Management of Sexually Transmitted Diseases during Pregnancy

Joong Shin Park

doi:10.5124/jkma.2008.51.10.897

J Korean Med Assoc > Volume 51(10); 2008 > Article

Park: Management of Sexually Transmitted Diseases during Pregnancy

Focused Issue of This Month

Sexually Transmitted Diseases

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2008; 51(10): 897-904.

Published online: October 31, 2008

DOI: http://dx.doi.org/10.5124/jkma.2008.51.10.897

Management of Sexually Transmitted Diseases during Pregnancy

Joong Shin Park, MD

Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Korea. jsparkmd@snu.ac.kr

Abstract

Sexually transmitted diseases (STDs) are not rare during pregnancy; however, they are usually asymptomatic and may be unrecognized. STDs in pregnancy can cause serious complications to both pregnant women and fetuses. Screening tests are recommended, because the treatment of these diseases can be curative in most cases, or at least effective in reducing complications. In this point of view, the Centers for Disease Control and Prevention recommends screening of all pregnant women for several STDs including human immunodeficiency virus (HIV) infection, hepatitis B, and syphilis, and screening selectively in high risk women for gonorrhea and hepatitis C. To reduce vertical transmissions, highly active antiretroviral therapy and timed Cesarean delivery is recommended in HIV-infected pregnant women. Penicillin is still a drug of choice for syphilis in pregnancy. In women who have active genital herpetic lesions at the time of labor, Cesarean delivery is indicated to protect neonates from perinatal transmissions. However, in women who have genital warts with human papilloma virus infection, Cesarean delivery is not recommended to prevent neonatal laryngeal papillomatosis. In women infected with gonorrhea, Chlamydia or Trichomonas, tests for HIV infection are recommended because of high prevalence of concomitant infections.

Sexually transmitted disease; Pregnancy; Screening test; Management

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Figure 1

Estimation of timing of perinatal HIV transmission rates (18).

Table 1

CDC Recommendations for sexually transmitted infection (STI) screening in pregnancy

"Yes" indicates screening is recommended at the first prenatal visit, with repeat screening in the third trimester for those at risk.

CDC: Centers for Disease Control and Prevention; NAAT: nucleic acid amplification test; HBsAg: hepatitis B surface antigen; HCV: hepatitis C virus; PCR: polymerase chain reaction; HIV: human immunodeficiency virus; EIA: enzyme immunoassay; HPV: human papillomavirus; RPR: rapid plasma reagin; VDRL: Venereal Disease Research Laboratories.

^*Bacterial vaginosis is not an STI, but it is more common in sexually active women.

^††Women who have a new or more than one sex partner.

^‡‡Women with a history of injection drug use, repeated exposure to blood products, or blood transfusion or organ transplant before 1992.

Table 2

Recommended treatment for pregnant women for syphilis

^aPrimary, secondary, and latent syphilis of less than 1 year duration.

^bLatent syphilis of unknown or more than 1 year duration; tertiary syphilis.

^cSome recommend benzathine penicillin, 2.4 million units intramuscularly after completion of the neurosyphilis treatment regimens.

From the Centers for Disease Control and Prevention (5).

Table 3

Pediatric AIDS clinical trials group (PATCG) 076 zidovudine regimen

^aAcceptable alternative regimens include 200 mg three times daily or 300 mg twice daily.

^bFor elective cesarean delivery, intravenous zidovudine is begun at least 3 hours prior to surgery. For premature rupture of membranes or labor with a planned operative delivery, the loading dose may be given during 30 minutes prior to surgery.

^cIntravenous dosage for infants who cannot tolerate oral intake is 1.5 mg/kg intravenously every 6 hours.

From U.S. Public Health Service, 2003. (21)