25. Sexually Transmitted Diseases
Sexually transmitted diseases (STDs)
during pregnancy are serious because they can harm a developing fetus.
STDs are contracted during sexual contact, including vaginal, oral or
anal intercourse. If you have an STD, seek treatment as soon as
possible!
Many pregnant women have an STD but don’t
know they are infected. Ask for a test or treatment if you think you
have an STD. Your healthcare provider routinely offers tests for
hepatitis B, HIV and syphilis.
Sexually transmitted diseases are more
common in women than in men. A woman is more susceptible because her
reproductive organs are inside her body, a fertile environment for
infections to grow. This also makes diagnosis in women more difficult
than in men.
Some STDs are transmitted when the baby
comes in contact with the virus during birth. Others are passed to the
baby through the mother’s blood and infect the baby during pregnancy or
birth. Left untreated, STDs can harm an unborn baby. Every year,
thousands of babies are born early or suffer from infection because of
undetected STDs passed to them by their mothers. Babies may suffer
serious effects. In some cases, effects are not evident until years
after birth.
The most common sexually transmitted
diseases include monilial vulvovaginitis, trichomonal vaginitis,
condyloma acuminatum (venereal warts; HPV), genital herpes simplex
infection, chlamydia, gonorrhea, syphilis and HIV/AIDS.
Many sexually transmitted diseases can be
diagnosed and treated during pregnancy. It’s important to be tested for
an STD if you believe you might have been exposed. Discuss this
important subject with your healthcare provider.
HIV and AIDS
HIV (human immunodeficiency virus) is
the virus that causes AIDS (acquired immune deficiency syndrome). About
1.2 million people in the United States are HIV-positive or have AIDS.
Nearly 56,000 new HIV infections occur every year—20% of those infected
don’t know they are infected.
About 2 out of every 1000 women who enter
pregnancy are HIV-positive, and the number of cases among women is
rising. It’s estimated that 6000 babies are born every year to mothers
infected with HIV. In fact, the CDC now recommends all pregnant women
be offered HIV testing. Home testing kits are available; most are very
reliable.
Two tests are used to
determine if someone has HIV—the ELISA test and the Western Blot test.
The ELISA is a screening test. If positive, it should be confirmed by
the Western Blot test. Both tests involve testing blood to measure
antibodies to the virus. The Western Blot test is believed to be more
than 99% sensitive and specific.
For those at high risk of HIV, experts
suggest testing before pregnancy or as early in pregnancy as possible
and testing again in the third trimester. Rapid HIV testing during
labor is recommended if a woman’s HIV status is unknown. With rapid HIV
screening, results are available within 30 minutes.
After HIV enters a person’s bloodstream,
the body begins to produce antibodies to fight the disease. A blood
test can detect these antibodies. When detected, a person is considered
“HIV-positive” and can pass the virus to others. This is not the same
as having AIDS. A person is HIV-positive before developing AIDS. The
process can take many years, due to medications in use at this time.
Gynecological problems can be an early
sign of an HIV infection, including ulcers in the vagina, yeast
infections that won’t go away and severe pelvic inflammatory disease.
If you have any of these problems, discuss them with your healthcare
provider. Early diagnosis and treatment are crucial. In most cases,
antibodies can be detected 6 to 12 weeks after exposure. In some cases,
it can take many months before antibodies can be found. Studies
indicate taking over-the-counter multivitamins containing vitamins B, C
and E every day may delay the progression of HIV and delay the need to
start antiretroviral medications.
We know 90% of all cases of HIV in
children are related to pregnancy—mother to baby during pregnancy,
childbirth or breastfeeding. Research has shown an infected woman can
pass the virus to her baby as early as 8 weeks of pregnancy. A mother
can also pass HIV to her baby during birth. Breast-feeding is not
recommended for women who are HIV-positive.
Research shows the chance of a woman
infected with HIV passing the virus to her baby can be nearly
eliminated with some medications. However, if an infection is not
treated, there’s a 25% chance a baby will be born with the virus. If a
woman takes AZT during pregnancy and has a Cesarean delivery, she
reduces the risk of passing the virus to her baby to about 2%! Studies
have found no birth defects linked to the use of AZT. Other HIV
medications have also been proved safe for use during pregnancy.
If you’re HIV-positive, expect more blood
tests during pregnancy. These tests help your healthcare provider
assess how well you’re doing.
The rate of AIDS
among women has grown to 20% of all reported cases. AIDS can leave a
person prone to, and unable to fight, various infections. If you’re
unsure about your risk, seek counseling about testing for the AIDS
virus. Pregnancy may hide some AIDS symptoms, which makes the disease
harder to discover.
There is some positive news for
women who suffer from AIDS. We know if a woman is in the early course
of the illness, she can usually have an uneventful pregnancy, labor and
delivery.
26. Shingles
Shingles occurs when a type of herpes
virus becomes active after having been dormant in nerve root ganglia.
This can happen long after the primary infection has gone away. It
occurs more often in people who are older, although it can occur in
younger people as well.
Shingles occurs mainly in adults whose
immune systems are compromised. During pregnancy, shingles can be a
severe illness, with sharp pain and even breathing problems. The times
of greatest concern for a pregnant woman are during the first half of
pregnancy and around the time of delivery. Exposure during the first
trimester, when major organs are developing in the fetus, can cause
some birth defects. Fortunately, shingles rarely occurs during
pregnancy.
Pain from shingles occurs in
specific areas of nerve distribution. Treatment includes pain control
with pain medications. If you think you have shingles, contact your
healthcare provider, who can decide on treatment for you.
