Sexually transmitted diseases are relatively common in pregnancy. Some of the common sexually transmitted diseases which are sought in routine antenatal care are discussed here. These include syphilis, gonorrhea, chlamydia and human immunodeficiency virus (HIV). In India, it is routinely recommended to screen for syphilis in the antenatal period whereas other infections are looked for whenever suspected, or in high-risk population.
SYPHILIS
Syphilis in a pregnant woman shows its effect on the offspring. If diagnosed and treated in pregnancy, the effects are minimised.
EFFECT OF PREGNANCY ON SYPHILIS
In most cases, syphilis runs a mild course during pregnancy, but some of the secondary manifestations such as condylomata and skin rashes may appear in an aggravated form, probably because of the increased Avascularity.
GONORRHEA
Gonorrhea is not infrequent in pregnant women, the infection occurring either prior to or to conception. In subsequent most pregnant women, gonococcal infection is limited to the lower genital tract, including the cervix, urethra, and peri-urethral and vestibular glands.
EFFECT OF PREGNANCY ON GONORRHEA
There is some evidence that pregnancy alters the clinical presentation of gonorrhea. Pregnancy would appear to favour exacerbation and extension of the infection.
CHLAMYDIA TRACHOMATIS
Chlamydia trachomatis is an obligate intracellular bacterium that has several serotypes, including those that cause lymphogranuloma venereum. Commonly encountered strains are those that cause cervical infection. Most pregnant women have subclinical or asymptomatic infection.
CHLAMYDIAL INFECTION AND PREGNANCY OUTCOME
It has been observed that untreated maternal cervical chlamydial infection during pregnancy increases the risk for preterm delivery, preterm premature rupture of membranes thereby increasing the perinatal mortality.
MANAGEMENT
The first line of treatment when the diagnosis is made is erythromycin base 500 mg orally four times a day for 7 days or amoxicillin 500 mg orally three times a day for 7 days.
NEONATAL INFECTIONS
Ophthalmic chlamydial infections are one of the most common causes of preventable blindness. Inclusion conjunctivitis develops in as many as a third of the neonates born to mothers with cervical infection.
HUMANS IMMUNO DEFICIENCY VIRUS INFECTION
The prevalence rate of HIV infection among pregnant women is around 0.3% and the vertical transmission rate to the fetus is around 30%. Hence it is essential to diagnose and treat the condition to minimise the chances of perinatal infection.
ROUTINE ANTENATAL SCREENING
In India, the National Aids Control Organisation (NACO) recommends that all pregnant women should be counselled to undergo testing for HIV infection. The test is performed after getting an informed consent.
DIAGNOSIS
The enzyme immunoassay (EIA) is used as a screening test. If it is found to be positive, it is repeated a second time with another kit. If both are positive, then the patient is considered a HIV positive.
VARICELLA ZOSTER (CHICKENPOX)
This is a DNA herpes virus that remains latent in the dorsal root ganglia after primary infection. Most adults have had chickenpox during childhood and nearly 95% have serological evidence of immunity. There is evidence that varicella infection is specially severe during pregnancy. In general, varicella infection tends to be much more severe in adults than in children. beevention: Vaccination during pregnancy is not recommended since an attenuated live-virus vaccine is used. Administration of varicella zoster immunoglobulin will either prevent or attenuate varicella infection in exposed susceptible individuals if given within 96 hours. The dose is 125 U/10 kg given intramuscularly with a maximum dose of 625 units.
Fetal effects:
• Maternal chickenpox during the first half of pregnancy may cause congenital malformations by transplacental infection. Some of these include chorioretinitis, cerebral cortical atrophy, hydronephrosis etc. The risk of fetal infection varies from 0.4% to 2%.
• Fetal exposure later in pregnancy is associated with congenital varicella lesions.
• Varicella zoster or zoster immunoglobulin is administered to the neonate whenever the onset of maternal disease is within 5 days before or after delivery.
MALARIA
In endemic areas, malaria may occur as a complication in pregnancy. In India, this problem is frequently encountered. The disease is characterised by fever and flu-like symptoms including chills, headaches, malaise which may occur at intervals. Malaria may be associated with anemia and jaundice.
EFFECT OF PREGNANCY ON MALARIA
Malarial episodes increase significantly three-four fold during the last two trimesters of pregnancy and 2 months postpartum.Pregnancy enhances the severity of malaria specially in non-immune nulliparous women.
EFFECT OF MALARIA ON PREGNANCY
The incidence of abortion and preterm labour is increased with malaria. Increased fetal loss may be related to placental and fetal infection. Neonatal infection is uncommon is not infrequent in pregnant women, the infection occurring either prior to or to conception. In subsequent most pregnant women, gonococcal infection is limited to the lower genital tract, including the cervix, urethra, and peri-urethral and vestibular glands.