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Pregnancy & Sexually Transmitted Diseases. (Ages & Stages).

Twice in the past year, Beth E. Cheney, RN, MSN, CFNP, has had to tell a pregnant woman that she tested positive for HIV. It's one of the worst things about her job as women's health coordinator at the Windham Hospital in Willimantic, CT.

Luckily, Ms. Cheney can simultaneously deliver some good news: that treatment with AIDS drugs such as AZT during pregnancy will nearly always prevent transmission of the virus to the fetus. In fact, thus far, the Windham clinic has a perfect record--all the babies born to HIV-infected mothers have tested HIV negative.

But HIV is in the minority in terms of the STDs she sees in the pregnant women who come into her clinic. The clinic performs an STD screening on every patient, testing for such diseases as chlamydia, HPV, gonorrhea and hepatitis B, and between one-third to one-half turn up positive. Once they get the results, the women's first question, says Ms. Cheney, is "How did this happen?" Their second: "How will this affect my pregnancy?"

The potential dangers are immense. Pregnant women with untreated STDs may experience early onset of labor, premature rupture of the membranes surrounding the baby and uterine infection after delivery. Some STDs, like syphilis, cross the placenta and infect the fetus during its development; others, like gonorrhea, chlamydia, hepatitis B and genital herpes, are transmitted from mother to infant as the baby passes through the birth canal. Other harmful effects on the baby include stillbirth, conjunctivitis, pneumonia, brain damage or motor disorders, blindness, deafness, acute hepatitis and meningitis. (19)

The U.S. Centers for Disease Control and Prevention (CDC) recommends that all pregnant women be tested for syphilis, hepatitis B, chlamydia, gonorrhea, hepatitis C (for those at high risk) and be offered voluntary HIV testing on their first prenatal visit; then, if they fall into a high-risk category, be tested again in their third trimester, and have a Pap smear, if they haven't had one in the past year. (16) Women should ask for these tests specifically, however, since many doctors don't routinely perform them. (19)

Once diagnosed, most STDs can be safely treated during pregnancy, and/or precautions taken to insure the baby doesn't contract the disease. For instance:

* Bacterial STDs, like chlamydia, gonorrhea and syphilis, can be treated and cured with antibiotics during pregnancy.

* While there is no cure for viral STDs such as herpes and HIV, antiviral medication may reduce symptoms and dramatically reduce the risk of passing the virus onto the baby. (19)

* If you have a herpes outbreak when you go into labor, your health care professional will perform a C-section to avoid transmitting the virus to the baby during birth.

The best way to prevent STDs during pregnancy, notes the CDC, is to remain monogamous with a monogamous partner; if you're not sure about your partner, consider consistent and correct use of latex condoms for every act of intercourse, particularly during the last trimester when an active infection presents the greatest threat. (16)

RESOURCES

Adolescent Wellness and Reproductive Education (AWARE) Foundation

1015 Chestnut Street, Suite 1225 Philadelphia, PA 19107-4302

215-955-9847

http://www.awarefoundation.org

Offers reproductive health education materials for teens, parents and educators.

Advocates for Youth

1025 Vermont Avenue, NW, Suite 200 Washington, DC 20005

202-347-5700

http://www.advocatesforyouth.org

Offers information to help teens make informed reproductive health decisions.

American Social Health Association

P.O. Box 13827 Research Triangle Park, NC 27709

1-800-361-8400

http://www.ahastd.org

CDC National STD Hotline: 1-800-227-8922

Provides basic STD information; coordinates CDC STD hotline.

Division of Reproductive Health

National Center for Chronic Disease Prevention and Health Promotion

4770 Buford Hwy, NE Mail Stop K20 Atlanta, GA 30341-3717

770-488-5200

http://www.cdc.gov/nccdphp/drh/index.htm

Publishes research-based reproductive health information on wide range of topics.

Girls Inc.

120 Wall Street New York, NY 10005-3902

1-800-374-4475

http://www.girlsinc.org

Develops educational programs to encourage girls to master physical, intellectual and emotional challenges.

HIV Over Fifty

http://www.hivoverfifty.org

Promotes access to educational and health care programs for persons over age 50 affected by HIV.

