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Sexually transmitted diseases and pregnancy. STD is a serious threat to future generations

Sexually transmitted infections (STIs) are diseases that are contracted through sexual intercourse with an infected partner. STIs can be either viral or bacterial. There are also diseases (for example, hepatitis B) that are transmitted through personal hygiene items (toothbrushes, kitchen utensils, razors, etc.), contaminated medical instruments, and the blood of an infected person. For a pregnant woman and fetus, such diseases are extremely dangerous.

Consequences of STIs

They can cause:

  • miscarriage;
  • premature birth;
  • frozen pregnancy;
  • premature rupture of membranes;
  • urinary tract infections.

Based on the above, it should be noted that it is extremely important to be tested for STIs during pregnancy. The referral is issued by a gynecologist. Also, without fail, tell your gynecologist if you have had similar infections in the past, whether you have had any experience of taking drugs and how many sexual partners you had in the past.

Preparation for analysis

  • refuse to take fried and fatty foods, alcoholic beverages 2 days before the test;
  • within 12 hours before the examination, it is forbidden to eat;
  • do not smoke an hour before the analysis;
  • donating blood is recommended in a calm state.

It is forbidden to take tests immediately after the x-ray. Rectal examination or physiotherapy procedures.

What tests should be done

During pregnancy, the following tests for STIs are given:

  1. Blood for HIV, hepatitis, cytomegalovirus, RV;
  2. A smear for "hidden infections";
  3. smear on flora;
  4. Bacteriological seeding on flora.

Among the most common sexually transmitted diseases are: HIV, hepatitis B, TORCH infections (such as herpes, rubella, syphilis, etc.), trichomoniasis, candidiasis, gonorrhea, gardnerellosis, ureaplasmosis. It is important that both sexual partners are tested for STIs, because treatment of one will not give the desired results. It should be noted that the greatest danger of STIs is in the early stages of pregnancy. Antibodies will prevent the passage of pathogens to the placenta only if the woman's disease is chronic. Therefore, in order to know for sure whether a person is sick, is a carrier of the disease, or whether he has never encountered it, it is necessary to undergo an examination. This is best done at the planning stage of pregnancy. During pregnancy, it is important to take tests several times to prevent the acute phase of the disease. The average price of analysis for one type of STI varies from 500 to 1000 rubles.

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1 Pregnancy and sexually transmitted infections Manual for pregnant women Kyzyl, 2013

2 Dear women! If you are pregnant or planning to become pregnant, there are simple steps you can take to protect your unborn child or newborn from infections that cause serious health problems. Our manual will allow you to accept it as a guide to be responsible for your life and for the life, health and full development of your baby. We invite you to cooperate so that you maintain your health and the child is born healthy! The editor-in-chief of the collection is a freelance specialist in dermatovenereology of the Republic of Tyva Obukhov A.P. Photos from the site and from the presentation “Syphilis in China”, Kyzyl, RT, 2011, author candidate of medical sciences Obukhov A.P. 2

3 Sexually transmitted infections (STIs) in a pregnant woman can cause problems for her and her baby. A pregnant woman with an STI can infect her baby early in pregnancy, during pregnancy, and after the baby is born. She may have complications of pregnancy: miscarriage, early birth, premature detachment of the placenta. Pregnant women should ask their doctors to get tested for STIs, as some doctors may not perform these tests. Questions and Answers: Can pregnant women be infected with STIs? Yes, women who are pregnant can be infected with the same STIs as women who are not pregnant. Pregnancy does not provide women or their babies with any protection against STIs. The consequences of an STI can be much more serious, even life-threatening for a woman and her baby, if a woman becomes infected with an STI during pregnancy. It is important that women are aware of the harmful effects of STIs and know how to protect themselves and their children from infection. How common are STIs among pregnant women in the Republic of Tyva? Syphilis and trichomoniasis, chlamydia are quite widespread in pregnant women of the Republic of Tyva. Others - HIV, genital herpes and bacterial vaginosis - are much less common in pregnant women. How do STIs affect a pregnant woman and her baby? STIs lead to the same consequences in pregnant women as they do in women who are not pregnant. STIs can cause cancer, chronic hepatitis, pelvic inflammatory disease, infertility, and other complications. Many of the STIs in women are asymptomatic; that is, no symptoms. A pregnant woman with an STI can infect her baby early in pregnancy, during pregnancy, and after the baby is born. Some STIs (like syphilis) cross the placenta and infect the baby while it is in the uterus. Other STIs (like gonorrhea, chlamydia, hepatitis B, and genital herpes) can be passed from mother to baby during childbirth as the baby passes through the birth canal. HIV can cross the placenta during pregnancy, infect the baby during the birth process, and unlike most other STIs, it can infect the baby through breastfeeding. A pregnant woman with an STI may also have early onset of labor, placental abruption, and postpartum infection. Harmful effects from STIs in infants can include stillbirth (a baby that is stillborn), low birth weight, conjunctivitis, neonatal pneumonia, sepsis, neurological damage, blindness, deafness, acute hepatitis, meningitis, chronic liver disease, and cirrhosis of the liver. Most of these diseases can be prevented if the pregnant woman gets up on time for prenatal 3

4 registration in the antenatal clinic, is tested for STIs at the beginning of pregnancy and closer to childbirth, if necessary. Should pregnant women be tested for STIs? Yes, STIs affect women of various socioeconomic and educational levels, age, marital status, ethnicity and religion. Pregnant women should be screened for STIs at their first prenatal OB/GYN visit: Chlamydia Gonorrhea and Trichomoniasis Hepatitis B, HIV C Syphilis Pregnant women should ask their doctors about getting tested for STIs as some doctors may not comply these surveys. There are currently many STI tests available. Even if a woman has been tested for STIs in the past, she should be tested again when she becomes pregnant. Can STIs be treated during pregnancy? Chlamydia, gonorrhea, syphilis, trichomoniasis, and bacterial vaginosis can be treated with antibiotics during pregnancy. Antiviral treatment may be used for pregnant women with herpes and is mandatory for those with HIV. For women who have active genital herpes during labor, a caesarean section may be performed to protect the newborn from infection. Women who test negative for hepatitis B can be vaccinated against hepatitis B during pregnancy. How can pregnant women protect themselves from infection? The surest way to avoid the transmission of sexually transmitted diseases is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested for STIs and is not infected. Latex condoms, when used consistently and correctly, are very effective in preventing the transmission of HIV, the virus that causes AIDS. Latex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea, chlamydia, and trichomoniasis. Proper and consistent use of latex condoms can reduce the risk of genital herpes, syphilis, and chancre only when the infected area or site of potential exposure is protected by a condom. Proper and consistent use of latex condoms can reduce the risk for transmission of human papillomavirus and related diseases (such as venereal warts and cervical cancer). 4

