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Chlamydia, gonorrhea, syphilis, trichomonas, and bacterial vaginosis (BV) can be treated and cured with antibiotics during pregnancy. There is no cure for viral STDs, such as genital herpes and HIV, but antiviral medication for herpes and HIV may reduce symptoms in the pregnant woman. For women who have active genital herpes lesions at the time of delivery, a cesarean delivery (C-section) may be performed to protect the newborn against infection. C-section is also an option for some HIV-infected women. Women who test negative for hepatitis B, may receive the hepatitis B vaccine during pregnancy.

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The surest way to avoid 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 and is known to be uninfected.

Latex condoms, when used consistently and correctly, are highly effective in preventing 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. Genital ulcer diseases and human papillomavirus (HPV) infections can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of genital herpes, syphilis, and chancroid only when the infected area or site of potential exposure is protected. While the effect of condoms in preventing human papillomavirus infection is unknown, condom use has been associated with a lower rate of cervical cancer, an HPV-associated disease.

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STDs affect women of every socioeconomic and educational level, age, race, ethnicity, and religion. The CDC 2002 Guidelines for Treatment of Sexually Transmitted Diseases recommend that pregnant women be screened on their first prenatal visit for STDs which may include:

Chlamydia
Gonorrhea
Hepatitis B
Hepatitis C
HIV
Syphilis

In addition, some experts recommend that women who have had a premature delivery in the past be screened and treated for bacterial vaginosis at the first prenatal visit.

Pregnant women should ask their doctors about getting tested for these STDs, since some doctors do not routinely perform them. New and increasingly accurate tests continue to become available. Even if a woman has been tested in the past, she should be tested again when she becomes pregnant.

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Some STDs, such as genital herpes and bacterial vaginosis, are quite common in pregnant women in the United States. Other STDs, notably HIV and syphilis, are much less common in pregnant women. The table below shows the estimated number of pregnant women in the United States who are infected with specific STDs each year.

STDs Estimated Number of Pregnant Women

Bacterial vaginosis 800,000
Herpes simplex 800,000
Chlamydia 200,000
Trichomoniasis 80,000
Gonorrhea 40,000
Hepatitis B 40,000
HIV 8,000
Syphilis 8,000

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Sexually transmitted infections (STIs) are infections you can get by having sex with someone who has an infection. Having intercourse usually passes on these infections, but they can also be passed on through other types of sex, such as oral sex. Viruses or bacteria can cause STIs. Some of the most common STIs and their symptoms are listed below.

Types of STIs

Caused by bacteria

Chlamydia:
No symptoms may occur at first or at all, especially in women. Later symptoms for women may include itching around the vagina, a yellow, odorless discharge from the vagina, pain during sex, and needing to urinate often or having pain when urinating. Women may also have bleeding between periods or dull pain in the pelvic area. Symptoms for men may include pain or burning when urinating and a watery, milky-colored discharge from the penis.

Gonorrhea (or “GC”):
Men may have a thick, yellow discharge from the penis and pain when urinating or may have no symptoms. The opening of the penis may be sore. Gonorrhea doesn’t cause symptoms in most women. When symptoms do occur, women may have white, green or yellow discharge from the vagina, pain when urinating, spotting between periods, or heavy bleeding during periods. Sometimes fever and abdominal pain occur. Gonorrhea can cause sore throats in people who have oral sex or can cause pain in the anus in people who have anal sex.

Syphilis:
Early signs include a chancre (a painless, red sore). The sores may appear where you were touched during sex, including your genitals, anus, tongue and throat. The glands near the chancre may swell. A few months later, you may have a fever, sore throat, and headache, not feel hungry or have joint pain. A scaly rash may appear on the palms of your hands and the soles of your feet. After these symptoms pass, you may not have any symptoms for a number of years. When the symptoms return, the infections can affect the brain, spinal cord, and skin and bone.

Caused by viruses

Hepatitis B:
Symptoms may include muscle aches, fever, tiredness, loss of appetite, headache and dizziness. As the disease worsens, you may have dark urine, loose, light-coloured stools, yellow eyes and skin, and tenderness in the liver area (just below the ribs on the right side). Hepatitis B can be fatal if it leads to liver failure or liver cancer.

Herpes:
Symptoms start with tingling or itching around your genitals. Small blisters may form in the area and then pop open. When this happens, you might feel burning, especially when urinating. The sores then turn to scabs. During the first outbreak, you might have swollen glands, fever and body aches. But some people don’t have such obvious symptoms. Outbreaks may occur for the rest of your life, but usually become less frequent and less painful with time.

Human immunodeficiency virus (HIV):
HIV is the virus that causes AIDS (acquired immunodeficiency syndrome). It weakens your body’s ability to fight off disease. As your body’s immune system weakens, illnesses begin to develop until you can no longer fight them off. Symptoms may take years to develop and may include unusual infections, unexplained fatigue, night sweats and weight loss.

Human papillomavirus (HPV):
HPV may cause a growth of soft, flesh-coloured warts around the genital area or on the cervix. The warts are painless, but may be bothersome because of the way they look. Sometimes the virus causes warts that can’t be seen by the naked eye. There is a link between some types of HPV and cancer of the cervix; this is why Pap smears are so important.

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See your doctor if you’re at risk for having an STI or if you have any concerns about whether you have one. Most STIs can cause further problems if not treated.

Chlamydia can lead to pelvic inflammatory disease (PID) in women (a disease that can cause women not to be able to have children) and epididymitis in men (painful swelling of the tubes that carry sperm from the testicles).