Sexuality Information and Education Council of the United States (SIECUS)

130 West 42nd Street, Suite 350 New York, NY 10036

212-819-9770

http://www.siecus.org

Develops and distributes reproductive health information for teens, parents, educators and health care professionals.

RELATED ARTICLE: The Changing Face of HIV/AIDS

By the time Sharon (*), 55, was diagnosed with AIDS in 1994, she'd been married 12 years. Her husband had been leading a double life as a homosexual, without her knowledge, and had infected her with the HIV virus. When he died three years ago, she found herself single, and over 50 with AIDS.

The rate of AIDS among those 50 and older is increasing, both as a result of older people becoming infected with the AIDS virus, and living longer with the virus, notes David J. Landry, senior research associate at The Alan Guttmacher Institute in New York City.

"People over 50 don't think they're at risk," says Sharon, who is active in the organization HIV Over 50 (see Resources, p. 5). "Half the women I know who are over 50 in my group of friends contracted the virus from having unprotected sex. They thought they didn't have to worry about it." But every woman, regardless of her age, needs to worry about AIDS, she says.

* Not her real name

References

(1.) "HPV and Cervical Cancer Fact Sheet." Kaiser Family Foundation, Nov. 2001. http://www.kff.org

(2.) Collins, S. et al. "High incidence of Cervical Human Papillomavirus Infections in Women During Their First Sexual Relationship. BJOG, Jan. 2002, Vol. 109, 96-98.

(3.) "Counseling Can Help Correct misconceptions about Sexually Transmitted Diseases. Center for the Advancement of Health. [Press release]. Sept. 27, 2000.

(4.) Kaiser Family Foundation Reproductive Report, April 12, 2002.

(5.) "HIV/AIDS Among U.S. Women: Minority and Young Women at Continuing Risk." Fact sheet. U.S. Centers for Disease Control and Prevention (CDC). 2002. http://www.rdc.gov

(6.) "African Americans Disproportionately Affected by STDs." CDC. Dec. 5, 2000.

(7.) Wiesenfeld HC, Lowry DL, Heine RP, Krohn MA, Bittner H, Kellinger K, Shultz M, Sweet RL. "Self-collection of Vaginal Swabs for the Detection of Chlamydia, Gonorrhea and Trichomoniasis: Opportunity to Encourage Sexually Transmitted Disease Testing Among Adolescents." Sex Transm Dis. 2001 Jun; 28(6):321-5.

(8.) "Tracking the Hidden Epidemics: Trends in STDs in the U.S. 2000." CDC. http://www.cdc.gov

(9.) "New Resistant Gonorrhea Migrating to Mainland U.S." NY Times. May 7, 2002.

(10.) Rosenberg PS, Biggar RJ, Goedert JJ. "Declining Age at HIV Infection in the United States." [Letter]. New Engl J Med 1994;330:789-90.

(11.) "Women in a New York City Clinic Mistakenly Believe that HIV Testing is a Good Way to Prevent Infection." The Alan Guttmacher Institute. [Press release]. May 8, 2002.

(12.) "An Introduction to Sexually Transmitted Disease" Fact sheet. National Institute of Allergy and Infectious Diseases (NIAID). 1999. http://www.niaid.nih.gov

(13.) "NIAID Topical Microbicide Research Developing New Tools to Protect Women from HIV/AIDS and other STDs." Fact sheet. March 2000. http://www.niaid.nih.gov

(14.) "Older Americans Make Up the New Face of HIV/AIDS, Experts Say." Associated Press. May 11, 2002.

(15.) "The HIV/AIDS Epidemic in the United States." Fact sheet. Kaiser Family Foundation June 2001. http://www.kff.org

(16.) "Sexually Transmitted Diseases Treatment Guidelines," 2002. MMWR, May 10, 2002. CDC.

(17.) "Viral Hepatitis, Type B." Fact sheet. CDC. http://www.cdc.gov

(18.) "Some Facts About Syphilis." CDC. March 16, 2000. http://www.cdc.gov

(19.) "STDs and Pregnancy." Fact sheet. CDC. Oct. 1997. http://www.cdc.gov
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Publication:National Women's Health Report
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Date:Jun 1, 2002
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