5 Where can I get more information? GBUZ RT "Reskozhvendispanser" Kyzyl, Republic of Tyva, st. Shchetinkina-Kravchenko, house. 66. Room 7 (for syphilis), room 2 (female), room. 1 (male), cab. 10 (dispensary registration for syphilis and in the evening anonymous paid reception). Tel. registry: Internet address: What is syphilis? Syphilis is a sexually transmitted disease caused by the bacterium Spirochete pallidum. Syphilis leads to damage to the skin and internal organs and can cause death if left untreated. How common is syphilis? In 2011, 645 people were infected with syphilis in the Republic of Tyva, of which 63 were pregnant. In 2012, 614 people were infected with syphilis in the Republic of Tyva, 58 of them were pregnant. 70% of them had an early infectious stage (primary and secondary syphilis). 1 child was born with congenital syphilis. 97 newborns received prophylactic treatment for congenital syphilis. How do people get syphilis? Syphilis is transmitted from person to person by direct contact through the manifestations of syphilis. Usually manifestations of syphilis are present on the external genitalia, vagina, in the rectum. Manifestations can also be on the lips and in the mouth. Syphilis can be transmitted during vaginal, anal, or oral sexual (sexual) contact. Pregnant women with syphilis pass it on to their unborn children. How quickly do signs of infection appear after infection? The median time between syphilis infection and the onset of the first symptom is 21 days, but this time can range from 14 to 90 days. What are the signs of syphilis in adults? Stage of primary syphilis The appearance of a single wound (ulcer, erosion) marks the beginning of the first stage of syphilis, but there may be multiple wounds. The wound appears in the place where syphilis entered the body. The wound is usually firm, round, and painless. Because the wound is painless, it can easily go unnoticed. The wound lasts 3-6 weeks and heals whether the person is treated or not. If the infected person does not receive appropriate treatment, then the disease progresses and passes to the secondary stage. five

6 Secondary syphilis Skin rash and/or sores in the mouth, vagina, or anus (mucosal lesions) distinguish secondary syphilis. This stage usually begins with a rash on one or more areas of the body. The rash associated with secondary syphilis may appear from the time the primary wound heals or several weeks after the wound has healed. The rash usually does not itch. This rash may appear as rough, red, or reddish-brown patches on the body, palms, and soles. However, this rash may look different on other parts of the body and may be similar to rashes caused by other diseases. Large, raised, gray or white lesions may form in warm, moist areas such as the mouth, genitals, or groin area. Sometimes the rash associated with secondary syphilis is so mild that it is barely noticeable. Other symptoms of secondary syphilis include fever, enlarged lymph glands, sore throat, hair loss on the head, eyebrows, eyelashes, headaches, weight loss, muscle and bone pain, and fatigue. Symptoms of secondary syphilis go away after treatment. Without appropriate treatment, the infection will progress to a latent period and advanced stages of the disease. Late and latent stages of syphilis The latent stage of syphilis begins when the main and secondary signs disappear. Sometimes, and often in the Republic of Tyva, syphilis initially proceeds without any manifestations, bypassing the primary and secondary stages, secretly. Especially often syphilis occurs in pregnant women. Without treatment, an infected person continues to have 6

7 syphilis in your body even though there are no signs or symptoms of the disease. This latent stage can last for years. Between 15 and 30% of people who have not been treated for syphilis have manifestations of late syphilis, which can appear 5 to 30 years after the infection begins. Signs of advanced syphilis include bone and muscle damage, paralysis, gradual blindness, and dementia. In the advanced stages of syphilis, the disease damages internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This damage can lead to death. How does syphilis affect a pregnant woman and her baby? A pregnant woman with syphilis can pass the disease on to her unborn child. Babies with syphilis can have many health problems. Syphilis in pregnant women leads to preterm labor and often to stillbirth. To protect the baby from syphilis, a pregnant woman should be regularly tested for syphilis during pregnancy (when registering at the antenatal clinic for a period of weeks, at 32 weeks of pregnancy and at birth). Urgent treatment should be obtained if blood tests for syphilis are positive. A child infected with syphilis may be born without symptoms of the disease. If not treated immediately, the child may develop serious problems within a few weeks. Untreated babies may have many health problems (cataracts, deafness) and may die. A pregnant woman who has previously received treatment for syphilis and who has a positive precipitation microreaction (PMP, formerly called the Wasserman reaction) for syphilis during pregnancy should receive prophylactic treatment for her baby. The earlier the better. 7

8 How is syphilis diagnosed? Micrograph of Treponema pallidum (pallid spirochete). A blood test for syphilis is the most common way to determine if someone has syphilis. Shortly after infection occurs, the human body produces antibodies to syphilis that can be detected by an accurate, safe, and inexpensive blood test. In a venereal dispensary, syphilis can be diagnosed by examining material from syphilis wounds using a special microscope. If syphilis bacteria are present in the wound, they will show up on observation. Special Note: Because untreated syphilis in a pregnant woman can infect and kill her developing baby, every pregnant woman should receive prenatal care and should be tested for syphilis during pregnancy and delivery. What is the relationship between syphilis and human immunodeficiency virus (HIV-AIDS)? 8

