Chlamydia is a common bacterial sexually transmitted infection (STI) caused by Chlamydia trachomatis. It often presents without noticeable symptoms, so many individuals are unaware they have it. This silent nature can have significant implications during pregnancy, making it important to understand its potential effects on both the expectant parent and the newborn.
Impact on the Expectant Parent
Untreated chlamydia in pregnant individuals can lead to several complications. These include cervicitis, an inflammation of the cervix, which may cause abnormal vaginal discharge or bleeding. Although less common during pregnancy, pelvic inflammatory disease (PID), an infection of the reproductive organs, can occur and lead to chronic pelvic pain.
Chlamydia also carries risks for the pregnancy itself. It can increase the likelihood of premature rupture of membranes and preterm labor. Some studies suggest an association with an increased risk for low birth weight in infants. Untreated infection can also contribute to endometritis, an inflammation of the uterine lining, after childbirth.
Effects on the Newborn
When chlamydia is present in the birth canal, it can be transmitted to the baby during vaginal delivery. This can lead to specific infections in the newborn, primarily affecting the eyes and lungs. Neonatal conjunctivitis, an eye infection with redness, swelling, and discharge, typically develops within 5 to 12 days after birth. If left untreated, it can potentially lead to severe eye damage.
Another complication is chlamydial pneumonia, which usually presents as a subacute illness with symptoms like a repetitive cough and rapid breathing. This pneumonia typically emerges between 1 and 3 months of age, though it can appear earlier.
Screening and Management During Pregnancy
Screening for chlamydia is a routine part of prenatal care, recommended at the first prenatal visit. Individuals younger than 25, or those over 25 with increased risk factors like a new sexual partner or multiple partners, should be screened. For high-risk individuals, retesting may be advised in the third trimester.
Diagnosis typically involves analyzing a urine sample or a vaginal swab. The most sensitive method is a nucleic acid amplification test (NAAT). If a pregnant individual tests positive, prompt treatment is important to prevent complications for both the parent and the baby.
The recommended first-line treatment for chlamydia during pregnancy is a single oral dose of 1 gram of azithromycin. An alternative is amoxicillin, 500 mg three times daily for 7 days. Doxycycline, commonly used for chlamydia in non-pregnant individuals, is not used during pregnancy due to potential effects on fetal development. After treatment, a “test of cure” is recommended 3 to 4 weeks later to confirm the infection has cleared. Treating all sexual partners is also important to prevent reinfection.