Pregnancy specific STD screening

SEXUALLY transmitted infections and diseases can be quite dangerous and even life-threatening and when a woman is pregnant not only is she at risk of associated complications, but also her developing foetus. Fortunately, Dr Samantha Nicholson, medical internist at Imani Medical Centre, Papine Plaza, said that an integral part of prenatal care is screening and treating pregnant women and their partner/s for these diseases that could potentially lead to adverse pregnancy outcomes.

“Once a mother has an STD it is quite possible that the unborn infants will become infected or develop complications related to the disease or infection. The likelihood of this happening increases if adequate measures are not put in place to treat the mother or protect the foetus and so this is why as early as your first prenatal visit you are sent to do blood tests to check for some STDs and STIs,” Dr Nicholson said.

She pointed out that since infections during pregnancy affect the mother and often the child either in utero or at the time of delivery, as well as increases complications associated with morbidity and mortality, screenings for certain STDs are recommended as part of the standard prenatal care to ensure that the mother and child are given the best outcome. The STDs often screened for include:

Chlamydia

Chlamydia is one of the most common sexually transmitted infections globally. The infection, which is caused by the bacteria Chlamydia trachomatis, is passed through infected vaginal fluids or semen. Dr Nicholson explained that the infection, which is usually tested for as soon as pregnancy is confirmed, is particularly important because chlamydia, if untreated, may lead to pregnancy complications such as pre-term labour, pre-term rupture of membranes, and low birth weight. In addition, mother-to-child transmission can also occur during delivery resulting in pneumonia or conjunctivitis which can lead to blindness if untreated. In the case of the mother, she may develop postpartum endometritis (inflammation of the lining of the uterus). Once confirmed, not only the mother but her partner will be offered antibiotics for treatment and the test repeated in the third trimester.

Gonorrhoea

Gonorrhoea is another common sexually transmitted disease. Similar to chlamydia, this test is done in the first trimester of pregnancy and then repeated in the third trimester. According to Dr Nicholson, untreated gonorrhoea during pregnancy has been linked to pregnancy complications such as miscarriage, premature birth, premature rupture of the membranes and low birth weight and may pass to the newborn during vaginal delivery. This may cause neonatal conjunctivitis, pneumonia, or infections of the joints or blood in the infant and maternal endometritis or pelvic infection. Treating gonorrhoea early, however, will reduce the risk of transmission.

Herpes Simplex Virus

While the herpes virus does not pose much risk during pregnancy, during vaginal delivery the child may be infected with the virus. The likelihood of the child contracting the virus increases when there are lesions and/or sores present on the woman’s genitals at the time of delivery. For the newborn to whom the virus has been transmitted, Dr Nicholson said that the infection is potentially life-threatening. The newborn’s exposure to the virus may lead to brain damage, blindness, and damage to other organs. If a woman with genital herpes had an outbreak prior to becoming pregnant, there are prescription drugs available that she can use to reduce the possibility of an outbreak thereby reducing the risk to her infant. However, in the event a woman going into labour has active herpes sores, the doctor will change the mode of delivery to a Caesarean section if that was not the original birth plan to reduce the likelihood of transmission to the infant.

HIV/AIDS

About two decades ago the transmission of HIV/AIDS from mother to child was almost inevitable. However, with developments in science, antiretrovirals have been developed to protect or reduce the possibility of the foetus becoming infected while in the womb or during labour and vaginal delivery.

If the woman goes undiagnosed the disease is passed on and the baby may develop an HIV infection, which can further progress to AIDS in the absence of medical intervention. It is also important that the woman is made aware of her status so that she knows she should refrain from breastfeeding the baby since the virus can also be passed on to the child through the milk.

Hepatitis B

If a woman is infected with Hepatitis B the foetus may also become infected; however, the possibility of this happening depends on when the mother becomes infected during the pregnancy. If the woman is exposed to Hepatitis B while pregnant, she will be treated with antibodies that will lessen the possibility of her getting the infection. Dr Nicholson explained that if the infection occurs early in pregnancy the chances of the foetus becoming infected is low. However, if this occurs later in pregnancy, it is very high. The effects of Hepatitis B on an infant can be catastrophic, resulting in issues such as liver scarring, failure, and cancer which can be fatal. Infected newborns also have a very high risk of becoming carriers of the Hepatitis B virus and can spread the infection to others. However, transmission can be prevented if at-risk infants are treated shortly after birth.

Syphilis

Syphilis is another common sexually transmitted infection that can have catastrophic effects on a foetus. If a pregnant woman is infected during the course of her pregnancy Dr Nicholson said that this increases the possibility of complications such as premature birth, miscarriage, stillbirth, and, in some cases, death after birth. If left untreated infants are at a high risk of complications such as skin lesions or problems with the liver, spleen, bones, or nervous system.