9 Manifestations of syphilis in the mouth, on the genitals, in the vagina, in the rectum facilitate the transmission and transmission of HIV infection. A person with manifestations of syphilis is 2-5 times more likely to become infected with HIV. How is syphilis treated? No home remedies or over-the-counter medicines will cure syphilis, but syphilis can be easily treated with appropriate antibiotics prescribed by a venereologist. The treatment will kill the syphilis bacterium and prevent further damage. People who are being treated for syphilis should refrain from sexual contact with new partners until the syphilis sores are completely healed. People with syphilis should notify their sexual partners so that they can also be tested and treated. Who should be tested for syphilis? Husbands of pregnant women (it doesn't matter what kind of marriage it is - civil or legal), sexual partner (partners) are required to be examined 2 times! 1. when their wives are registered for antenatal care at the antenatal clinic (the gestational age of weeks or more if necessary) 2. at the gestational age of the wife of a week In the Republic of Tyva, such a rule is mandatory! Can syphilis recur, or "come back?" Individuals who have received treatment should be followed up to ensure that the treatment is successful. Having syphilis once does not protect a person from getting it again. Even after successful treatment, people can still be reinfected. Only laboratory tests can confirm if someone has syphilis. A pregnant woman who has previously received treatment for syphilis and who has a positive microprecipitation reaction (RMP, formerly called the Wasserman reaction) for syphilis during pregnancy should receive prophylactic treatment for her child. The earlier the better. Because manifestations of syphilis may be hidden in the vagina, rectum, under the foreskin, or in the mouth, it may not be obvious that a sexual partner has syphilis. If a person does not know that their sexual partner(s) have been tested and treated, they may be at risk of contracting syphilis again from an untreated sexual partner. How can syphilis be prevented? Proper and consistent use of latex condoms can reduce the risk of syphilis. Contact with a wound outside of the area covered by the latex condom can cause an infection. The surest way to avoid the transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected. I

10 Transmission of STIs, including syphilis, cannot be prevented by washing the genitals after intercourse, or by urinating or douching after intercourse. Any unusual manifestations, sores, or rash, especially in the groin area, should be a signal to refrain from having sex and an immediate visit to a venereologist or gynecologist. Avoiding alcohol and drug use can also help prevent the transmission of syphilis because these activities lead to risky sexual behavior. It is important that sexual partners talk to each other about their health, their HIV and syphilis status, and other STIs so that preventive measures can be taken. What is chlamydia? Chlamydia is a common sexually transmitted disease caused by a bacterium. Chlamydia can infect men and women and can cause serious, often irreparable damage to a woman's genitals. How common is chlamydia? Chlamydia is a sexually transmitted infection that is most often talked about in Russia. In 2011, 553 cases of chlamydia were reported in the Republic of Tyva, in 2012 - 319 cases. More cases are not reported because most people with chlamydia have no symptoms and do not want to be tested. Chlamydia is most common among young people. How do people get chlamydia? People get chlamydia by having sex with someone who has the infection. "Having sex" means anal, vaginal, or oral sex. Chlamydia can be passed on even if the man is not ejaculating. People who have had chlamydia and have been treated can become infected again if they have sex with an infected person. Chlamydia can also be passed from an infected woman to her baby during pregnancy. Who is at risk of contracting chlamydia? Any sexually active person can be infected with chlamydia. This is a very common STI, especially among young people. It is estimated that 1 in 15 sexually active women of age has chlamydia. What are the signs of chlamydia? Chlamydia is known as a "silent" infection because most infected people show no symptoms. If there are signs, they may appear a few weeks after intercourse. Even when there are no symptoms, chlamydia can damage a woman's genitals. In women, the bacteria first infect the cervix (the structure that connects the vagina or birth canal to the uterus) and/or the urethra (urethra). Some infected women have abnormal vaginal discharge or a burning sensation when urinating. Untreated infections can spread up to the uterus and 10

11 fallopian tubes (the tubes that carry fertilized eggs from the ovaries to the uterus), causing pelvic inflammatory disease. Pelvic inflammatory disease may be "silent" or may cause signs such as pelvic pain in the abdomen. Chlamydia leads to infertility (not being able to become pregnant) and other complications. In Russia, 40% of infertility is caused by chlamydia. A terrible complication of chlamydia is an ectopic pregnancy. Some infected men have penile discharge or cutting and burning with boiling water when urinating. The testicles may enlarge and there is pain in one or both testicles (known as "orchitis" and "epididymitis"). Chlamydia can also infect the rectum in men and women, either through receptive anal sex or through spread from the vagina. While these infections often cause no symptoms, they can cause rectal pain, discharge, and/or bleeding (known as "proctitis"). How are chlamydia and HIV related? Untreated chlamydia can increase a person's chances of acquiring the HIV virus that causes AIDS. How does chlamydia affect a pregnant woman and her baby? In pregnant women, untreated chlamydia can spread to the newborn, causing an eye infection or pneumonia. Getting tested and treated for chlamydia during pregnancy is the best way to prevent these complications. All pregnant women should be tested for chlamydia at their first prenatal visit. Who should be tested for chlamydia? Any sexually active person can be infected with chlamydia. Anyone with sexual symptoms such as discharge, cramps, burning when urinating, unusual sores or rashes should avoid having sex until they are examined and treated by a doctor. In addition, anyone who has recently been diagnosed with an STI after oral, anal, or vaginal contact with a sexual partner should see a doctor for evaluation and treatment. How is chlamydia diagnosed? There are laboratory tests to diagnose chlamydia. Swabs or scrapings for testing are taken with a cotton swab from the vagina, cervix or urethra. How is chlamydia treated? Chlamydia can be easily diagnosed and treated with antibiotics. HIV-positive people with chlamydia should receive the same treatment as those who are HIV-negative. People with chlamydia should refrain from having sex until the course of antibiotics is completed to prevent spreading the infection to a partner. eleven

