very seriously.

Treatment

Primary outbreaks of genital herpes early on in pregnancy can be treated with antiviral medications, most commonly acyclovir. If genital sores are present around the time of delivery, a cesarean section is the best course of action. Newborns who are infected with herpes are also treated with acyclovir, topically or through an IV.

It is important to note that it isn't just genital herpes that poses a risk. Parents who have active oral herpes when their baby is tiny should avoid spreading the virus to their baby at all costs. Don't kiss your baby, wash your hands very frequently, and consider wearing a surgical mask until your cold sore goes away to prevent accidental contact.

The Big Two: HIV And Hepatitis B

Hepatitis B

Hepatitis B is the most common serious liver infection in the world. Not everyone who is infected with Hep B has symptoms, but when there are symptoms they are initially very similar to the flu. This means people who contracted Hep B may not be aware of it. Jaundice — a yellowish skin tone — is one tell-tale sign some people will get. Hepatitis B usually goes away on its own, but it can also become chronic.

Risks During Pregnancy

The main risk of Hepatitis B during pregnancy is transmission to the baby. Failure to follow the proper treatment protocol immediately following a baby's birth will lead to chronic Hep B in approximately 40 percent of all cases. That disease will prove to be fatal to a further fourth of those children, in the end.

Treatment

Babies born to mothers who are Hep B positive should always receive a shot of Hep B immunoglobulin immediately upon birth. This is shortly followed by the first dose of the Hepatitis B vaccine, and the baby should receive two more doses of the vaccine at one and six months of age. This treatment ensures that the baby is free of Hepatitis B. 

HIV/AIDS

HIV was the equivalent of a death sentence not that long ago, but modern medicine has come a long way in a relatively short time. With access to a good (social) healthcare system, life with HIV can be pretty normal. Still, plenty of people die from AIDS on a global scale, and your average human is terrified of the disease.

What is it? This article about sexually transmitted diseases is definitely too short to deal with all the ins and outs of HIV/AIDS. What we can say is that HIV is a virus that targets vital cells in the immune system. Without proper management, half of HIV+ people go on to develop AIDS within 10 years. AIDS causes all kinds of opportunistic infections and will eventually lead to death.

HIV And Pregnancy

Throughout this article, we have looked at the risks of sexually transmitted diseases during pregnancy and after a baby is born. Since everyone knows how terrible HIV/AIDS can be, I want to focus on the positive side here instead. Both men and women who are HIV positive can now become biological parents, if they have access to modern medicine. For men, a special sperm washing procedure follow by intrauterine insemination (IUI) can cut the risk of HIV transmission to their baby and their partner. And with antiviral medications for both mother and baby (after birth), the risk of HIV transmission from mother to child can be reduced to an absolute minimum — to around one percent!

HIV positive pregnant women and new mothers should always be under the close supervision of competent doctors, and should not breastfeed, as the virus can be transmitted through breast milk. Women who know they are HIV+ and who would like to become mothers should plan their pregnancy with their doctors. Those who find out they are HIV+ when they are in their first trimester of pregnancy can also benefit from antiviral treatment to prevent vertical transmission.

A pregnancy with HIV can bring a lot of worries and uncertainties, but it is a great victory that people who are HIV positive can now not only live a long and relatively healthy life, but can even plan to have a family! Still, it is important to emphasize that your safety, your baby's, and your partner's completely depends on the availability of the right medical regime and the support and supervision of a very competent healthcare team.