Sexually Transmitted Diseases in Women

Sexually transmitted diseases (STDs) are among the most common infectious diseases in the United States today. More than 20 STDs have been identified and they affect an estimated 19 million men and women in this country each year. The annual treatment cost of STDs in the United States is estimated to be more than $14 billion.

How do STDs affect women?

Health problems caused by STDs tend to be more severe and more frequent for women than for men, in part because for women there are often no visible symptoms, so they do not seek care until serious problems have developed.

Some STDs can spread into the uterus (womb) and fallopian tubes to cause pelvic inflammatory disease (PID), which is a cause of both infertility and ectopic (tubal) pregnancy. Ectopic pregnancy can be fatal. STDs in women also may be associated with cervical cancer. Human papillomavirus infection (HPV) can cause genital warts and cervical and other genital cancers. STDs can be passed from a mother to her baby before, during or immediately after birth. Some of these new-born infections can be cured easily, but others may cause a baby to be permanently disabled or even die.

What are the most common types of STDs?

Chlamydial Infection

This infection is the most common of all bacterial STDs, with an estimated 2.8 million new cases occurring each year. Chlamydial infection may cause an abnormal vaginal discharge and burning during urination. In women, untreated chlamydial infection may lead to pelvic inflammatory disease (PID), one of the most common causes of ectopic pregnancy and infertility in women. Many people with chlamydial infection, however, have few or no symptoms of infection; it often goes undiagnosed and untreated. Once diagnosed with chlamydial infection, a person can be treated with an antibiotic.

Genital Herpes

Genital herpes affects at least 45 million Americans ages 12 and older. Approximately 500,000 new cases of this incurable viral infection develop annually. Herpes infections are caused by the herpes simplex viruses type 1 and type 2. Most genital herpes is caused by HSV-2. Most individuals have no or only minimal signs or symptoms. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender sores that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter. The virus remains in the body for life and the lesions may recur from time to time. Severe or frequently recurrent genital herpes is treated with one of several antiviral drugs that are available by prescription. These drugs help control the symptoms, but do not eliminate the herpes virus from the body. Suppressive antiviral therapy can be used to prevent recurrences and perhaps transmission. Women who acquire genital herpes can transmit the virus to their babies during delivery. Untreated HSV infection in new-borns can result in mental retardation and death.

Genital Warts 

Genital warts (also called venereal warts or condylomata acuminata) are caused by the human papillomavirus, a virus related to the one that causes common skin warts. Certain high-risk types of HPV can cause cervical cancer and other genital cancers, but these are different from the types that cause genital warts. Genital warts usually first appear as small, hard painless bumps in the vaginal area or around the anus. If untreated, they may grow and develop a fleshy, cauliflower-like appearance. There is a very low risk that a pregnant woman with genital warts can pass HPV to her baby. In the rare cases where HPV is passed, the baby could develop warts in the throat or voice box. Genital warts infect between 500,000 to 1 million Americans each year. They are usually removed by freezing, burning or laser treatment. If the warts are very large, they can be removed by surgery. If they recur, they may be treated with injections of a type of interferon. Although treatments may get rid of warts, they do not get rid of HPV, which can still be passed on to sex partners.

Gonorrhea

Gonorrhea is the second most commonly reported infectious disease in the United States. The CDC estimates that more than 700,000 persons in this country get new gonorrheal infections each year; only about half of these infections are reported to the CDC. Most women who are infected have no symptoms. Even when a woman has symptoms, they can be so non-specific as to be mistaken for a bladder or vaginal infection. The most common symptoms of gonorrhea are a vaginal discharge or vaginal bleeding between periods. Untreated cases can lead to serious complications, including PID, ectopic pregnancy and infertility. Historically, penicillin has been used to treat gonorrhea, but in the last decade resistance to penicillin has emerged. New antibiotics or combinations of drugs must be used to treat these resistant strains.

Syphilis 

While the rate of primary and secondary (P&S) syphilis – the most infectious stages of the disease – reached an all-time low in 2000, it has increased dramatically in recent years. Between 2004 and 2005, the number of reported P&S syphilis cases in the United States increased from 7,980 to 8,724. The overall increase in syphilis cases was driven primarily by increases among males. However, troubling trends also were seen among females, as the rate of reported cases among females increased for the first time in more than 10 years. Syphilis is easily curable in its early stages. The initial symptom is a chancre, a painless open sore that usually appears around or in the vagina. If untreated, it can lead to serious long-term complications, including problems of the heart and central nervous system, organ damage and even death. Congenital syphilis can cause stillbirth, death soon after birth, and physical deformity and neurological complications in children who survive. The full course of the disease can take years. Penicillin remains the most effective drug in the treatment of syphilis.