Gonorrhea can lead to arthritis and PID. HPV (the virus that cause venereal warts) can lead to cancer of the cervix or penis, and syphilis can lead to paralysis, mental problems, heart damage, blindness and death.

Most STIs can be diagnosed through an exam by your doctor, a culture of the secretions from your vagina or penis, a blood test or a urine test, depending on the type of infection.

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The sex partners of people who have chlamydia may receive free medication for their own treatment without ever seeing a doctor, under a new health program in Kitsap County.

The initiative, pioneered in Seattle, is designed to stem the spread of chlamydia trachomatis, the germ behind the most common sexually transmitted bacterial infection in the United States.

The approach presumes that the partner of an infected person is likely to be infected, too, and puts a priority on being practical.

“Some (people) don’t have good access to medical care,” said Matthew Golden, an associate professor of medicine at the University of Washington and one of a team of infectious disease and public health specialists in the country who came up with the program.

“We’re not telling people not to see their doctor. We’re telling them to see their doctor,” Golden said. “But if that’s not happening right away, they need to be treated.”

The program, known in medical circles as “expedited partner therapy,” began June 1 in Kitsap County, where the rate of chlamydia (kluh-MID-ee-uh) among residents ages 15 to 24 has risen an average of 5 percent a year in the past decade.

Left untreated, the infection can lead to pelvic inflammatory disease in women, which may result in sterility. More rarely, chlamydia can cause infertility in men, too. Symptoms for men and women alike include discharge from the sex organs and a burning sensation while urinating. But frequently, the pathogen lurks in the body without any signs, making it possible for an infected person to pass on the disease unknowingly.

Nationally, more than 1 million chlamydial infections were reported in 2006, but the U.S. Centers for Disease Prevention and Control estimates that 19 million new infections occur each year.

In Kitsap County, 350 cases of chlamydia were reported in the first five months of the year alone — making it far and away the most commonly reported sexually transmitted infection. By comparison, there were 33 cases of herpes, 30 cases of gonorrhea and one case of syphilis in the same period.

Expedited partner therapy aims to make treatment as available and convenient as possible for chlamydia as well as for gonorrhea. It starts when a patient who has symptoms seeks a doctor’s care, or — in the case of women — is found during her annual gynecological exam to have one or both infections.

A patient with chlamydia can be treated immediately with a single dose of the antibiotic azithromycin (sold in this country under the brand name Zithromax), said Beth Phipps, a nurse epidemiologist and chlamydia project point person at the Kitsap County Health District.

Gonorrhea also may be treated instantly with a second antibiotic.

Phipps said patients may then obtain free “Partner Packs” containing antibiotics, information about the medicine and the

disease, and a pair of condoms, directly from the health district clinic in downtown Bremerton or through their own physicians, who may call in prescriptions to any of seven Rite-Aid pharmacies in the county.

The partners never have to be identified. The patient simply gives a name under which the prescription should be written, and the person picking up the prescription asks for the packet under that name. Nor does the partner need to be the one to pick it up. “The prescription could be for Joe Schmo, but Minnie Mouse can pick it up,” Phipps said.

Phipps said discretion, delicacy and confidentiality are paramount.

When she started the job, Phipps admitted, she was abashed by the questions she had to ask her clients.

“I’m asking them about their sexual practices,” said Phipps, a grandmother who has been with the health district for 13 years. “I’m asking them about the frequency, the type, male, female, both; and that, actually, to start, was hard for me. It took me two days to call my first person.”

She has since learned to conduct interviews matter-of-factly and without judgment, as casually as if she were asking what the person had for lunch.

She’s also found that people of all types are vulnerable to sexually transmitted infections. “The perception would be icky, dirty, but not necessarily,” Phipps said. “I probably talk to more people who are regular Kitsap County citizens — professional people who just had a mishap.”

Nor are they necessarily promiscuous. One woman who had been to Harrison Medical Center’s emergency department three months in a row with a recurring chlamydia infection was, Phipps found, in a steady relationship. And her partner had been treated, too.

The problem was, the couple weren’t treated for the infection at the same time. “So they were passing it back and forth,” Phipps said. The trick was to treat them simultaneously, and counsel them to abstain from sex for one week until the infections cleared.

Golden at the UW, who also directs the sexually transmitted disease control program at Public Health-Seattle & King County, said that in the search for methods to slow the spread of chlamydia, he and a colleague at the U.S. Centers for Disease Control and Prevention found in a study that about half of all physicians at least occasionally give medicine to patients to take to their partners.

Until the advent of expedited partner therapy, the practice was done informally, under the radar. In fact, in some states, it is illegal to provide prescription drugs to someone who has not been evaluated by a health-care professional, although Golden said laws are changing because of the growing popularity of the formal program and its support from federal health agencies.

In Washington, the spread of partner therapy is funded largely through a five-year, $2.5 million grant from the National Institutes of Health, Golden said. Kitsap is part of a second wave of counties to join. The approach is now available in 18 counties in the state, including Clallam, Jefferson and Pierce. All of Washington is expected to be involved by the middle of 2009.

With 261 cases per 100,000 people, Kitsap’s chlamydia incidence rate is lower than the state’s rate of 283 per 100,000, which in turn is lower than the national rate of about 348 per 100,000.

However, Phipps said she expects Kitsap’s numbers to go up before they go down because of her concentrated efforts to track down infections.

In King County, where partner therapy has been available in some fashion since 1998, Golden said, the infection rate has been stable since 2002. He said researchers should be able to tell how well the program works statewide by 2011.

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