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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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STDs can have many of the same consequences for pregnant women as women who are not pregnant. STDs can cause cervical and other cancers, chronic hepatitis, pelvic inflammatory disease, infertility, and other complications. Many STDs in women are silent; that is, without signs or symptoms.

A pregnant woman with an STD may also have early onset of labor, premature rupture of the membranes surrounding the baby in the uterus, and uterine infection after delivery.

STDs can be passed from a pregnant woman to the baby before, during, or after the baby’s birth. Some STDs (like syphilis) cross the placenta and infect the baby while it is in the uterus (womb). Other STDs (like gonorrhea, chlamydia, hepatitis B, and genital herpes) can be transmitted from the mother to the baby during delivery 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 STDs, can infect the baby through breastfeeding.

The harmful effects of STDs in babies may include stillbirth (a baby that is born dead), low birth weight (less than five pounds), conjunctivitis (eye infection), pneumonia, neonatal sepsis (infection in the baby’s blood stream), neurologic damage (such as brain damage or lack of coordination in body movements), blindness, deafness, acute hepatitis, meningitis, chronic liver disease, and cirrhosis. Some of these problems can be prevented if the mother receives routine prenatal care, which includes screening tests for STDs starting early in pregnancy and repeated close to delivery, if necessary. Other problems can be treated if the infection is found at birth.

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Yes, women who are pregnant can become infected with the same sexually transmitted diseases (STDs) as women who are not pregnant. Pregnancy does not provide women or their babies any protection against STDs. In fact, the consequences of an STD can be significantly more serious, even life threatening, for a woman and her baby if the woman becomes infected with an STD while pregnant. It is important that women be aware of the harmful effects of STDs and know how to protect themselves and their children against infection.

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In most cases you can’t prevent CMV, and you wouldn’t even want to. It’s best to be infected when you are young to reduce the risk of getting it for the first time during pregnancy. Pregnant women who get CMV infection ma pass the virus along to their unborn baby. How can you prevent this? Unfortunately, I can’t offer any easy answers.

One expert suggested that pregnant mothers with children younger than two who attend group child care should avoid intimate contact with their toddlers during the first six months of pregnancy. I find this utterly unrealistic. But you can make a point of washing your hands well after changing diapers and wiping noses. Disposable wipes are handy when frequent running to a sink becomes impossible.

Pregnant nurses at the Children’s Hospital of Philadelphia had to do their best to avoid CMV. We advised them to assume that all babies and toddlers were shedding CMV in their urine and to use care when handling urine and saliva. Some wore gloves while others preferred to wash their hands carefully after handling a young patient. If you are pregnant and work with small children, or have a toddler attending day care, you can request a test for CMV antibodies when you begin prenatal care. Babies born to mothers with prior immunity are at less risk of congenital CMV infection.

In the future, we hope to learn more about why some babies who are infected with CMV become sick while most others don’t, and we will likely develop better medicines to fight this infection. In the meantime, strange as it seems, the best protection is to be infected young.

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There is no cure for congenital CMV because the virus damages the baby before birth. Antiviral drugs cannot undo this damage once the baby is born. Doctors have good results with two antiviral drugs—ganciclovir (Cytovene) and foscarnet (Foscavir)— for treating and curing CMV disease in AIDS patients. Both these drugs are used to treat CMV retinitis and must be given by IV.

Nursing Care

Babies with congenital CMV need hospital care. Nursing care will depend on which organs the virus has damaged. Transplant patients and AIDS patients also need hospital care. Patients with serious CMV pneumonia require intensive care.

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Information about the incubation period varies, and it is not well determined. Illness following transfusion may begin from three to eight weeks after receiving the infected blood. Babies born with congenital CMV may show symptoms from three to eight weeks after birth.

Infectiousness

Babies infected before birth excrete the virus on and off for years and are infectious during this time. Young children are infectious from six months to two years old. Adults are infectious for only a few months.

Immunity

Once you are infected, the virus remains latent in your body, just like other herpes viruses, and can be reactivated later in life under periods of stress or weakened immunity.

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Babies. Almost all babies infected before birth are perfectly normal. Only about 10 percent of babies infected before birth are sick, and of these, 20 to 30 percent may die. Most survivors will have permanent damage. Some long-term studies suggest that a small number of apparently normal but CMV-infected babies at birth may have problems later in life. Congenital CMV has been linked to hearing loss and learning disabilities in children.

Children. Young children may have a mild cold or fever for a few days when first infected
with CMV.

Adults. CMV causes no signs or symptoms of illness in most adults. It will, however, cause an illness similar to mono  in about ten percent of young adults.

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Babies. Babies infected before birth who become sick with CMV have symptoms affecting many major organs including the liver, brain, eyes, and lungs. The baby may suffer from convulsions, lethargy, a rash that looks like tiny red pinpoints on the skin, and breathing problems. Surviving babies often have such permanent damage as mental retardation, small brain or water on the brain (micro- or hydrocephalus), hearing loss, eye inflammations, poor coordination, and liver disease.

Children. Young children have few, if any symptoms. They may experience a mild cold- or flulike illness with fever, but you can’t tell it apart from any other mild viral illness.

Adults. Very few adults, including pregnant women, have any symptoms. Symptoms will be so mild—achiness, a low fever, sore throat—that you won’t be aware you are sick.

Tests

Because the virus is excreted in blood, urine, saliva, cervical secretions, and breast milk, CMV can be grown in any of these samples. It is not difficult to grow the virus, and the test is available in most large hospital and commercial labs. The virus grows slowly, however, and you may wait from two to six weeks for results.

You can also have your blood tested for the CMV antibody. If you have the antibody, you’ve been previously infected with CMV, but this test won’t tell whether the virus is present in your blood, urine, or saliva.

Newborns with possible congenital CMV infection must have virus cultured from their urine, nose, eyes, or spinal fluid to confirm CMV as the cause of illness.

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You catch CMV from close, intimate contact with infected urine; saliva; respiratory, vaginal, or cervical secretions; breast milk; or semen. It can be sexually transmitted, but most people get CMV through close household contact. Poor people are much more likely to be infected as young children, probably because they live in crowded conditions.

Babies get it from their mothers before birth, during delivery, or in the first few weeks of life. The baby is infected during pregnancy if its mother has either a first-time CMV infection or a reactivation of a past one.

Women who have toddlers attending child care are often infected. CMV transmission is rapid in these places because urine and saliva are passed from child to child on dirty hands. Young children rarely have symptoms, but they excrete the virus in their urine and saliva for months to years. Anyone working in child care or in any area with lots of young diapered children is exposed to CMV.
It is often transmitted from blood transfusions because so many people, including blood donors, have CMV infections with no symptoms.

Most people are infected with CMV before they reach adulthood, but very few people experience any symptoms or signs of illness. People with AIDS and organ transplant recipients are at highest risk for serious CMV infection—either pneumonia or retinitis, an eye infection. Often, their own latent CMV infections will reactivate as their immune systems either weaken or are suppressed by drugs to prevent organ rejection.

People who need organ transplants are tested for antibodies to CMV. Doctors will try to match CMV-negative organ donors to CMV-negative organ recipients. But a match isn’t always possible and the CMV-negative organ recipient faces a risk of serious CMV infection from the transplanted organ weeks to months later. To prevent this, the doctor will give the transplant recipient an injection of CMV antibody.

CMV-negative organ recipients who need blood transfusions will receive CMV-negative blood. This blood is hard to come by and is saved for people who really need it. If no CMV-negative blood is available, the blood can be filtered to remove the cells containing CMV. Otherwise, transplant patients may become ill if they receive CMV-infected blood.

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