STDs and pregnancy related problems
Intrauterine or perinatally transmitted STDs (sexually transmitted diseases) can have fatal or severely debilitating effects on a fetus.
The following are the CDC (Centers for Diseases Control) recommendations for screening of pregnant women for sexually transmitted diseases (STDs):
A serologic test for syphilis should be performed on all pregnant women at the first prenatal visit. In populations in which utilization of prenatal care is not optimal, rapid plasma reagin (RPR)-card test screening and treatment, if that test is reactive, should be performed at the time a pregnancy is diagnosed. For patients at high risk, screening should be repeated in the third trimester and again at delivery. Some states also mandate screening all women at delivery. No infant should be discharged from the hospital without the syphilis serologic status of its mother having been determined at least one time during pregnancy and, preferably, again at delivery. Any woman who delivers a stillborn infant should be tested for syphilis.
Hepatitis B surface antigen (HBsAg)
A serologic test for hepatitis B surface antigen (HBsAg) should be performed for all pregnant women at the first prenatal visit. HBsAg testing should be repeated late in the pregnancy for women who are HBsAg negative but who are at high risk for HBV infection (e.g., injecting-drug users and women who have concomitant STDs).
A test for Neisseria gonorrhoeae should be performed at the first prenatal visit for women at risk or for women living in an area in which the prevalence of N.gonorrhoeae is high. A repeat test should be performed during the third trimester for those at continued risk.
A test for Chlamydia trachomatis should be performed in the third trimester for women at increased risk (i.e., women aged less than 25 years and women who have a new or more than one sex partner or whose partner has other partners) to prevent maternal postnatal complications and chlamydial infection in the infant. Screening during the first trimester might enable prevention of adverse effects of chlamydia during pregnancy. However, evidence for adverse effects during pregnancy is minimal. If screening is performed only during the first trimester, a longer period exists for acquiring infection before delivery.
A test for HIV infection should be offered to all pregnant women at the first prenatal visit.
Bacterial vaginosis (BV)
A test for bacterial vaginosis (BV) may be conducted early in the second trimester for asymptomatic patients who are at high risk for preterm labor (e.g., those who have a history of a previous preterm delivery). Current evidence does not support universal testing for BV.
Papanicolaou (Pap) smear
A Papanicolaou (Pap) smear should be obtained at the first prenatal visit if none has been documented during the preceding year.
Other STD-related concerns are to be considered as follows: Pregnant women who have either primary genital herpes infection, HBV, primary cytomegalovirus (CMV) infection, or Group B streptococcal infection and women who have syphilis and who are allergic to penicillin may need to be referred to an expert for management. HBsAg-positive pregnant women should be reported to the local and/or state health department to ensure that they are entered into a case-management system and appropriate prophylaxis is provided for their infants.
In addition, household and sexual contacts of HBsAg-positive women should be vaccinated. In the absence of lesions during the third trimester, routine serial cultures for herpes simplex virus (HSV) are not indicated for women who have a history of recurrent genital herpes. However, obtaining cultures from such women at the time of delivery may be useful in guiding neonatal management. Prophylactic cesarean section is not indicated for women who do not have active genital lesions at the time of delivery. The presence of genital warts is not an indication for cesarean section.