Sexually transmitted diseases during pregnancy - These are bacterial or viral diseases that can be infected during sex (oral, vaginal, anal) with an infected partner. Another name for such diseases is sexually transmitted infections (diseases) (STIs or STDs). Such diseases can have serious consequences for the health of the expectant mother and her child.
Sex is not the only way to transmit some of these infections. For example, you can become infected with the hepatitis B virus, which can live outside the body for at least a week, and is transmitted by direct contact with infected needles or other sharp instruments, contact with the blood or open wounds of an infected person, and even through the exchange of personal hygiene items such as like a toothbrush or razor.
Some infections can penetrate the baby through the placenta or be transmitted to him during childbirth or as a result of rupture of the fetal bladder and leakage of amniotic fluid. All sexually transmitted infections for a newborn can be very dangerous (even life-threatening), and some of them can lead to long-term irreversible problems with the health and development of the baby.
Moreover, sexually transmitted diseases during pregnancy increase the risk of miscarriage, premature rupture of the amniotic membranes, premature birth, intrauterine infection and stillbirth.
The most common sexually transmitted infections that are detected in pregnant women include:
- chlamydia (pathogen - Chlamydia chlamydia trachomatis),
- genital herpes (pathogen - HSV - herpes simplex virus),
- gonorrhea (gonorrhea, gonococcal infection, caused by the gonococcus Neisseria gonorrhoeae),
- Hepatitis B (the causative agent is hepatitis B virus - HBV),
- HIV AIDS (pathogen - RNA-containing retrovirus - human immunodeficiency virus of the genus Retrovirus),
- HPV (human papillomavirus, pathogen - HPV - Human Papillomavirus - human papillomavirus),
- syphilis (pathogen - treponema pallorum - Treponema pall> Identifying and treating these diseases during pregnancy is very important, therefore, your gynecologist will examine you for these infections during your first prenatal visit. If you (or your spouse) have one of The following risk factors - the presence of an STD in the past, the presence of two or more sexual partners, the use of intravenous drugs, recent tattooing or piercing - be sure to inform your gynecologist! If you belong to a group of high If you are at risk, you will need to repeat the examination in the third trimester of pregnancy, or earlier if you (or your spouse) have any symptoms of STDs.
Prevention of sexually transmitted diseases in pregnant women
The only reliable way to avoid infection sexually transmitted diseases during pregnancy is complete abstinence from sex (including oral, vaginal and anal sex). But such drastic measures hardly anyone wants to take, so you can protect yourself if you have sex with only one partner, in which you are absolutely sure. Such a partner should be healthy (including not having any of the STDs), not taking intravenous drugs, and only have sex with you. If you are not sure about your partner, then you need to do the following:
Do not have sexual intercourse with a partner who has body ulcers or any symptoms of STIs, including a monogamous partner (those who have multiple sexual partners). If you suspect that your partner has sex with other women or injects drugs intravenously, be sure to use a condom every time you have sex, and use special dental dams during oral sex. These precautions will reduce the risk of transmission of most STIs.
Keep in mind that even having one unprotected intercourse can increase the risk of contracting all types of STDs, including those that are dangerous such as HIV / AIDS, if your partner becomes infected with them.
If you are going to receive treatment for STIs, your sexual partner should also be treated and you should completely refrain from sex until you receive treatment and your infection is confirmed by laboratory methods. Otherwise, you will endlessly transmit the infection to each other.
Is it possible to treat sexually transmitted diseases in pregnant women?
Not only possible, but simply necessary! Treatment will vary depending on the type and complexity of the disease. Of course, it is impossible to cure sexually transmitted infections without the use of antibiotics, but do not worry: your doctor will prescribe those antibiotics that are approved for use by pregnant women.
But there are viral infections that do not respond to antibiotics. These include HIV and herpes. Unfortunately, you cannot cure herpes, but your obstetrician-gynecologist can prescribe you antiviral drugs that you will need to take during the last month of pregnancy to minimize the likelihood that you will have an exacerbation of the disease during childbirth. If you are HIV positive, you will need to take a combination of antiretroviral drugs to reduce the risk of getting your baby infected.
Remember that the sooner it is revealed sexually transmitted disease during pregnancy, the faster it will be cured and, accordingly, will bring your child less harm. Do not hesitate to go to the doctor, think more about the baby, and not that talking about such diseases is "not convenient." A doctor is primarily a specialist, and there is nothing shameful that this could happen to you.
Many STDs occur without symptoms, so a woman at the time of conception may not be aware of the presence of any infections that would later adversely affect the period of gestation.
In this regard, both partners must undergo diagnostics at the planning stage. If the pregnancy was unplanned, then the examination should be done immediately after the determination of the gestational age is made.
This will allow you to identify the infection on time and, if available, immediately begin treatment, which minimizes the possible risks for the mother and child.