12 Chlamydial infection is widespread. Sexual partners who are not examined and properly treated are at high risk for reinfection. Having multiple chlamydial infections increases a woman's risk of serious reproductive health complications, including pelvic inflammatory disease and ectopic pregnancy. Women and men with chlamydia should be retested one and a half and three months after treatment, whether or not they believe their sexual partners have been successfully treated. Babies infected with chlamydia can develop conjunctivitis and/or pneumonia. Chlamydial infection in infants is treated with antibiotics. What about treating partners? If a person has been diagnosed and is being treated for chlamydia, he or she should tell all partners who have had anal, vaginal, or oral sex in the past 2 months so that they can see a doctor and be treated. This will reduce the risk that sexual partners will develop serious complications and will also reduce the person's risk of being reinfected. A person with chlamydia should avoid having sex with all of his or her sexual partners until they have finished their chlamydia treatment. How can you protect yourself from chlamydia? Latex condoms prevent chlamydia infection in men by 70% with a single sexual intercourse, with their consistent and correct use, in women by 50% with a single sexual intercourse. The surest way to avoid chlamydia is to abstain from vaginal, anal, and oral sex, or to be in a long-term, mutually monogamous relationship with a partner who has been tested and is known to be uninfected. Where can I get more information? GBUZ RT "Reskozhvendispanser" Kyzyl, Republic of Tyva, st. Shchetinkina - Kravchenko, house. 66. Room 7 (for syphilis), room 2 (female), room. 1 (male), cab. 10 (dispensary registration for syphilis and in the evening anonymous paid reception). Tel. Registry Office: Internet address: Based on the materials of special literature, the collection was compiled by the Deputy Chief Physician of the State Budgetary Institution of Healthcare of the Republic of Tatarstan "Reskozhvendispenser", the Chief Freelance Dermatovenereologist of the Republic of Tatarstan, Candidate of Medical Sciences Obukhov A.P. Photo on the front page from the site and from the presentation "Syphilis in China", Kyzyl , RT, 2011. 12

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Neglect of one's health, unprotected sex and insufficient understanding of the nature of sexually transmitted diseases leads to the spread of infections. Increasingly, sexually transmitted diseases are detected in pregnant women. Because of the hidden or erased, the girls do not complain. Often, infection with an infection is determined during the first medical examination for pregnancy up to 12 weeks. As you know, the most important rudiments of the unborn child are formed during this period. Sexual infections in the mother can kill the baby.

The impact of STDs on the fetus can be unpredictable and irreversible. Through the fault of a sexually transmitted disease, abortion is possible - - or premature birth (in the period from 22 to 37 weeks).

For a child, an infection of the mother can be reflected in a number of complications: malnutrition, developmental disorders, malformations, pneumonia, lack of vision, diseases of the brain and its membranes, and much more, up to death.

Do not forget about the dangers of STDs to a woman's health. You can make a huge list of the negative impact of sexual infections on the female body. Infertility, the spread of infection and complications, an increased risk of contracting HIV infection - these are the few things that STD infection can lead to.

Saving yourself and your unborn baby is easy. You just need to plan your pregnancy and start monitoring your health and the health of your sexual partner in a few months. To do this, you should contact the gynecologist of the antenatal clinic, who will appoint a specific list of studies for both women and men.

Before pregnancy, STD treatment does not pose any threat to the unborn child and mother. The exception is HIV - at the moment the infection is incurable. The virus is transmitted to the child in 20-30% of cases. If time is lost, pregnancy has come, and the girl is sick with a sexually transmitted disease, the necessary treatment with chemicals during pregnancy can harm the baby, sometimes even no less than the STD itself.

What kind of infections should expectant mothers be afraid of in the first place?

Symptoms: Most often, chlamydia does not show any symptoms, that is, it proceeds hidden. With an obvious course, a woman complains of frequent, painful urination, discharge from the genital tract, pain in the vagina and abdomen during sexual intercourse, burning and itching, fever, sore throat, joints, vomiting, nausea. The incubation period for chlamydia is from several days to 3-4 weeks.

Consequences for the mother: Chlamydia causes inflammatory diseases of the pelvic organs in almost half of the affected women. It can be inflammation of the vagina and external genitalia, ovaries, fallopian tubes, uterus. All these complications can lead to a terrible situation - infertility. In addition, chlamydia increases the risk of an ectopic (tubal) pregnancy, a condition that threatens a woman's life. During pregnancy, the infection can cause miscarriage or premature birth.

Risk for newborns: it is possible to transmit chlamydia to a child during passage through the birth canal. After a short time, the baby develops pneumonia or infectious eye diseases (blepharitis, conjunctivitis).

Treatment: Antibacterial therapy for STDs is carried out according to the pathogen. Treatment is mandatory for men as well.

Symptoms: this STD can also be asymptomatic. Manifestations of infection are similar to those of chlamydia, possibly an increase in lymph nodes. The incubation period is 3-7 days.

Consequences for the mother: in 20%, gonorrhea causes inflammatory diseases of the genital organs, and also negatively affects the urinary system, causing urethritis, cystitis and pyelonephritis.

Risk for newborns: blindness.

Treatment: antibacterial therapy, for the prevention of gonoblenorrhea in newborns, tetracycline ointment or silver nitrate solution is used. Men who become infected also need to be treated.

Symptoms: The vast majority of those infected with herpes do not have any manifestations of the infection. It is rare to see sores and blisters with clear contents that are very itchy. Burning sensation of the vulva and vagina, fever, discomfort in the abdomen, pain in the legs, buttocks.

Consequences for the mother: with an exacerbation of the disease during pregnancy, the question of the method of delivery will be decided in favor of a caesarean section.

Infant risk: the possibility of infection of the child is small if the mother fell ill before pregnancy or in the first months. When a pregnant woman is infected with an STD for more than 28 weeks, the risk of transmitting the disease to the child increases significantly, which poses a huge threat to the life of the baby. Perhaps the development of encephalitis and meningitis, death, inflammation of the pharynx and eyes, damage to the nervous system, developmental delay. The incubation period for herpes is up to 3 weeks. The first manifestations: irritability, loss of appetite, lethargy, sores around the eyes, convulsions.

Treatment: it is impossible to completely recover, but it is possible to suppress the exacerbation and prevent its occurrence with the help of modern antiviral drugs. Treatment of men is not essential for the health of the child.

Symptoms: In the first stages of HIV, there are no symptomatic manifestations of the disease. The STD virus infects the immune system, and as long as it is able to fight, a person will feel quite normal. Decreased immunity begins with flu-like symptoms, then a bacterial infection joins, which can affect any system of the body.

Consequences for the mother: most likely, instead of natural childbirth, doctors will advise surgery - a caesarean section. This will help reduce the risk of infection in your baby. A young mother will have to completely abandon breastfeeding, given the fact that HIV is transmitted through breast milk.

