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An estimated two million pregnant women are infected with sexually transmitted diseases (STDs) each year in the United States. These STDs are common complications in pregnancy. Physiologic—including immunologic and hormonal—changes during pregnancy may alter susceptibility to infection.

STDs can cause significant maternal and fetal complications. Adverse pregnancy outcomes directly and indirectly attributable to STDs include ectopic pregnancy, spontaneous abortion, fetal demise, perinatal infections, intrauterine growth restriction, congenital abnormalities, premature rupture of membranes, preterm birth, chorioamnionitis, puerperal infections, low-birth-weight infants, and neonatal infections. The immunologic mechanisms involved in STDs and adverse pregnancy outcomes are not well understood. Inflammatory cytokines, in response to infection, may be involved in the pathogenesis of preterm premature rupture of membranes and preterm labor, as well as adverse fetal conditions.

Diagnosis and management of STDs in pregnancy may decrease maternal and fetal morbidity and mortality. Most STDs are commonly asymptomatic or present with nonspecific symptoms; without a high index of suspicion and low threshold for testing, a substantial number of STDs will be missed, potentially leading to adverse perinatal outcomes. Therefore, obtaining a complete STD history and performing appropriate screening studies of the pregnant patient at the first prenatal visit are essential.

STDs routinely screened for in pregnancy include syphilis, hepatitis B, HIV, and chlamydia. Leading authorities differ regarding STD screening recommendations in pregnancy (see Table 22–1). These variations arise from different risk stratification, cost-benefit, and prevention strategies. Of note, the Centers for Disease Control and Prevention (CDC) recommends chlamydia screening for all pregnant women at the first prenatal visit, whereas the American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG), in their 2002 Guidelines for Perinatal Care, recommend chlamydia testing only in high-risk pregnant women, given that evidence of prevention of adverse effects through screening in pregnancy is limited. High-risk individuals may be defined by numerous criteria, depending on the specific STD in consideration (see Table 22–1). Additionally, gonorrhea and hepatitis C testing are also recommended by the CDC for at-risk women during the first prenatal visit.

Table 22–1. Screening Guidelines for Sexually Transmitted Diseases (STDs) in Pregnancy.

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