Many new and expectant mothers are concerned about the potential transmission of sexually transmitted infections (STIs) through breast milk. Understanding STI transmission is important for making informed decisions about infant feeding. Evidence-based information helps clarify which infections pose a risk through breast milk and how to mitigate those risks, ensuring the health of both mother and infant. This knowledge empowers individuals to navigate breastfeeding choices confidently while prioritizing safety.
STIs Transmitted Through Breast Milk
Human Immunodeficiency Virus (HIV) and Human T-lymphotropic Virus (HTLV) are two sexually transmitted infections that can be transmitted from a mother to her child through breast milk. HIV, a retrovirus, can be present in breast milk. Without interventions, the risk of HIV transmission through breastfeeding can be significant, potentially accounting for a substantial portion of infant infections.
The risk of HIV transmission via breast milk is influenced by several factors. A higher maternal viral load increases the likelihood of transmission. Maternal immunosuppression also poses an independent risk. Additionally, inflammation in the breast, such as mastitis or cracked nipples, can elevate the risk of transmission. Mixed feeding, where infants receive both breast milk and other foods, has also been associated with a higher risk compared to exclusive breastfeeding.
Human T-lymphotropic Virus (HTLV-1) is another retrovirus primarily transmitted through breast milk from mother to child. The exact cellular mechanism of HTLV transmission through breastfeeding is still being studied, but it is known to involve the transfer of infected T lymphocytes present in the breast milk. Factors that increase the risk of HTLV-1 transmission include a high proviral load in both the mother’s blood and breast milk. The duration of breastfeeding is also a significant risk factor, with longer breastfeeding periods increasing the chance of transmission.
STIs Not Transmitted Through Breast Milk
Many common sexually transmitted infections are not transmitted through breast milk. These include Chlamydia, Gonorrhea, Syphilis, Human Papillomavirus (HPV), and Trichomoniasis. Mothers with these infections can generally breastfeed safely, especially when undergoing appropriate treatment.
Human Papillomavirus (HPV) is also considered to have a very low or negligible risk of transmission through breast milk. While HPV DNA has been detected in some breast milk samples, studies indicate that the likelihood of a baby contracting HPV from breast milk is extremely low, and there is no conclusive evidence linking it to later health issues in infants. The benefits of breastfeeding generally outweigh any theoretical risks associated with HPV. Trichomoniasis, caused by a parasite, is another STI that does not pose a risk for transmission through breast milk, and mothers can breastfeed while undergoing treatment for it.
Herpes Simplex Virus (HSV) is not transmitted through breast milk. The primary concern with HSV and breastfeeding arises from direct contact with active lesions. If a mother has active herpes sores on her breast, breastfeeding from that breast should be temporarily stopped to prevent direct transmission to the infant. Milk from the affected breast should be discarded if it comes into contact with the sores. If lesions are located elsewhere on the body and can be completely covered, or if there are no lesions on the breasts, breastfeeding is considered safe, and maintaining proper hand hygiene is important to prevent inadvertent transmission.
Informed Decision-Making for Breastfeeding
Making informed decisions about breastfeeding when living with an STI involves communicating with healthcare providers and following medical guidance. Regular STI testing, particularly during pregnancy and postpartum, is an important step to understand one’s status and any potential risks. Early detection allows for timely treatment, which can significantly reduce the risk of transmission to the infant. For instance, antiretroviral therapy (ART) for HIV-positive mothers can lower the risk of transmission through breast milk to less than 1% when viral suppression is maintained.
Healthcare providers can offer personalized recommendations based on the specific STI and the availability of treatments. In cases like HIV, while formula feeding has historically been recommended, current guidelines acknowledge that breastfeeding with consistent ART and viral suppression can be an option. Mothers are advised to take their medication as prescribed and attend regular check-ups to monitor their viral load.
For STIs not transmitted through breast milk, treatment typically allows for safe continuation of breastfeeding. In situations involving Herpes Simplex Virus, if active lesions are present on the breast, temporarily stopping feeding from the affected breast and ensuring proper covering of lesions elsewhere are key precautions. Consulting with a healthcare professional ensures that mothers receive tailored advice, balancing the benefits of breastfeeding with strategies to minimize any potential risks to their infant.