Risk for the child: an infant can become infected with the virus during childbirth, during pregnancy and lactation. Thanks to modern drugs, the risk of HIV transmission from mother to baby can be significantly reduced. A sick child lags behind in development, often gets sick, secondary infections are difficult to treat.

Treatment: There are a number of drugs recommended for the treatment of HIV infection. One of them is Zidovudine. Antiretrovirals are also used.

Symptoms: genital warts.

Consequences for the mother: some strains of HPV indicate the development of cervical cancer. Caesarean section is indicated for large warts.

Infant risk: mother-to-child transmission of HPV is rare. If the baby is infected, the virus infects the pharynx.

Treatment: during pregnancy it is allowed to use laser coagulation, cryodestruction, electrocoagulation.

Symptoms: in the first stage of such an STD as syphilis, one or more round ulcers appear at the site of infection, distinguished by their painlessness (hard chancre). The incubation period for syphilis is 10 to 90 days. When a rash appears without itching on other parts of the body, we can talk about the second stage of the disease.

Threat to the mother: the third stage is characterized by a decrease in immunity and the total addition of a secondary infection. Severe bacterial and viral diseases lead to a significant deterioration in well-being. There are changes in the nervous, skeletal and muscular systems.

Risk for children: in 40% of pregnancies in the first stage of syphilis, the child dies. If the treatment of the expectant mother is started late, the risk of infection for the baby is 40-70%. In a child, syphilis can present with a runny nose, sometimes with blood, anemia, liver enlargement, ulcers, jaundice, a decrease in head size, inflammation of the bones, a change in the shape of the nose, and spots in the mouth. The incubation period is 3-8 weeks.

Treatment: penicillin preparations.

Symptoms: vaginal discharge with a sharp, fetid odor, itching, soreness during intercourse in the lower abdomen and lower back, frequent urination. The incubation period is 1-4 weeks.

Consequences for a pregnant woman: This STD can cause preterm labor.

Risk for the child: trichomoniasis is rarely passed from mother to newborn. However, when the girl is infected, discharge from the genital tract appears, there may be an increase in temperature.

Treatment: antibiotic therapy from the second trimester of pregnancy. Mandatory course of treatment for men.

Symptoms: 3-5 weeks after infection, and possibly earlier, clinical signs of the disease may appear. However, most often ureaplasmosis occurs hidden. When the infection is activated, a woman may complain of frequent urination, excessive vaginal discharge, pain in the lower abdomen and lower back.

Danger for the mother: often ureaplasmosis can be the cause of infertility and many inflammatory diseases of the female genital organs. During pregnancy, a woman's immunity decreases, ureaplasma can immediately begin its activity.

Impact on the child: treatment of infection in a pregnant woman is possible only after a period of 12 weeks. Antibacterial therapy for a baby in the early stages of development is detrimental. However, both from the disease itself and from drugs for treatment, the process of fetal formation can be disrupted, which is fraught with malformations of any of the systems of a small organism. Therefore, therapy for ureaplasmosis in pregnant women begins, on average, at 22 weeks. Intrauterine infection with ureaplasma is rare. The baby usually becomes infected during childbirth. The manifestation of the disease in newborns can be pneumonia and other inflammatory diseases.

Treatment: specific antibiotic therapy.

Mycoplasmosis

Symptoms: Like many STDs, mycoplasmosis often goes unnoticed. Clinical manifestations can be discharge from the genital tract, burning, pain in the lower back, sacrum, lower abdomen, fever.

Consequences for women: mycoplasmosis can be the culprit of numerous inflammatory diseases of the female genital area and, as a result, infertility. During pregnancy, the infection can cause miscarriage or fetal death (missed pregnancy), polyhydramnios, and postpartum complications.

Danger for the child: with intrauterine infection - fetal death, anomalies of the placenta and the development of the baby. In a newborn, damage to the kidneys, liver, eyes, nervous system, lymph nodes and skin can be detected.

Treatment: consists of a whole complex of drugs. Mandatory medicines for the treatment of mycoplasmosis: antifungal and antiprotozoal drugs, immunostimulants, physiotherapy, treatment of the urethra by irrigation. Treatment begins in the second half of pregnancy. Mandatory reorganization of the partner.

Sexually transmitted diseases such as HIV and syphilis are also transmitted through direct contact with blood; the household route of infection for HIV is not possible. To prevent sexually transmitted infections, do not neglect methods of protective contraception (at the moment, the most effective method is the use of a condom).

Sexually transmitted diseases (STDs) are very insidious. Pregnant women face a double danger. You are responsible not only for your health, but also for the health of your child!

Sexually transmitted infections (STIs) make a significant contribution to the problem of infectious diseases in pregnant women and newborns.

In recent years, there has been a trend towards an increase in the incidence of STIs, especially chlamydial and mycoplasmal etiology, during pregnancy, which increases the proportion of this pathology among lesions of the fetus and newborn.

According to the literature, in pregnant women, STIs such as bacterial vaginosis, herpetic and chlamydial infections are most often detected, less often - trichomoniasis, gonorrhea, viral hepatitis B (HBV), syphilis and HIV infection. However, the frequency of perinatal infection associated with individual STIs is determined not only by their prevalence in the population, but also by the frequency of transmission. The risk of perinatal infection is about 30% for gonococcal, 20-50% for mycoplasma, 20-40% for chlamydia, 5-50% for herpes infection and about 50% for syphilis. The risk of perinatal infection of the newborn is highest in acute primary infection.

The timing of perinatal infection with STIs varies depending on the nosological form. For example, syphilis is transmitted transplacentally and infects the baby in the womb. Gonorrhea, chlamydia, HBV, and genital herpes are transmitted intranatally when a baby passes through the birth canal. HIV infection can occur both transplacentally, and during childbirth, and postnatally during breastfeeding.

Infection of the fetus in the early stages of pregnancy is accompanied by the highest risk of its premature termination or the occurrence of severe, life-threatening malformations. Damage to the fetus at a later date can lead to the development of organ pathology. With antenatal infection, the clinical manifestations of infection in a newborn are usually detected in the first hours or days after birth, while with intranatal and postnatal infection, the manifestation of infection can occur much later, especially if the child was prescribed antibacterial or antiviral therapy for other indications.