Diagnostic methods used in medical practice include:
- PCR smear analysis
- enzyme immunoassay (ELISA),
- smear on the flora (bacterioscopy),
- bacteriological sowing on the flora.
Diagnosis of the most dangerous STDs is planned when registering and at 30 weeks of gestation. Genital inflammation, rash, various pathological discharge, abdominal pain, back pain during pregnancy are indications for unscheduled testing for STDs.
If during pregnancy the temperature is 37 ° C or higher, then this can also be a symptom of having a sexual infection in the body. Signs such as nausea and vomiting during pregnancy should not be ignored.
They can be a consequence of not only ordinary toxicosis, but also viral hepatitis. Especially in cases where these symptoms do not stop for a long time.
STD disease is most safely treated during pregnancy planning, since at this time you can take any medications without fear of negative effects on the fetus.
Treatment should be prescribed by a doctor!
If the infection happened during pregnancy, then drugs for treatment should be selected with extreme caution.
Some drugs are allowed to be used only in a certain trimester, others are safe throughout the entire period of pregnancy, and some are generally prohibited due to the large number of adverse reactions and a high degree of risk to the fetus (embryotoxicity, teratogenicity).
The appointment of certain drugs is the task of the attending physician, in no case should you self-medicate.
Currently, STD infection is treated comprehensively using the following groups of medications:
- antibiotics - are used to treat diseases caused by bacteria (chlamydia, pale treponema, gonococci, ureaplasma),
- antiviral drugs - used to treat HIV, hepatitis, herpes, cytomegalovirus infection, papilloma, etc.,
- antifungal drugs - mainly used to treat candidiasis,
- immunomodulatory drugs - increase immunity,
Such diseases as herpes, hepatitis, HIV, unfortunately, are currently not amenable to complete cure. The therapeutic measures taken are mainly aimed at combating exacerbations of these infections and preventing their relapses.
The effect of STDs on pregnancy and its outcome
Very often, the presence of an STD in one of the partners leads to problems with conceiving a child or infertility. For a long time, a woman does not have a long-awaited pregnancy.
This forces her to see a doctor and undergo a full examination. According to the results of the tests, the presence of infection in the body is detected. If pregnancy does occur, then the consequences of STDs can be quite serious. The most common complications include:
- miscarriages at various stages of pregnancy,
- fetal infection
- premature birth
- congenital malformations and abnormalities of the development of various organs and systems in the fetus,
- frozen pregnancy
- pathology of the placenta.
Transmission of the infection to the child from the mother can occur intranatally when the pathogen penetrates the placental barrier, during the birth process or during lactation.
It has been established that infection with gonococci, genital herpes, chlamydia and hepatitis virus in most cases occurs when a child passes through the birth canal.
In this regard, to prevent infection of the baby, a woman undergoes a cesarean section. A child born to a patient with an STD identified during pregnancy should be examined for these infections.
With the timely and adequate treatment of sexually transmitted infections, they may not affect the health and development of the unborn child. Below we will consider the effect of some of the STDs on pregnancy and its outcome.
Primary infection with cytomegalovirus (CMV) during pregnancy, as well as an exacerbation of the chronic form of this infection, is a great threat to the fetus.
Infection in the first trimester of pregnancy leads to pathologies of the development of the brain in the fetus (anencephaly, hydrocephalus), which refers to indications for abortion.
If infection of the fetus occurred in the third trimester, then the symptoms of infection in the child are usually absent, but antibodies to CMV are found in his blood. In the future, with the progression of the disease, he may experience pathologies from the nervous system.
The presence of antibodies to CMV in a woman during planning or during pregnancy suggests that she had previously suffered this infection. In this case, the prognosis for a successful pregnancy outcome is favorable. For the prevention of exacerbations of CMV, a patient is prescribed vitamin complexes and drugs that increase immunity.
Chlamydia during pregnancy is often asymptomatic. This is its main danger. It becomes possible to identify the disease only with a routine examination and diagnosis, which delays the start of treatment.
Complications of chlamydia include the threat of premature birth, a frozen pregnancy, polyhydramnios, the development of pathologies of the placenta and membranes, stillbirth, and damage to the internal organs of the fetus.
A newborn infected with chlamydia has a chance of developing conjunctivitis or pneumonia. Chlamydia can be treated well, therefore, with timely diagnosis and therapy, pregnancy due to chlamydial infection ends successfully.
Herpes during pregnancy is dangerous only in case of primary infection. If a woman had genital herpes before conception, then the risk of contracting a baby becomes minimal, as her body has already developed immunity to this virus, which is transmitted to the baby.
With a primary infection in the first or second trimester, in rare cases, premature birth, intrauterine growth retardation, and dropsy of the brain in the child are possible. When infected in the third trimester, the risk of complications in the fetus and newborn becomes the highest.
