Every month since January 2011, we’ve been sharing installments of our STD Awareness series, and each month, we’ve encouraged you to protect yourself from sexually transmitted diseases (STDs) by using dental dams and condoms. But what if you’re trying to get pregnant? In that case, you’re probably not using condoms! However, it is very important that partners know their STD status — being screened and treated for STDs prior to pregnancy is a good idea for your health, and can protect your future baby.
If you and a partner are trying to get pregnant, you might consider being screened for STDs together.
When present during pregnancy, certain STDs can have negative health effects for you or your future baby (including preterm labor, stillbirth, low birth weight, pneumonia, certain infections, blindness, and liver disease), especially if they are not cured or treated in time. Receiving prenatal care can help prevent these problems, so it is important to be screened and treated for STDs prior to or early in your pregnancy.
During pregnancy, the immune system undergoes changes, which are probably necessary to ensure that the body doesn’t reject the fetus — normally, the immune system recognizes non-self cells as potential pathogens and attacks. These immune system changes might make a pregnant person more susceptible to disease. Latent viral infections, like genital warts or herpes, might come out of dormancy. Additionally, anatomical changes lead to a larger exposed area of the cervix, which is potentially more vulnerable to initial infections.
Many STDs can be transmitted to the baby before, during, or after birth. For example, syphilis and HIV can cross the placenta and infect the fetus in utero, while gonorrhea, chlamydia, and hepatitis B can be transmitted to the baby during vaginal delivery. HIV and cytomegalovirus can be transmitted during breastfeeding.
Bacterial STDs are very common, but are curable with antibiotics. They include chlamydia, gonorrhea, and syphilis. As a bonus, we’re including trichomoniasis, a non-bacterial infection, in this section, since it can also be easily cured with drugs.
“What if I’m pregnant and I have …
- chlamydia?” If you have untreated chlamydia during labor, the baby’s risk is increased for eye infections, respiratory infections, and pneumonia. A chlamydia infection might also lead to preterm labor.
- gonorrhea?” If gonococci, the bacteria that cause gonorrhea, make their way into a vagina, they’ll set up shop on the cervix, lying in wait for a passing infant. During vaginal delivery, the gonococci can hitch a ride on the baby to the outside world — putting the infant in danger of ophthalmia neonatorum, an eye infection that can lead to blindness. If, during labor, you are known to be infected with gonorrhea, your baby will get an injection of antibiotics in addition to the routine antimicrobial eye drops that are administered to all newborns.
- syphilis?” Congenital syphilis is serious, but rare in the United States. During pregnancy, the bacteria that cause syphilis can cross the placenta to infect the fetus in the womb. Since syphilis doesn’t always have symptoms, it’s important to be screened as early as possible, as syphilis can be treated. When syphilis infects the fetus, risk for stillbirth and preterm labor skyrockets; other symptoms might affect the infant temporariliy (e.g., fevers and rashes), or could be permanent, affecting the child throughout his or her life (e.g., deafness or blindness).
- trichomoniasis?” A trichomoniasis infection during pregnancy could increase risk for a preterm labor or low birth weight.
Despite the severity of some of these possible outcomes, the salient point here is that bacterial infections and trichomoniasis can be cured. Treating them prior to or as early as possible during pregnancy will drastically reduce risk. Routine screening for you and your partner is important!
Once you’re infected with a virus, it can remain in your body for the duration of your life. Some viruses, like HIV and the herpes simplex virus, can be managed with medication but can’t be cured. Other viruses, like human papillomavirus (HPV), which causes genital warts, and hepatitis B, can’t be cured by medicine (though both can be prevented with vaccines), but can be eliminated by your immune system. If your immune system can’t clear these viruses, however, they will become chronic infections just like HIV and herpes.
“What if I’m pregnant and I have …
- HIV?” If you have HIV, steps can be taken to reduce risk for your future baby. If you are treated with specific antiretroviral medications early in your pregnancy, there is less than a 2 percent chance of delivering a baby with HIV — compared to a 25 percent chance when HIV is not correctly managed during pregnancy.
