Sexually transmitted diseases (STDs), also referred to as STIs, are bacterial, viral, or parasitic infections passed primarily through sexual contact. These infections often affect the reproductive tract and may exist without noticeable symptoms. While an STD does not automatically prevent conception, understanding the health implications during pregnancy is important. Timely medical intervention is necessary to manage any existing infection and protect the health of both the pregnant person and the developing fetus.
STDs and the Ability to Conceive
The ability to conceive is usually unaffected by most STDs in the short term. However, certain untreated bacterial infections can cause long-term damage leading to infertility. Chlamydia and gonorrhea are the primary culprits because they can progress into Pelvic Inflammatory Disease (PID). PID occurs when bacteria travel from the cervix into the upper reproductive tract, infecting the uterus, ovaries, and fallopian tubes.
Untreated PID causes scarring and blockage of the fallopian tubes, a major cause of tubal factor infertility. This damage prevents the egg from traveling down the tube to meet sperm, thus preventing conception. Partial tubal blockages also increase the risk of an ectopic pregnancy, where a fertilized egg implants outside the uterus. An estimated 10% to 15% of women with untreated chlamydia or gonorrhea develop PID, linking these infections to compromised fertility.
Viral STDs, such as Human Immunodeficiency Virus (HIV) or Herpes Simplex Virus (HSV), do not typically cause anatomical damage leading to tubal scarring or physical blockages. These infections do not interfere with ovulation or fertilization. Because chlamydia and gonorrhea often cause no symptoms, testing for these infections is a routine part of a fertility workup, as they are the most preventable causes of infertility.
Maternal and Fetal Health Risks
Once conception occurs, the presence of an STD poses substantial health risks to the pregnant person and the developing fetus. Infections can be transmitted across the placenta, during passage through the birth canal, or through breastfeeding (vertical transmission). This transmission can lead to various adverse pregnancy outcomes and complications.
The pregnant person faces an increased risk of premature rupture of membranes and preterm labor (delivery before 37 weeks). Preterm birth is the leading cause of infant death and can cause long-term developmental and health problems. Syphilis can cross the placenta early in pregnancy, causing severe outcomes including stillbirth, low birth weight, and congenital syphilis. Congenital syphilis can result in blindness, deafness, and brain damage in the newborn.
Bacterial infections like chlamydia and gonorrhea, if present at delivery, can infect the newborn’s eyes and lungs as they pass through the birth canal. This may result in serious eye infections (neonatal conjunctivitis) and pneumonia. While HIV transmission is a concern, modern medical management has dramatically reduced this risk. Untreated STDs during pregnancy can also result in low birth weight, acute hepatitis, and neurological damage for the newborn.
Treatment and Management Protocols During Pregnancy
Immediate identification and treatment of STDs during pregnancy are necessary to minimize maternal and fetal complications. Treatment protocols are carefully selected to be safe and effective for both the pregnant person and the fetus. Curable bacterial STDs are generally treated with a single course of antibiotics.
Bacterial Infections
Chlamydia is typically treated with azithromycin, which is safe during pregnancy. Gonorrhea is managed with an injection of ceftriaxone, often combined with azithromycin. For both infections, retesting within three months is recommended due to high rates of reinfection, and a test-of-cure may be performed to confirm elimination.
Syphilis management is a high priority due to the severe risk of congenital syphilis. It is exclusively treated with penicillin, which is the only treatment proven to prevent fetal infection. The dosage and number of injections depend on the stage of the disease. If a person has a penicillin allergy, they must undergo a desensitization process to safely receive the medication.
Viral Infections
Management for incurable viral infections focuses on viral suppression and preventing transmission. People with HIV receive highly active antiretroviral therapy (ART) throughout pregnancy, which can reduce the risk of vertical transmission to less than 1%. For herpes, suppressive therapy using oral antivirals like acyclovir or valacyclovir is often started around 36 weeks of gestation. If active genital herpes lesions are present during labor, a Cesarean section is typically recommended to prevent the newborn from contacting the virus.
Screening Recommendations and Prevention
Proactive STD screening is a standard component of prenatal care, allowing for early detection and treatment. Universal screening for HIV, syphilis, and Hepatitis B is recommended for all pregnant individuals at the first prenatal visit. Testing for chlamydia and gonorrhea is also recommended for all pregnant people under 25 years of age and for older individuals at increased risk.
Risk factors necessitating additional or repeat screening include having multiple sex partners during pregnancy or having a partner with a known STD. Repeat screening in the third trimester is advised for high-risk individuals to catch infections acquired later in pregnancy. Preconception counseling offers an opportunity to get tested and treated for existing infections before attempting to conceive.
Using barrier methods, such as condoms, consistently and correctly is an effective way to prevent acquiring a new STD during pregnancy. Open communication with a healthcare provider about sexual history and risk factors ensures the correct testing and management plan is implemented. Regular testing and preventative measures safeguard the health of both the mother and the baby.