Gonorrhea is a common bacterial infection caused by Neisseria gonorrhoeae, primarily transmitted through sexual contact. The infection is frequently asymptomatic, meaning many individuals are unaware they carry the bacteria, which allows for continued spread and potential complications. When contracted during pregnancy, this sexually transmitted infection (STI) presents a serious risk to both the pregnant person and the developing fetus or newborn. Prompt identification and management are essential for preventing severe and permanent health consequences.
Maternal Health Risks
Untreated gonorrhea can lead to significant complications for the pregnant individual. While pelvic inflammatory disease (PID) is a common consequence in non-pregnant individuals, its presentation during gestation can be atypical. The bacteria can ascend, causing inflammation and infection of the uterine lining, which may lead to adverse outcomes.
A major concern is the increased likelihood of poor pregnancy outcomes, including miscarriage, especially when the infection is contracted early in gestation. The presence of untreated N. gonorrhoeae is also strongly associated with an increased risk of premature rupture of membranes (PROM) and subsequent preterm labor and birth.
In rare but serious cases, the infection can spread through the bloodstream, leading to Disseminated Gonococcal Infection (DGI), which is more common in women and seems to occur more frequently during pregnancy. DGI is a systemic infection that can cause symptoms like fever, skin lesions, and migratory polyarthritis, affecting the joints. This systemic spread necessitates hospitalization and aggressive treatment to prevent potentially life-threatening complications such as endocarditis or meningitis.
Neonatal and Fetal Complications
The most significant risk to the newborn occurs during a vaginal delivery, where the baby may be exposed to the bacteria residing in the mother’s birth canal. This exposure can result in a severe eye infection known as gonococcal ophthalmia neonatorum, or neonatal conjunctivitis. This condition typically presents between two and five days after birth with symptoms like profound eyelid swelling and abundant purulent discharge.
Gonococcal ophthalmia neonatorum is considered a medical emergency because the bacteria can rapidly invade the cornea, potentially causing ulceration, scarring, and perforation of the globe. If left untreated, this eye infection can lead to permanent visual impairment or blindness. Prophylactic eye treatment for newborns is a common practice in many regions.
Less commonly, the bacteria can spread systemically in the newborn, leading to disseminated gonococcal disease. This systemic infection can result in serious complications like sepsis, a life-threatening blood infection, or joint infection (septic arthritis). Furthermore, maternal gonorrhea infection is linked to an increased risk of the baby having a low birth weight and being born small for gestational age (SGA).
Screening and Diagnostic Procedures
Identifying N. gonorrhoeae infection in pregnant individuals is a crucial step in preventing both maternal and neonatal complications. Current guidelines recommend screening at the first prenatal visit for all pregnant people under the age of 25, as well as for older individuals considered to be at increased risk. Risk factors include:
- Having a new sex partner.
- Multiple partners.
- A partner with concurrent partners.
- A partner who has another STI.
The preferred method for diagnosing the infection is the Nucleic Acid Amplification Test (NAAT). NAATs detect the genetic material of the bacteria and can be performed on easily collected samples, such as urine or vaginal/cervical swabs. For individuals who remain at continued high risk throughout their pregnancy, a repeat screening in the third trimester is advised to prevent transmission at delivery and postnatal complications.
Safe Treatment Protocols
Treatment of gonorrhea during pregnancy is essential and must use antibiotic regimens that are both highly effective and safe for the developing fetus. The recommended first-line therapy involves a single, intramuscular dose of the cephalosporin antibiotic ceftriaxone. While ceftriaxone monotherapy is now the standard for uncomplicated gonorrhea, pregnant patients should also be treated for chlamydial co-infection if it has not been ruled out, typically with a single dose of azithromycin.
The importance of using ceftriaxone is rooted in its effectiveness and its safety profile in pregnancy, as other common treatments like doxycycline are generally avoided due to potential effects on fetal bone and tooth development. Following treatment, a test-of-cure is specifically recommended for pregnant patients, typically performed three to four weeks after therapy to confirm that the infection has been successfully eradicated. This step is a procedural difference from non-pregnant individuals with urogenital or rectal infection, for whom a test-of-cure is often unnecessary.
A comprehensive management plan requires that all sexual partners from the preceding 60 days be evaluated, tested, and treated to prevent immediate reinfection. Pregnant patients should be advised to abstain from sexual activity until both they and their partners have completed treatment and any symptoms have resolved. The goal of this aggressive approach is to break the chain of transmission, protect the mother’s health, and ensure a healthy outcome for the baby.