- genital herpes?” Neonatal herpes is serious but rare, affecting about 1,500 infants in the United States annually. The herpes simplex virus can cross the placenta, potentially causing miscarriage or severe damage to the fetus, including vision or hearing defects and mental retardation. Acquiring a symptomatic herpes infection during the first 20 weeks of pregnancy leads to a high risk of miscarriage; after 20 weeks there are high risks for low birth weight and neonatal herpes. Even when there are no symptoms of an initial herpes infection during pregnancy, there is still a high risk for preterm labor and viral transmission to the fetus. If you aren’t infected with genital herpes and your partner is, your partner should consider herpes medication if you’re trying to get pregnant. After you become pregnant, medication should be continued and condoms should be used — an initial herpes infection during pregnancy carries many risks. Discuss your situation with a health care provider. If you’re pregnant and have genital herpes, the amniotic fluid can be analyzed to determine if the fetus has been infected; if it’s virus-free, precautions can protect the baby from exposure during birth, as vaginal delivery can expose the infant to the virus.
- genital warts?” Genital warts are caused by certain strains of HPV. Hormonal changes can induce them to grow in size, and transmission to the infant during vaginal delivery is possible, though rare. A congenital infection, called recurrent respiratory papillomatosis (RRP), can lead to the growth of warts in the respiratory tract, which can cause breathing problems. This is a rare condition — only 1 in 200,000 children develops it. Babies can also be infected with HPV in their genitals, resulting in genital warts — like RRP, this is rare. Risk can be decreased by performing a C-section. Certain wart medications, such as podophyllin, are dangerous to use while pregnant, so you should ask a doctor about treatment options during pregnancy. Other strains of HPV are known to cause cancer; fortunately, there are no documented cases of a child developing cancer that was caused by HPV acquired during birth.
- hepatitis B?” Babies can be exposed to hepatitis B (HBV) during delivery. Fortunately, treating the infant at birth with a vaccine and an injection of immune globulin, and completing the vaccine series afterward, provides almost total protection to babies exposed to HBV during birth. Refusing treatment for your child almost guarantees that the newborn will be infected with HBV as well. HBV increases the risk for liver diseases, especially when the infection strikes the pediatric population, so it’s very important for an exposed baby to be vaccinated.
- cytomegalovirus?” About 1 in 100 U.S. babies is born with cytomegalovirus (CMV), which can infect them in utero, but symptomatic babies are rare. Every year in the United States, around 5,500 babies are born with symptomatic cytomegalic inclusion disease (CID). Symptoms of CID vary, but the most severe include developmental disorders and hearing loss. If you were already infected before conception, there is a 2 percent chance the virus will be transmitted to the fetus; however, if the infection occurs during pregnancy, this risk jumps into the 40 to 50 percent range. CMV can also be transmitted via breast milk.
If you and a partner are trying to get pregnant, you can make an appointment to be screened for STDs together. Doctors do not routinely screen for STDs, so it’s up to you to request this testing. If you test positive for a bacterial STD, such as chlamydia or syphilis, you can be cured with antibiotics, even if you are already pregnant. Unfortunately, viral STDs, such as HIV and herpes, cannot be cured — but they can be treated with antiviral drugs that reduce the risk of transmission to your pregnant partner or to the baby. Additional precautionary measures might include giving birth by C-section to avoid transmission during vaginal delivery.
If you and your partner test negative for STDs, it is important to remain monogamous during the time you are having unprotected sex — this will help ensure that your STD status doesn’t change. If you’re pregnant and non-monogamous, you can use condoms and dental dams. While the HPV vaccine is not recommended during pregnancy, you can be vaccinated for hepatitis B while pregnant if you’re at risk for acquiring it.
Click here to check out other installments of our monthly STD Awareness series!