Since STI infection can occur both before the onset of pregnancy and at any of its stages, as a prevention of perinatal infection, it is important to screen women at the stage of pregnancy planning, as well as follow-up with repeated examinations, including in the prenatal period.

General principles for the prevention of perinatal STI infection include:

Detection and treatment of STIs in a woman and her sexual partner at the stage of pregnancy planning, when the infection has not yet managed to have a negative impact on the course of pregnancy, and the range of drugs acceptable for use is unlimited (the most effective strategy);
. the practice of STI-safe sexual contact between a woman and her partner before and during pregnancy;
. examination of a woman during pregnancy to identify previously undiagnosed or recent infection with STIs;
. adequate therapy (with simultaneous treatment of the sexual partner) if an STI is detected during pregnancy (in most cases it helps to prevent infection of the newborn);
. examination and provision of necessary medical care to the newborn in the postpartum period (antibiotic therapy, vaccination, etc.).

Gonorrhea

Gonorrhea is one of the most common STIs. According to WHO experts, about 200 million new cases of gonococcal infection (GI) are detected annually in the world, but it is difficult to estimate the true extent of the spread of GI.

Although transmission of GI from mother to child occurs predominantly intrapartum, women with untreated gonorrhea have an increased rate of preterm birth (15-22%). Neisseria gonorrhoeae causes intranatal infection of newborns most often (30-50%) causes eye damage - gonococcal ophthalmia of newborns, which can be complicated by corneal ulceration with perforation, leading to blindness. There are also localized lesions of the mucous membranes of the larynx and genitourinary tract. Premature infants may develop disseminated infection with arthritis, meningitis, and sepsis.

Chlamydia

Since the beginning of the registration of the incidence of chlamydia in our country in 1993, there has been a steady increase in the frequency of detection of new cases of infection, which, however, may be due to the improvement of diagnostic methods. The frequency of chlamydia infection in pregnant women ranges from 3 to 40%, reaching 70% in chronic inflammatory diseases of the urogenital tract (UGT) and burdened obstetric and gynecological history

Pregnancy in women with urogenital chlamydia often occurs with complications such as polyhydramnios, damage to the placenta and its membranes, premature birth, threatened miscarriage or spontaneous termination of pregnancy and stillbirth. In a prospective US study, infection with Chlamydia trachomatis during pregnancy has been shown to result in intrauterine growth retardation and increase the risk of preterm birth.

Infection of the fetus can occur antenatal and intranatal as a result of aspiration of infected amniotic fluid. The probability of antenatal infection is, according to various sources, from 60 to 70%, even with an asymptomatic course of infection in the mother, 6-7% of newborns are intranatally affected. Perinatal mortality in chlamydia reaches 15.5%, and the proportion of newborns who die in the postnatal period is more than 50% of all perinatal losses.

CI in newborns can be asymptomatic or manifest as conjunctivitis, lesions of the upper and lower respiratory tract, genitals, central nervous system, etc. According to foreign authors, the risk of developing conjunctivitis in newborns infected with chlamydia ranges from 20 to 50%, pneumonia - from 5 to twenty %. Preterm infants may develop respiratory distress syndrome and sepsis.

Pregnancy screening is the most effective strategy for preventing perinatal exposure to CI. In the United States, all sexually active women and adolescents and pregnant women are routinely screened for C. trachomatis at their first antenatal visit. Women from high-risk groups are examined again in the third trimester of pregnancy. Although screening for CI is not included in the list of mandatory tests during pregnancy and is performed in our country occasionally, its expediency is beyond doubt, especially in women with a burdened obstetric and gynecological history.

Since doxycycline (and other tetracyclines) are contraindicated during pregnancy and lactation, CI therapy in pregnant women is carried out mainly with macrolides.
All newborns with symptoms of conjunctivitis are recommended to be treated with drugs that are active against both chlamydia and gonococci, due to the high likelihood of mixed infection.

Mycoplasmosis/ureaplasmosis

The true extent of infection of the population with mycoplasmas / ureaplasmas is unknown, however, according to estimates, the frequency of colonization by these microorganisms is up to 50%. Although the issue of the etiological role of mycoplasmas and ureaplasmas in the infectious pathology of UGT is being discussed, in recent years there has been a tendency to consider them as facultative pathogens that can, under certain conditions (for example, during pregnancy), cause infectious and inflammatory processes in UGT, mainly in association with other pathogens. and opportunistic pathogens.

The frequency of detection of Ureaplasma urealyticum in pregnant women is 50-75%, Mycoplasma hominis - 20-25%. It should be noted that pregnancy contributes to an increase in UGT colonization by these pathogens by one and a half to two times, which is explained by changes in the immune and hormonal status of women.

In almost all women infected with urogenital mycoplasmas, pregnancy proceeds with complications, the most common of which are premature termination at different times, polyhydramnios, damage to the placenta and fetal membranes, premature rupture of amniotic fluid, postpartum endometritis and other forms of infection. The frequency of perinatal infection of newborns reaches 45% with ureaplasmosis and 3-20% with mycoplasmosis.

With antenatal infection of the fetus, a generalized pathological process can develop with damage to the respiratory and vision organs, liver, kidneys, central nervous system, and skin. With intranatal infection, the most common entry gates of infection are the mucous membranes of the eyes, mouth, genitals and respiratory tract. The risk of intrapartum infection in premature newborns is three times higher than in full-term ones.

Routine screening for mycoplasma infection in pregnant women is considered inappropriate. However, in the case of a pathological course or miscarriage of a previous pregnancy, an examination and, if it is positive, treatment is necessary.

Treatment of urogenital mycoplasmosis in pregnant women is recommended to be carried out with erythromycin at a dose of 500 mg orally four times a day for 7-10 days starting from the second trimester.

Trichomoniasis

According to WHO, about 180 million women in the world are infected with Trichomonas vaginalis, while the infection rate of clinically healthy women of childbearing age ranges from 2-10% in the United States to 15-40% in tropical countries. Trichomonas infection (TI) is often associated with other STIs, especially GI and bacterial vaginosis (BV). A number of foreign studies have shown that infection with T. vaginalis increases the risk of premature discharge of amniotic fluid, preterm labor and the birth of a child with low body weight.

