Sexually Transmitted Infections in Pregnancy, Screening and Treatment

Abstract

Purpose of Review Sexually transmitted diseases (STD) often complicate the pregnancy when conception occurs through unprotected intercourse. The importance and management of STDs in terms of pregnancy are examined in this review. Recent Findings During pregnancy, STDs must be investigated and treated aggressively because of the effects on both mother and fetus. With screening tests, an STD such as gonorrhea, chlamydia or syphilis can be determined in approximately 10% of all pregnant patients. In addition, when the spouse is not monogamous, a new STD can be contracted during pregnancy, and any STD in pregnancy has significant risks for the mother and infant. Syphilis, gonorrhea, trichomoniasis, chlamydia, hepatitis B, human immune deficiency virus (HIV), herpes simplex virus 1 and 2 (HSV-1-2) and human papillomavirus (HPV) are infections which affect pregnant women and potentially the fetus. Summary STDs are prevalent in pregnant women in many countries and are widely reported to be associated with increased risk of poor maternal and neonatal outcomes. Etiologic screening for syphilis, gonorrhea, trichomoniasis, chlamydia, hepatitis B, HIV, HSV-1-2 and HPV infection in all pregnant women combined with targeted treatment might be an effective intervention. However, the evidence base is insufficient to support the development of global recommendations. Adverse maternal-child health outcomes of potential interest are wide ranging and variably defined. Evidence from observational studies was limited, and trials of presumptive STD treatment have shown mixed results. Cost-effectiveness was influenced by STD prevalence and availability of testing infrastructure and high-accuracy/low-cost tests. Preliminary data suggested high patient acceptability. Preliminary data on harms, acceptability and feasibility and the availability of emerging test technologies suggest that etiologic STD screening deserves further evaluation as a potential tool to improve maternal and neonatal health outcomes worldwide.