Prenatal care is a comprehensive approach to health management that begins early in pregnancy. This care focuses on monitoring the health of both the pregnant individual and the developing fetus. A core component of this care is the screening for sexually transmitted diseases (STDs). STD screening is a standard practice necessary to protect the health and safety of both the mother and the unborn child.
Standardized Routine STD Screening
Professional medical organizations recommend that all pregnant individuals undergo a standardized panel of STD tests during their initial prenatal visit, usually in the first trimester. This initial screening establishes a baseline health profile and is often mandated by public health laws. The core panel of tests recommended for all pregnant people includes Syphilis, Human Immunodeficiency Virus (HIV), and Hepatitis B Virus (HBV) infection.
These infections are screened for using a simple blood test, often collected concurrently with other routine blood work. Syphilis testing detects antibodies in the blood. HIV testing is an opt-out procedure, offered routinely unless the patient declines. Testing for Hepatitis B identifies the current infection status.
This universal screening guides immediate care and treatment planning. Identifying infections early allows for timely intervention, which dramatically reduces the risk of transmission to the fetus. Retesting is performed with each pregnancy because infection status may change, and screening is standard because these infections are often asymptomatic.
Fetal and Maternal Health Consequences of Untreated Infections
Leaving infections like Syphilis, HIV, and Hepatitis B untreated during pregnancy can lead to severe health outcomes for both the mother and the child. Untreated Syphilis poses a high risk; up to 40% of babies born to affected mothers are stillborn or die shortly after birth. The infection can cross the placenta, resulting in congenital syphilis, which causes bone damage, severe anemia, neurological damage, or blindness in the infant.
If HIV is not managed, it carries a risk of vertical transmission to the baby during gestation, labor, or delivery. Undiagnosed infants born with HIV are vulnerable to disease progression and opportunistic infections. Proper antiviral therapy, however, can reduce the risk of transmission significantly.
Hepatitis B Virus infection also risks transmission to the infant during birth. Without preventive measures, up to 90% of infants born to HBV-infected mothers may become infected. These infants risk developing chronic HBV infection, which can lead to life-threatening liver complications later in life. Untreated bacterial infections like Chlamydia and Gonorrhea can also cause adverse outcomes such as preterm birth or eye and lung infections in the newborn.
Targeted Testing Based on Specific Risk Factors
While Syphilis, HIV, and Hepatitis B are universally screened, testing for Chlamydia and Gonorrhea is often targeted based on age and specific risk factors. Screening for both Chlamydia and Gonorrhea is routinely recommended for all pregnant individuals under 25 years old at their first prenatal visit. This is due to the higher prevalence of these infections in that demographic.
Individuals over 25 are screened if they have specific risk factors. These factors include having a new or multiple sex partners during the pregnancy, having a partner with concurrent partners, or having another sexually transmitted infection. Testing for these infections usually involves a swab of the vagina or cervix.
Beyond the initial testing, retesting is recommended later in the pregnancy, typically in the third trimester, for patients at increased risk of acquiring an infection. This follow-up screening detects infections acquired later in gestation, helping prevent transmission to the newborn at delivery. Due to rising congenital syphilis rates, some organizations now recommend universal rescreening for Syphilis during the third trimester and at delivery for all pregnant individuals.
Safe Treatment and Management Protocols During Pregnancy
Upon a positive diagnosis, immediate treatment begins using regimens safe for both the mother and the developing fetus. The goal is to eradicate the infection or significantly reduce the viral load to prevent transmission.
For bacterial infections like Syphilis, penicillin is the treatment of choice and the only effective therapy to prevent congenital syphilis. If the pregnant person is allergic to penicillin, they must undergo a desensitization process to receive this medication, as no alternative adequately treats the fetal infection.
For Chlamydia, the preferred treatment is a safe antibiotic, often given as a single oral dose, avoiding contraindicated drugs. Gonorrhea is typically treated with an injection, often combined with medication to address potential co-infection with Chlamydia.
Viral infections like HIV cannot be cured, but they are managed with highly effective antiretroviral therapy (ART) safe for use during pregnancy. ART dramatically lowers the risk of vertical transmission. Successful management also involves treating the pregnant person’s sex partner to prevent reinfection.
Follow-up testing is necessary after treatment for curable infections, such as a test-of-cure for Chlamydia, to ensure the infection has been eradicated. Early detection and appropriate treatment significantly improve maternal health outcomes and offer the best chance for the infant to be born without infection.