Routine screening for TI in pregnant women in the absence of clinical symptoms is not recommended.

Treatment of trichomoniasis in pregnant women (not earlier than the second trimester) and children is carried out with drugs of the nitroimidazole group. The possibility of using metronidazole during pregnancy remains controversial due to its potential mutagenic and carcinogenic effects. At the same time, an increased risk of developing fetal defects and teratogenicity has not been confirmed, therefore, in a number of countries (USA, Canada), TI therapy with metronidazole is carried out as early as possible, including in the first trimester of pregnancy. The intravaginal forms of metronidazole or clotrimazole are recognized as a safer alternative to oral administration, although the microbiological efficacy of topical therapy is lower. Treatment of TI is indicated for children with signs of trichomoniasis or urogenital colonization that persists beyond the fourth month of life.

Bacterial vaginosis

BV is characterized by changes in the vaginal ecosystem in the form of the replacement of the dominant lactobacilli in the microflora by the association of Gardnerella vaginalis and anaerobic bacteria.
According to Russian authors, the prevalence of BV varies in different age and social groups: 17-19% in family planning groups, 24-37% in people undergoing treatment for venereal diseases, and 15-37% in pregnant women. Pregnancy can provoke the development of BV, as it is accompanied by pronounced changes in hormonal status.

The results of a multicenter study on the study of risk factors for preterm birth (2929 pregnant women) showed a significant relationship between the presence of BV in a woman and preterm birth before 32 weeks of gestation. The development of BV is also a risk factor for spontaneous abortion, premature rupture of amniotic fluid, and preterm birth. The risk of an adverse pregnancy outcome in women with VD is clearly increased with concomitant TI.

WHO experts recommend screening pregnant women for TI and BV if there is a history of spontaneous miscarriage or preterm birth. Total screening of pregnant women for these infections in the absence of clinical symptoms is not justified.

Given the local nature of lesions in BV during pregnancy, local therapy is optimal. A good clinical effect is shown for nitroimidazoles administered intravaginally in the form of tablets, tampons or suppositories. If local remedies are ineffective, WHO experts recommend using systemic therapy according to one of the following schemes:

Metronidazole 200-250 mg orally three times a day, 7 days (not earlier than the II-III trimester of pregnancy);
. metronidazole 2 g orally once (in emergency cases, treat in the first trimester, as well as in the II-III trimester);
. clindamycin 300 mg orally twice a day for 7 days.

Urogenital candidiasis

In recent years, there has been a pronounced increase in the incidence of candidal infection, including urogenital localization. According to WHO, the proportion of urogenital candidiasis (UGC) among infectious lesions of the vulva and vagina is 30-40%. The incidence of vaginal candidiasis increases both during pregnancy and with an increase in gestational age.

The main route of infection of newborns is postnatal. In healthy term infants, the candidal process is usually limited to the skin and/or mucous membranes and responds well to topical antimycotic therapy. In premature infants, newborns with low birth weight, as well as in violation of the integrity of the skin, the development of invasive candidiasis with hematogenous dissemination up to a generalized infection is possible.

Treatment of UGC in pregnant women is recommended to be carried out exclusively with local azole preparations, the most effective of which are considered by WHO experts to be miconazole, clotrimazole, butoconazole and terconazole. Systemic azoles during pregnancy are contraindicated.

In relatively healthy newborns with normal birth weight, local treatment can be limited. In children at high risk of acute hematogenous or visceral dissemination, systemic therapy is recommended. As the drug of choice, you can use amphotericin B (at a dose of 0.5-1 mg / kg / day, the total dose is 10-25 mg / kg), as an alternative - fluconazole.

papillomavirus infection

Human papillomavirus infection (PVI) is widespread, especially in women of childbearing age. According to the results of screening examinations, PVI is detected in 40-50% of young women, however, long-term persistence of the virus in the cervix, less often in the vulva and vagina, is observed only in 5-15% of women. Pregnancy predisposes to the recurrence of papillomatous formations, their loosening and increase in size.

The path of perinatal infection is not completely clear, and its frequency varies, according to various sources, from 4 to 87%. The most common manifestation of PVI in newborns is juvenile papillomatosis of the larynx. Cases of papillomatosis of the larynx in children born by caesarean section are described.

Since the treatment of PVI is limited solely to the removal of exophytic foci, and the ways of infection of the newborn are not fully defined, screening of pregnant women to prevent perinatal infection is not advisable.

In the presence of exophytic rashes, the treatment of pregnant women is carried out with caution, as early as possible, using physical methods of destruction (cryolysis, laser therapy, diathermocoagulation, electrosurgical excision). Children are treated in the same way. The use of chemical methods during pregnancy and in newborns is contraindicated.

Although, according to a number of sources, caesarean section reduces the risk of developing respiratory papillomatosis several times, the presence of genital warts or subclinical forms of infection are not an indication for this operation due to the possibility of ante- and postnatal infection. Operative delivery may be necessary for large warts with a threat of obstruction of the birth canal and bleeding.

Viral hepatitis B

HBV remains the most common of all viral hepatitis today. About 2 billion people in the world are infected with it, and more than 350 million have a chronic infection. The total number of patients with chronic HBV and “virus carriers” in the Russian Federation ranges from 3 million to 5 million people and tends to grow.

Pregnancy in women with chronic HBV in most cases is not accompanied by complications. Cases of antenatal infection are rare, but it can occur with an increase in the permeability of the placenta, for example, with the threat of termination of pregnancy. Infection of the child occurs mainly when passing through the birth canal. When the mother is co-infected with viral hepatitis D, it can also be transmitted perinatally. The risk of perinatal infection largely depends on the state of the infectious process in a pregnant woman and is 85-90% with a positive HBeAg test result and 32% with a negative one.

A particular threat is the emergence of mutant strains of the virus that do not produce HBeAg. Children infected with them are at high risk of developing viral hepatitis with a fulminant course in the first 2-4 months after birth. Therefore, immunization should be given to all children born to HBsA gamma-positive mothers, regardless of HBeAg test results.

Screening for HBV infection (HBsAg determination) is included in the screening program for pregnant women, is recommended for initial treatment and is mandatory in the third trimester.

