Chlamydia and its impact on pregnancy
FOR some women, the road to motherhood, and the journey to getting there, is paved with many complications. And according to obstetrician-gynaecologist Dr Keisha Buchanan, one of the common reasons is rooted in untreated sexually transmitted diseases such as chlamydia, which can spell doom for the reproductive system and cause serious complications in pregnancy.
“Chlamydia is a very common sexually transmitted disease. This condition is caused by a bacterial infection and in most cases has no symptoms. It can be easily treated once identified, with antibiotics such as Azithromycin which is safe for use in pregnancy,” Dr Buchanan said.
She pointed out that in the case of untreated chlamydia, a plethora of pregnancy and fertility-related challenges may arise. Chlamydia, according to Dr Buchanan, can lead to infertility as it blocks the Fallopian tubes and may preclude a woman from becoming pregnant naturally depending on the severity of the blockage. In the case of men, it blocks the tubes that transport sperm from the testicles. Depending on the severity of the blockage, pregnancy may not be possible without in vitro fertilization.
Dr Buchanan outlined a risk of pregnancy complications such as ectopic pregnancy, which requires surgery or a medication to remove the pregnancy and prevent it from rupturing the Fallopian tube, an issue which may progress to internal bleeding.
“Whenever symptoms are present, they may include a vaginal or penile discharge, bleeding from the vagina after sex, lower abdominal pain, burning on urinating, and in men, pain in the scrotum. During pregnancy, however, the chlamydia infection can also cause irritation of the cervix and bleeding. Bleeding can also be triggered by sex as the cervix is irritated and may mimic a threatened miscarriage,” Dr Buchanan said.
She reasoned that the possibility of these complications arising is one reason why it is recommended that women under age 25 should test yearly for the STD since they are at high risk for the infection. Other groups include those who have multiple sexual partners, or for patients who suspect or know that their partners have other sexual partners.
Screening for chlamydia in early pregnancy (first trimester) is also recommended for all pregnant women. This is done by way of a cervical swab or a urine test.
“When chlamydia is present in a pregnant woman what can happen is that the infection spreads up along the cervix into the uterus and infects and weakens the amniotic sac which encloses the baby. This can trigger premature rupture of the membranes and premature labour; this is potentially a catastrophic complication as there is a high chance of foetal loss, foetal illness from infection, and prematurity,” Dr Buchanan warned.
She said once the sac around the baby is ruptured, not only can chlamydia ascend into the womb to infect the foetus and the womb, but other vaginal bacteria such as streptococcus is also likely to enter. This can also result in the foetus developing a number of complications such as pneumonia and meningitis.
“If the rupture occurs prior to 24 weeks or six months it can trigger a miscarriage and loss of the foetus because at this stage it would be too underdeveloped to survive. Premature rupture of the membranes between 24 weeks and 34 weeks, on the other hand, is associated with a risk of foetal loss or illness due to infection and prematurity. After 34 weeks the risks associated with prematurity are less as the foetal lungs are better developed and the mortality rate is lower, but the morbidity rate is still high from infections and other factors associated with prematurity, such as hypothermia (difficulty maintaining body temperature) and poor feeding,” Dr Buchanan shared.
In addition to foetal complications, Dr Buchanan said that there is also the risk of the womb becoming infected and infection spreading to the mother’s bloodstream causing the mother to be ill. These complications, she said, require admission to hospital and neonatal intensive care for the baby. There is also the possibility that infection of the womb can occur with bacteria from the vagina when the membranes rupture from the chlamydia infection. This can lead to future scarring of the womb; however, if antibiotic therapy is started early enough scarring can be prevented.
And even if these babies make it to full term, Dr Buchanan warned that they are not out of the woods because the infection can also be passed during delivery.
“Chlamydia infections can spread to the baby’s eyes during the passage of the baby at vaginal delivery and this can cause an eye infection called conjunctivitis (pink eye). It can also cause pneumonia. The eye infection and pneumonia are treated with antibiotics. So if a baby develops pink eye within a few days after birth a STD should be suspected,” Dr Buchanan advised.
Importantly, Dr Buchanan recommends that once chlamydia is detected during pregnancy, this should prompt screening of the patient and her sexual partner(s) for the full range of STIs including swab tests for gonorrhoea, mycoplasma, trichomoniasis, and blood tests for genital herpes, hepatitis B and C, HTLV 1/1, syphilis and HIV. She said treatment of all additional infections should be administered and counselling the patient and her spouse about safe sex (using a condom) or abstinence and having only one sexual partner should be done.
