19-32: Syphilis, Gonorrhea, & Chlamydia Trachomatis Infection in Pregnancy

These STDs have significant consequences for mother and child (see also Chapters 33 and 34). They are also on the rise in the United States. Untreated syphilis in pregnancy can cause late abortion, stillbirth, transplacental infection, and congenital syphilis. Gonorrhea can produce large-joint arthritis by hematogenous spread as well as ophthalmia neonatorum. Maternal chlamydial infections are largely asymptomatic but are manifested in the newborn by inclusion conjunctivitis and, at age 2–4 months, by pneumonia. The diagnosis of each can be reliably made by appropriate laboratory tests. All women should be tested for syphilis and C trachomatis as part of their routine prenatal care. Repeat testing is dependent on risk factors, prevalence, and state laws. A pregnant patient treated for C trachomatis should have a test of cure 3–4 weeks later and then 3 months after that because of high reinfection rates. Women at risk should be tested for gonorrhea. The sexual partners of women with STDs should be identified and treated also if possible; the local health department can assist with this process.