If the baby is infected during childbirth, then it develops neonatal herpes, which most often manifests itself in the form of a characteristic rash around the eyes and mouth, but damage to the brain and other organs is possible.
In the presence of syphilis, a pregnant woman has a chance of fetal infection of the fetus (congenital syphilis). Primary infection with syphilis in the absence of timely treatment leads to miscarriage, stillbirth, or death of the baby shortly after birth.
In the absence of serious fetal lesions, a child is born with a small weight and growth, wrinkled skin, the presence of a rash on the skin is possible. Deformations of the skeletal system characteristic of the disease are observed, which can occur immediately or some time after birth.
Mycoplasmosis and ureaplasmosis
Mycoplasmas and ureaplasmas are sometimes present in the normal microflora of the vagina. They are classified as opportunistic microorganisms. During pregnancy, the woman’s immunity is significantly reduced, which can lead to the development of inflammatory processes due to an increase in the number of these microbes.
Ureaplasmosis and mycoplasmosis do not have a teratogenic effect on the fetus. However, often these infections cause premature birth or miscarriage, polyhydramnios and placental insufficiency, leading to fetal hypoxia.
In pregnancy, cases of fetal infection are extremely rare. In most cases, infection occurs during childbirth, which leads to the development of pneumonia and other complications in the newborn.
Trichomoniasis does not lead to the appearance of defects in the development of the fetus, since its pathogens are not able to pass through the placental barrier. Infection of the baby can occur during the birth process.
Infection of a pregnant woman with trichomoniasis increases the risk of premature birth and insufficient birth weight. The danger of trichomonads lies in the fact that they can contribute to the development of infections such as chlamydia, gonorrhea, etc.
Gonorrhea is a danger to the expectant mother and her baby only in the early stages of pregnancy. It can cause a miscarriage or an undeveloped pregnancy.
After the fourth month of pregnancy, gonococci can no longer penetrate the fetus due to the membranes. Often, against the background of gonorrhea, placental insufficiency is observed.
Infection of the child during childbirth leads to the emergence of the so-called gonococcal conjunctivitis. In women in the postpartum period, inflammation of the uterus and its appendages is possible.
Approximately half of patients during pregnancy have an exacerbation of vaginal candidiasis, which is due to a change in hormonal levels and a general decrease in immunity.
A lot of antifungal drugs have been developed for its treatment. In the absence of therapy for infection, the child may become infected by his mother as a result of passage through the birth canal.
This will contribute to the development of thrush in him, a characteristic symptom of which in children is the formation of white plaque in the oral cavity.
Sexually transmitted diseases in pregnant women: effects on the fetus and possible complications
Sexually transmitted diseases during pregnancy have the same symptoms as non-pregnant women. The first signs of the disease are characterized by minor disorders, to which the expectant mother does not pay attention. A pregnant woman should be examined, even with mild symptoms. The smaller the infection is in the mother’s body, the less harm it does to the child. Diseases detected prior to delivery can be treated or controlled. With the passage of the birth canal, the probability of infection of the child increases. Diseases affect the fetus in different ways.
- Syphilis. Infection occurs transplacental and during childbirth. In untreated women, more than 30% of pregnancies end in embryo rejection and stillbirth. More than 40% of children born are diagnosed with syphilis. In newborns observed: jaundice, inflammation of the bones, syphilitic pemphigus, swelling of the liver and spleen, anemia, ulcers. With a high intensity of lesions, the baby dies in the first weeks of life. Untimely treatment can lead to mental retardation, blindness, hydrocephalus.
Gonorrhea. Gonococcal infection can cause fetal death or premature birth. A third of children are born with low weight and infectious eye lesions. У девочек часто развивается гонококковый вульвовагинит.
Трихомониаз. The disease in rare cases provokes a miscarriage, premature birth, is transmitted to the child. In newborns, fever is observed.
Chlamydia Against the background of infection, the functions of the placenta are disrupted, the child can die or be born with brain damage, anemia, low body weight, conjunctivitis.
Herpes is genital. Infection with herpes in the first trimester of pregnancy provokes a halt in the development of the embryo, a violation in the formation of the brain, and organs of vision. With intranatal infection, the skin, brain, and organs of vision are affected. The disseminated form of herpes in 80% of newborns ends in death.
HIV In the absence of antiviral therapy, the possibility of infection of the child through the birth canal is about 45%. When the fetus and newborn are infected, 80% of children develop immunodeficiency. Often observed: neurological diseases, weight loss, microcephaly, persistent diarrhea, an increase in lymph nodes.
Diagnosis of sexually transmitted diseases during pregnancy
The presence of CMV, herpes, syphilis, and HIV is recommended to be checked before conception. The specialist should be consulted at the first symptoms of the disease at home or with your partner. To detect sexually transmitted infections:
- blood and urine tests,
- smears on the microflora,
- bacteriological crops,
- immunocytological analysis.