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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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Young people blamed for rise in sex infection rates

Casual sex is fuelling a big rise in sexual disease among young people, health experts warned today, as figures showed a 6% increase in infections.

Young people, aged 16 to 24, accounted for half of all newly diagnosed sexually transmitted infections (STIs) in 2007, though they make up only one-eighth of the population.

Infections rose across the UK, figures from the Health Protection Agency (HPA) show.

Professor Peter Borriello, the director of the HPA centre for infections, blamed the rise among young people on the prevalence of unsafe sex.

“It’s increasingly the case that among young people a casual shag is part of the territory, it’s part of life,” he said.

“Increasingly a shag now stands for syphilis, herpes, anal warts and gonorrhoea.

“If you are going to go swimming, dive into the pool, make sure you know how to swim, be safe. That really means wear a condom.”

There were 397,990 newly diagnosed STIs in clinics last year, up from 375,843 in 2006.

New cases of genital herpes rose 20% while there was a 7% rise in genital warts and chlamydia.

Young people accounted for 65% of all chlamydia, 50% of genital warts and 50% of gonorrhoea infections diagnosed in genitourinary medicine clinics across the UK last year, the HPA said.

This is the eleventh year in a row that STIs have risen year-on-year.

And young people are not the only group affected. Sexually transmitted infections among people over 45 have doubled in under a decade, a recent study showed.

The HPA said increases in testing and diagnoses accounted for some of the rise.

But Borriello called for a strong message to be delivered to those who engage in casual encounters without taking proper precautions.

The HPA want sexually active young people to be screened for chlamydia annually and every time they change their sexual partner.

Chlamydia, which often has no symptoms, remains the most common STI in the UK.

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Sexually transmitted diseases have risen to record high despite high profile advertising campaigns aimed at young people.

Almost 400,000 new infections were diagnosed last year - a six per cent increase on the previous year - and the highest since records began.

Half of all new cases were found in young people aged 16 to 24, despite them only accounting for 12 per cent of the population, prompting calls for them to be screened every year.

Casual sex and having multiple partners are driving the rate of sexually transmitted infections higher than ever and it is time people started taking responsibility for their own health, Government scientists said.

In 2006 the Government launched a high profile advertising campaign showing young people together in nightclubs and bars displaying the names of sexually transmitted infections like Chlamydia and gonorrhoea on their clothes to get the message across that it is not easy to tell who has an infection and that condoms should be ‘essential wear’ for a night out.

But despite this infections are rising faster.

The Health Protection Agency recommended all young people should be tested for Chlamydia every year as part of the national screening programme.

But Government targets to test just 15 per cent of 16 to 24-year-olds last year was missed and a significant increase in testing is needed.

Gwenda Hughes, from the Health Protection Agency Centre for Infections, said: “Young people are disproportionately affected by sexually transmitted infections. This is because they are more sexually active, have more sexual partners, they have a tendency to have overlapping sexual partners and they are more likely to have casual sex partnerships.”

Professor Peter Borriello, Director of the Agency’s Centre for Infections, said even though young people have the most infections it is still a minority of that age groups. He said most young people do abide by the safe sex message.

“We really should applaud and be proud of the way young people do overcome some of these problems and do take responsibility and don’t come away with a sexual infection.”

Around one in ten 16 to 24-year-olds is thought to be infected with Chlamydia, which is the most prevalent infection.

The HPA report said while just one in eight of the population are aged 16 to 24 years old, this age group accounts for around half of all newly diagnosed STIs in the UK including 65 per cent of all new Chlamydia cases, 55 per cent of all genital warts and 50 per cent of gonorrhoea infections diagnosed in specialist clinics last year.

Some of the increase is down to more sensitive tests being used which detect cases that would not have been picked up before and more people coming forward for testing, but this cannot account for all of the rise.

There were 397,990 new sexually transmitted infections diagnosed in genito-urinary clinics last year.

The biggest rise was in genital herpes which has risen by 20 per cent in one year to reach 26,062 new cases in 2007. Chlamydia rose by seven per cent to reach 121,986 new cases and genital warts rose by seven per cent to 89,838 new diagnoses.

New cases of gonorrhoea and syphilis dropped slightly.

Chris Plummer of the sexual healthcare charity British Pregnancy Advisory Service, said: “It is difficult to assess the true picture of sexually transmitted infections, because part of the increase in diagnosed infections is undoubtedly due to improvements in access to STI screening, which has been targeted at 16-24 year olds. However, simply advocating condom use and better sex and relationships education does not seem to prevent young people spreading infections- nor does suggesting that they should abstain from sex.

“Getting young people screened and treated with an accessible, discreet and quick service is the answer.”

Shadow Health Minister Anne Milton, said: “The Government has been shamefully complacent about tackling public health problems like sexually transmitted infections, and these latest statistics show the cost of their failure.

“Chlamydia accounts for almost a third of new infections, proof that the Government have let down young people with their dithering and delays to their Chlamydia screening programme.

“Their fifteen per cent target was modest and they’re still nowhere near meeting it. Meanwhile we’re seeing thousands of new Chlamydia infections every year, with the potential to leave patients with very serious health problems.

“The Government urgently need to get their screening programme back on track.”

Health minister Dawn Primarolo said: “It is a concern that the number of diagnoses of levels of sexually transmitted infections have increased - but these figures must be set in context.

“There has been a 16% increase in the number of people accessing sexual health clinics since 2006.

“That means more people are being screened and therefore detected. It also means more people than ever before are getting the information, tests and advice they need.

“Rapid treatment and detection cuts the risk of transmitting sexually transmitted infections.

“If this increased access is maintained, it could have a significant impact on the control of sexually transmitted infections.”

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Evidence suggests that a substantial proportion of new HIV infections in African countries are associated with herpes simplex virus type 2 (HSV-2). Thus, the magnitude of HSV-2 infection in an area may suggest the expected course of the HIV epidemic.

We determined prevalence of genital herpes, syphilis and associated factors among pregnant women from a remote rural Tanzanian community that has a low but increasing HIV prevalence.

Methods:

We analysed 1296 sera and responses to a standard structured questionnaire collected from pregnant women aged between 15-49 years, attending six different antenatal clinics within rural Manyara and Singida regions in Tanzania.

Linked anonymous testing (with informed consent) of the serum for specific antibodies against HSV-2 was done using a non-commercial peptide- 55 ELISA. Antibodies against syphilis were screened by using rapid plasma reagin (RPR) and reactive samples confirmed by Treponema pallidum haemagglutination assay (TPHA).

Results:

Previous analysis of the collected sera had shown the prevalence of HIV antibodies to be 2%.

In the present study the prevalence of genital herpes and syphilis was 20.7% (95% CI: 18.53-23.00) and 1.6% (95% CI: 1.03-2.51), respectively. The presence of HSV-2 antibodies was associated with polygamy (OR 2.2, 95% CI: 1.62 - 3.01) and the use of contraceptives other than condoms (OR 1.7, 95% CI: 1.21 - 2.41).

Syphilis was associated with reporting more than one lifetime sexual partner (OR 5.4, 95% CI: 1.88 - 15.76) and previous spontaneous abortion (OR 4.3, 95% CI: 1.52-12.02).

Conclusions:

The low prevalence of HIV infection offers a unique opportunity for strengthening HIV prevention in a cost-effective manner. The identification and control of other prevalent curable STIs other than syphilis and specific intervention of HSV-2 in specific populations like pregnant women would be one among approaches towards preventing incident HIV infections.

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