Sexually Transmitted Infections are harmful in across populations, but can have especially devastating effects during pregnancy. Screening is essential during the first trimester for what we have identified as the "Big 5 STIs": chlamydia, gonorrhea, syphilis, HIV, and Hepatitis B. The unique effects of each of these diseases on pregnancy will be explained below.
Pregnant women with chlamydia hold a higher risk for birth complications. These include miscarriage, premature birth, and stillbirth. The disease can also be transmitted vertically during birth. Treatment for chlamydia is approved in pregnant women, and treatment before delivery erases the risk of transmission.
In 2012, the estimated global prevalence of chlamydia among women 15-49 was 4.2% (Newman et al 2012). Chlamydia is prevalent all over the world. It is more likely to develop in most of Africa and Asia due to lack of detection and treatment, but rates of infection are just as high in many parts of the world.
Gonorrhea in pregnancy is linked with higher rates of miscarriage, amniotic sac infection, preterm birth, premature rupture of membranes, and severe eye infection passed to the baby during delivery, which can lead to blindness. Gonorrhea is safe to treat with antibiotics during pregnancy. The estimated global prevalence of gonorrhea in 2012 among women 15-49 was 0.8% (Newman et al 2012). Rates are highest in Sub-Saharan Africa and Southeast Asia, but it is present in all parts of the world and highly prevalent in most.
Syphilis can move through the placenta to infect the baby at any time during pregnancy, as well as during delivery. Without treatment, the odds of passing the infection to the baby are as high as 50%. There is also increased risk of miscarriage, stillbirth, preterm birth, and neurological problems. Antibiotics are safe for treatment during pregnancy. Syphilis is considered especially important for testing during pregnancy because of both the severity and likelihood of effects on the baby. The 2012 estimated global prevalence of syphilis was 0.5% in women 15-49. The prevalence of syphilis worldwide is highest in Sub-Saharan Africa at more than 3% prevalence in both males and females, followed by the Americans and Southeast Asia.
HIV during pregnancy is a topic near and dear to us at Maternova. The Pratt Pouch, one of the innovations we distribute, is used for prevention of mother-to-child transmission of HIV. Without treatment, risk of vertical transmission ranges from 15-45%. With treatment, rates drop to around 2%. For HIV in pregnancy, the recommendation is antiretroviral treatment for the mother during pregnancy as well as the baby after delivery. As most people know, prevalence rates of HIV are staggering in many parts of Sub-Saharan Africa. From the 2014 estimate, the highest rate was 27.73% in Swaziland, and the 15 most affected countries were all located in Sub-Saharan Africa. Regardless, HIV is a global epidemic, and prevalence rates over 1% are present in the Caribbean, Central and South America, Southeast Asia, and Eastern Europe.
Hepatitis B during pregnancy increases the risk of premature birth, low birth weight, and hemorrhage. Without treatment, the odds of passing the infection to the baby are as high as 95%. However, babies born to Hepatitis B positive mothers can be vaccinated after birth which is a highly effective method of treatment.
Rates of Hepatitis B are the highest in West Africa, but prevalence remains high all over the world. According to WHO, rates of infection in infants are especially high in China, Senegal, and Thailand. In other countries, including Panama, New Guinea, and Greenland, rates are relatively low in infants but increase rapidly during childhood. This variation is important to consider for health system approaches and identifying at-risk populations.
The aim of this research is not to scare mothers of the possible effects of sexually transmitted infections, but to emphasize the global importance of testing. Screening for all 5 of these STIs should be done at the first prenatal visit.
Treatment for each of these diseases in pregnancy is available and proven effective. Maternova offers rapid tests with the idea that awareness of status is crucial for treatment.
Check out Maternova's HIV 1/2 rapid test, Chlamydia rapid test, Hep B, Hep C and HIV combination rapid tests.
By Leah Hardenbergh
Citations "Introduction to Sexually Transmitted Infections (STIs)." STIs, Your Body and Pregnancy. NYU Medical Center, n.d. Web. 29 June 2016. Newman, Lori et al. "Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting."PLOS ONE:. N.p., 8 Dec. 2015. Web.
Jean M. Bouquet, DO, is an Assistant Professor of Family Medicine and Co-Director of the Urban Underserved Track at the Rocky Vista University College of Osteopathic Medicine. He is the founder of the Bouquet Speculum, an innovative and FDA-cleared medical device that helps to screen women for cervical cancer. Dr. Bouquet also started the Cure Cervical Cancer nonprofit. The following blog post was written by Dr. Bouquet about his journey to creating the Bouquet Speculum.
Dr. Daniel Kimani is a trained and licensed medical officer in Kenya, holding a Bachelor of Medicine & Surgery, and a post-graduate certificate on basic oncology training. Dr. Kimani is the founder of the Global Cancer Care and Research Institute, and is an expert in clinical colposcopy — a procedure to examine the cervix, vagina, and vulva.