The main strategy for the prevention of perinatal HBV infection is currently passive-active immunization (administration of hyperimmune globulin to HBV and vaccination) to all newborns whose mothers are HBsA gamma-positive. According to foreign authors, adequate immunization can prevent infection in 90% of cases.

Preliminary results of a controlled study in pregnant women with a high degree of viremia (DNA concentration in the blood > 1000 mEq / ml) showed that a short course of therapy with lamivudine reduces the risk of perinatal infection, but the possibility of using this approach in everyday clinical practice is still under discussion.

Acute HBV during pregnancy is not associated with increased mortality or teratogenic effects and is not an indication for termination of pregnancy. Since there is no evidence to reduce the risk of HBV infection during delivery by caesarean section, this operation to prevent perinatal infection is also currently not recommended.

Conclusion

Despite the improvement of diagnostic methods and the emergence of new drugs, STIs continue to be an urgent problem in medicine in general and obstetrics and perinatology in particular. Raising the awareness of practitioners on this issue, the widespread introduction of modern strategies for examining women both at the planning stage and during pregnancy, and their timely treatment will undoubtedly reduce the incidence of perinatal infectious pathology.

Obstetrician-gynecologist / Ilyuk Zh.N./

Many women do not even assume that the causative agent of any sexually transmitted infection (STI) has reliably settled in their body. Sexual infections are often almost asymptomatic, but they can have a strong impact on the fetus and the course of pregnancy. That is why gynecologists urge expectant mothers to undergo an examination before conceiving a baby.

The most dangerous sexual infections during pregnancy:

1. Herpes during pregnancy disrupts the placenta

Herpes simplex virus (HSV) is of two types. HSV type 1 predominantly causes damage to the mucous membranes of the mouth and lips, HSV type 2 - damage to the genital organs. The latter ranks second after rubella in terms of teratogenicity (the ability to form malformations in the fetus). Fortunately, this only applies to herpes infection during pregnancy (infection in the first trimester is especially dangerous). If the infection occurred before conception, then the antibodies to the pathogen that circulate in the mother’s blood enter the fetus through the placenta and protect it from infection in the event of an exacerbation of the process, therefore, in such cases, the virus is rarely transmitted from mother to baby. Exacerbations of herpes during pregnancy, although they do not have a fatal effect on the fetus, can still disrupt the work of the placenta. Therefore, before pregnancy, it is necessary to have time to carry out treatment that reduces the likelihood of exacerbations.

2. Chlamydia during pregnancy can affect the internal organs of the child

With an exacerbation of chlamydia during pregnancy in the early stages, a miscarriage or fetal development is possible (). At later stages of pregnancy, damage to the placenta and fetal membranes occurs, as well as damage to the internal organs of the baby. A newborn in 40-50% of cases can become infected with chlamydia during childbirth when passing through the mother's birth canal.

3. Gonorrhea during pregnancy: the risk of miscarriage and premature birth

Inflammation caused by gonorrhea during first trimester pregnancy can lead to miscarriage or a missed pregnancy. When infected in the second half of pregnancy, fetoplacental insufficiency occurs (a condition in which the placenta does not cope with its work, and the baby lacks oxygen and nutrients). Intrauterine infection of the fetus and fetal bladder can occur - chorioamnionitis. With chorioamnionitis, preterm birth is more common.

During childbirth, a mother with gonorrhea can infect a child, and after the birth of a baby, such women may experience inflammation of the uterus - endometritis.

4. Mycoplasmosis and ureaplasmosis during pregnancy can cause pneumonia in a child

Ureaplasmosis and mycoplasmosis can be activated during pregnancy, causing miscarriages, premature births (up to 37 weeks), polyhydramnios and placental insufficiency. If a baby becomes infected during childbirth, then after birth, he may develop various complications, including pneumonia. In some cases, after childbirth, these infections cause endometritis in the mother.

5. Bacterial Vaginosis During Pregnancy Causes Preterm Labor

In bacterial vaginosis, a high concentration of microorganisms in the vagina can lead to the penetration of these bacteria into the upper genital organs. In such women during pregnancy, infection of the placental membranes is observed twice as often, chorioamnionitis develops, while the pregnancy is interrupted or premature birth occurs, children are born weakened, with low body weight, congenital pneumonia. In addition, it increases the frequency of postpartum complications in the mother.

6. Candidiasis during pregnancy in 70% of cases is transmitted to the child

Pregnancy contributes to exacerbation: during pregnancy, thrush occurs 2-3 times more often. The transmission of the fungus from mother to newborn during childbirth occurs in more than 70% of cases. Infection of the child is most often limited to the umbilical cord, skin, oral mucosa and lungs, however, very serious complications are possible in premature babies.

7. Trichomoniasis - "tram" for chlamydia and gonococci

Trichomonas (the causative agent of trichomoniasis) by itself is rarely the cause of infertility and does not cause malformations in the fetus. However, these microorganisms often serve as a "tram", within which chlamydia, gonococci and other infectious agents quickly move into the uterine cavity, which is associated with their ability to absorb microorganisms without killing them. The aggressive environment that forms in the vagina of a pregnant woman with trichomoniasis can “melt” the lower pole of the amniotic sac and lead to premature rupture of amniotic fluid, which means miscarriage or premature birth. In addition, infection of the child during the passage of the birth canal affected by Trichomonas is possible. So this infection must be treated at the stage of pregnancy planning.

What are the consequences of STIs for a child?

  • Many sexually transmitted infections have a teratogenic (causing malformations) effect that can affect the development of the fetus in the very early stages of pregnancy, when the woman is not yet aware of the completed conception.
  • The presence of sexual infection can lead to complications of pregnancy (polyhydramnios, placental insufficiency) and miscarriage (miscarriage, non-developing pregnancy, premature birth).
  • A mother-to-be can pass on most infections during pregnancy or childbirth to her baby, and some sexually transmitted infections can be passed through breast milk.

It is quite difficult to treat STIs during pregnancy, because this can not be done at any time, usually treatment begins after 12 or after 22 weeks. But before treatment, the pathogen already has an impact on health. In addition, pregnancy allows the use of only some drugs due to their effect on the fetus. The choice of safe drugs is very small, so curing STIs during pregnancy is much more difficult than before.