J Korean Med Assoc.  2008 Oct;51(10):897-904. 10.5124/jkma.2008.51.10.897.

Management of Sexually Transmitted Diseases during Pregnancy

• Park JS

• KMID: 2065029
• DOI: http://doi.org/10.5124/jkma.2008.51.10.897

Abstract

Sexually transmitted diseases (STDs) are not rare during pregnancy; however, they are usually asymptomatic and may be unrecognized. STDs in pregnancy can cause serious complications to both pregnant women and fetuses. Screening tests are recommended, because the treatment of these diseases can be curative in most cases, or at least effective in reducing complications. In this point of view, the Centers for Disease Control and Prevention recommends screening of all pregnant women for several STDs including human immunodeficiency virus (HIV) infection, hepatitis B, and syphilis, and screening selectively in high risk women for gonorrhea and hepatitis C. To reduce vertical transmissions, highly active antiretroviral therapy and timed Cesarean delivery is recommended in HIV-infected pregnant women. Penicillin is still a drug of choice for syphilis in pregnancy. In women who have active genital herpetic lesions at the time of labor, Cesarean delivery is indicated to protect neonates from perinatal transmissions. However, in women who have genital warts with human papilloma virus infection, Cesarean delivery is not recommended to prevent neonatal laryngeal papillomatosis. In women infected with gonorrhea, Chlamydia or Trichomonas, tests for HIV infection are recommended because of high prevalence of concomitant infections.

Keyword

Sexually transmitted disease; Pregnancy; Screening test; Management

MeSH Terms

Antiretroviral Therapy, Highly Active
Centers for Disease Control and Prevention (U.S.)
Chlamydia
Condylomata Acuminata
Female
Fetus
Gonorrhea
Hepatitis B
Hepatitis C
HIV
HIV Infections
Humans
Infant, Newborn
Laryngeal Neoplasms
Mass Screening
Papilloma
Penicillins
Pregnancy
Pregnant Women
Prevalence
Sexually Transmitted Diseases
Syphilis
Trichomonas
Viruses
Laryngeal Neoplasms
Papilloma
Penicillins

Figure

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  Figure 1 Estimation of timing of perinatal HIV transmission rates (18).

Reference

1. Donders GG, Desmyter J, De Wet DH, Van Assche FA. The association of gonorrhoea and syphilis with premature birth and low birthweight. Genitourin Med. 1993. 69:98–101.

2. Majeroni BA, Ukkadam S. Screening and treatment for sexually transmitted infections in pregnancy. Am Fam Physician. 2007. 76:265–270.

3. Golden MR, Marra CM, Holmes KK. Update on syphilis: resurgence of an old problem. JAMA. 2003. 290:1510–1514.

4. Nathan L, Bohman VR, Sanchez PJ, Leos NK, Twickler DM, Wendel GD Jr. In utero infection with Treponema pallidum in early pregnancy. Prenat Diagn. 1997. 17:119–123.

5. Workowski KA, Berman SM. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. 2006. 55:1–94. Erratum in: MMWR Recomm Rep. 2006; 55: 997.

6. Wendel GD Jr, Sheffield JS, Hollier LM, Hill JB, Ramsey PS, Sánchez PJ. Treatment of syphilis in pregnancy and prevention of congenital syphilis. Clin Infect Dis. 2002. 35:S2. S200–S209.

7. Klein VR, Cox SM, Mitchell MD, Wendel GD Jr. The Jarisch-Herxheimer reaction complicating syphilotherapy in pregnancy. Obstet Gynecol. 1990. 75(3 Pt 1):375–380.

8. Augenbraun MH. Treatment of syphilis 2001: nonpregnant adults. Clin Infect Dis. 2002. 35:S2. S187–S190.

9. Christmas JT, Wendel GD, Bawdon RE, Farris R, Cartwright G, Little BB. Concomitant infection with Neisseria gonorrhoeae and Chlamydia trachomatis in pregnancy. Obstet Gynecol. 1989. 74(3 Pt 1):295–298.

10. Andrews WW, Klebanoff MA, Thom EA, Hauth JC, Carey JC, Meis PJ, Caritis SN, Leveno KJ, Wapner RJ, Varner MW, Iams JD, Moawad A, Miodovnik M, Sibai B, Dombrowski M, Langer O, O'Sullivan MJ. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Midpregnancy genitourinary tract infection with Chlamydia trachomatis: association with subsequent preterm delivery in women with bacterial vaginosis and Trichomonas vaginalis. Am J Obstet Gynecol. 2006. 194:493–500.

11. American Academy of Pediatrics and American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care. 2002. 5th ed. Washington, DC: AAP and ACOG.

12. Donders GG. Management of genital infections in pregnant women. Curr Opin Infect Dis. 2006. 19:55–61.

13. Harger JH, Amortegui AJ, Meyer MP, Pazin GJ. Characteristics of recurrent genital herpes simplex infections in pregnant women. Obstet Gynecol. 1989. 73(3 Pt 1):367–372.

14. Nahmias AJ, Josey WE, Naib ZM, Freeman MG, Fernandez RJ, Wheeler JH. Perinatal risk associated with maternal genital herpes simplex virus infection. Am J Obstet Gynecol. 1971. 110:825–837.

15. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. No. 82 June 2007. Management of herpes in pregnancy. Obstet Gynecol. 2007. 109:1489–1498.

16. Clinton WJ. Turning the tide on the AIDS pandemic. N Engl J Med. 2003. 348:1800–1802.

17. Centers for Disease Control and Prevention. Achieve-ments in public health. Reduction in perinatal transmission of HIV infection-United States, 1985-2005. MMWR Morb Mortal Wkly Rep. 2006. 55:592–597.

18. Kourtis AP, Bulterys M, Nesheim SR, Lee FK. Understanding the timing of HIV transmission from mother to infant. JAMA. 2001. 285:709–712.

19. Cooper ER, Charurat M, Mofenson L, Hanson IC, Pitt J, Diaz C, Hayani K, Handelsman E, Smeriglio V, Hoff R, Blattner W. Women and Infants' Transmission Study Group. Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission. J Acquir Immune Defic Syndr. 2002. 29:484–494.

20. Bulterys M, Jamieson DJ, O'Sullivan MJ, Cohen MH, Maupin R, Nesheim S, Webber MP, Van Dyke R, Wiener J, Branson BM. Mother-Infant Rapid Intervention At Delivery (MIRIAD) Study Group. Rapid HIV-1 testing during labor: a multicenter study. JAMA. 2004. 292:219–223.

21. U.S. Public Health Service Task Force Perinatal HIV Guidelines Working Group. Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV-1 transmission in the United States. 2003. 11. 26. March 2004. http://AIDSinfo.nih.gov.

22. The International Perinatal HIV Group. The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1-a meta-analysis of 15 prospective cohort studies. N Engl J Med. 1999. 340:977–987.

23. Committee on Obstetric Practice. ACOG committee opinion scheduled Cesarean delivery and the prevention of vertical transmission of HIV infection. Number 234, May 2000 (replaces number 219, August 1999). Int J Gynaecol Obstet. 2001. 73:279–281.