General Health

Diagnosis and Medical Care for STDs During Pregnancy

Overview

Sexual intercourse has been related to the dissemination of more than 30 bacteria, viruses, and parasites. The most common sexually transmitted disease is caused by eight of these infections. Syphilis, gonorrhoea, chlamydia, and trichomoniasis are the only four that are currently treatable. Hepatitis B, herpes simplex virus (HSV or herpes), HIV, and human papillomavirus are the other four incurable viral illnesses (HPV).

Sexual contact, including vaginal, anal, and oral sex, is the most common way for STIs to spread. During pregnancy, childbirth, and breastfeeding, several STIs can be passed from mother to kid.

A person can have an STI without exhibiting any signs and symptoms of illness. Vaginal discharge, urethral discharge or burning in males, genital ulcers, and abdominal pain are all common STI symptoms.

Sexually transmitted diseases in pregnancy

All women who come in for prenatal care should be asked if they have ever had an STD or if they’ve ever done something that raises the risk for STDs. Their mates should be questioned in the same way if they are available. All pregnant patients should be diagnosed with five STDs. Initial HIV testing should be made available to all women.

The first test is an ELISA antibody test followed by a Western blot confirmation; screening should be offered in the first trimester. During the third trimester, repeat examinations should be offered to high-risk women (those who use illegal drugs, have STDs during pregnancy, have several sex partners during pregnancy, or have HIV-infected partners).

To detect patients with hepatitis B, serologic testing for hepatitis B surface antigen (HBsAg) should be done in the first trimester. For all women who are at high risk, testing should be repeated in the third trimester. At the first prenatal appointment, serologic testing for syphilis should be done. If the patient has high-risk behaviour, lives in a region with a high incidence of syphilis, has not been tested previously during the pregnancy, or had an initial positive screen, testing should be repeated in the third trimester.

Women who get a positive pregnancy test should be screened again shortly after giving birth. If she never had a PAP smear check-up in the last year, she should get one at her first prenatal visit to assess for human papillomavirus (HPV) infection. Hepatitis C antibodies should be screened in women who have had intravenous drug use, recurrent blood transfusions, or exposure to other blood products or organ transport. Finally, testing for asymptomatic bacterial vaginosis may reduce the risk of preterm delivery in the present pregnancy in women who have a history of preterm delivery. There is insufficient evidence to support routine bacterial vaginosis screening in pregnant women.

Symptoms

STDs do not usually elicit symptoms, and others only cause minor ones. As a consequence, it is possible to get infected without noticing it. Individuals can, however, transmit it to others.

If there are any signs or symptoms, they may include:

  • Penis or vaginal discharge that is abnormal
  • Sores or warts on the genital area
  • Unusual vaginal odour
  • Painful urination with polyuria
  • Itching and redness in the genital area
  • Blisters or sores in or around the mouth
  • Itching, pain, or bleeding in the anal region
  • Pain in the abdomen
  • Pyrexia, abnormally high body temperature

Prevention

The probability of contracting or spreading STDs is considerably reduced, but not eliminated when latex condoms are used correctly. Polyurethane condoms can be used if mates are allergic to latex. HPV and hepatitis B can both be prevented with vaccinations.

Diagnosis

In high-income countries, accurate STI diagnostic tests are frequently used. These are particularly beneficial for detecting asymptomatic illnesses. Diagnostic tests, on the other hand, are scarce in low- and middle-income nations. Where testing is offered, it is frequently costly and geographically distant, and patients must frequently wait a long time (or return) for findings. As a result, follow-up may be hampered, and therapy or care may be inadequate.

Syphilis, hepatitis B, and HIV are the only STIs for which inexpensive, quick testing is currently accessible. In some resource-constrained areas, the rapid syphilis test is already in use. A quick dual HIV/syphilis test is now available, which allows an individual to be tested for both HIV and syphilis with just one fingerstick and one testing cartridge.

These tests are precise, may produce results in 15 to 20 minutes, and require minimal training to use. The use of rapid syphilis tests has been shown to increase the number of pregnant women who are tested for the disease. However, in most low- and middle-income countries, more surveillance is needed to ensure that all pregnant women receive a syphilis test at their initial prenatal care visit.

Several quick tests for various STIs are in the works, with the potential to improve STI diagnosis and treatment, particularly in resource-constrained situations.

Treatment

Several STIs now have effective treatments accessible.

  • With existing single-dose antibiotic regimens, three bacterial STIs (chlamydia, gonorrhoea, and syphilis) and one parasitic STI (trichomoniasis) are generally curable.
  • Antivirals are the most effective treatments for herpes and HIV, as they can slow down the progression of the disease but not cure it.
  • Antiviral drugs for hepatitis B can help fight the virus and reduce liver damage.

Antimicrobial resistance (AMR) of STIs, particularly gonorrhoea, has increased significantly in recent years, limiting treatment options. AMR for other STIs does exist, however it is less prevalent, making prevention and quick treatment essential.

Author

 Yash Batra

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