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
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
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. |Favorite Table|Download (.pdf)
Table 22–1. Screening Guidelines for Sexually Transmitted Diseases (STDs) in Pregnancy.
|First prenatal visit||HIV||HIV|
|Hepatitis B||Hepatitis B|
|First prenatal visit (high-risk)c||Gonorrhea||Gonorrhea|
|Hepatitis C||Hepatitis C|
|Third trimester||Chlamydia (<25 y)||Chlamydia (<25 y)|
|Third trimester (high-risk)c||HIV (before 36 wk)||HIV (before 36 wk)|
|Syphilis (at 28 wk)||Syphilis|