Other STDs

Other diseases that may be sexually transmitted include human immunodeficiency virus (HIV), trichomoniasis, bacterial vaginosis, cytomegalovirus infections and pubic lice (crabs). STDs in pregnant women are associated with a number of adverse outcomes, including spontaneous abortion and infection in the new-born. Low birth weight and prematurity appear to be associated with STDs, including chlamydial infection and trichomoniasis. Congenital or perinatal infection (infection that occurs around the time of birth) occurs in 30 percent to 70 percent of infants born to infected mothers, and complications may include pneumonia, eye infections, and permanent neurologic damage.

What can you do to prevent STDs?

The best way to prevent STDs is to avoid sexual contact with others. If you decide to be sexually active, there are things that you can do to reduce your risk of developing an STD:

Have a mutually monogamous sexual relationship with an uninfected partner.

Use condoms correctly every time you have sex. The use of latex or polyurethane condoms during vaginal intercourse, when used consistently and correctly, can reduce the risk of transmission of STDs.

Delay having sexual relations as long as possible. The younger people are when having sex for the first time, the more susceptible they become to developing an STD. The risk of acquiring an STD also increases with the number of partners over a lifetime.

Source: http://www.idph.state.il.us/about/womenshealth/factsheets/std.htm

Vertical STD Transmission and its Effects

Contracting a sexually transmitted infection (STI) during or prior to pregnancy may cause damage to the developing fetus, which may result in physical and mental abnormalities or even the loss of the baby. Some infections are transmitted from the mother to the child through the placenta during pregnancy, affecting the fetus inside of the womb. Others can spread during the birthing process or postnatal period (through breastfeeding or direct contact). According to Centers for Disease Control, “The harmful effects of STDs in babies may include stillbirth (a baby that is born dead), low birth weight, conjunctivitis (eye infection), pneumonia, neonatal sepsis (infection in the baby’s blood stream), neurologic damage, blindness, deafness, acute hepatitis, meningitis, chronic liver disease, and cirrhosis.” The following list provides information on specific STDs and the potential threats they pose to pregnant mothers. It is crucial that women protect themselves and their children by learning how to avoid these infections and getting sufficient prenatal care.

Chlamydia

Although very easily curable, chlamydia is the most prevalent STD in the United States, possibly because it is often asymptomatic in both women and men. Women who have chlamydia during the early stages of pregnancy run an increased risk of miscarriage or premature delivery. Chlamydia may be transmitted from the genitals of the mother to the newborn child as it passes through the vaginal opening during childbirth, particularly to the baby’s respiratory system and eyes. This severe eye infection (trachoma) may cause blindness and requires immediate antibiotic treatment. In addition to physical damage, the child can also catch pneumonia, which is particularly dangerous for infants. It is crucial that the mother is also treated with antibiotics to rid herself of the infection and prevent a ping-pong cycle of re-infection between her and the child.

Bacterial Vaginosis

Bacterial vaginosis occurs when there is an imbalance of “normal” bacteria in a woman’s vagina, typically due to hazardous events like douching and engaging in unprotected sexual activity with multiple partners. Pregnant women who are infected with bacterial vaginosis are at risk of giving birth to premature and underweight babies (less than 5.5 pounds). This condition can easily be treated with a series of antibiotics, however it may return and require multiple treatments.

Gonorrhea

Gonorrhea is another prevalent bacterial infection that can grow inside of the reproductive tract, mouth, anus, eyes and throat. A pregnant woman with gonorrhea also has an increased chance of having a miscarriage or premature delivery. Like chlamydia, gonorrhea is commonly transferred to the child during the birthing process after the baby makes physical contact with the mother’s infected region. A child who acquires gonorrhea may develop blindness, pink eye (conjunctivitis), and joint infections. Gonorrhea is often asymptomatic for both males and females, which means women who are pregnant or planning on becoming pregnant must take extra precautions with sexual exposure and get tested.

Hepatitis B

Mothers with hepatitis B have an increased risk of a premature delivery and can transmit the infection to their child. Fortunately, the development of new vaccines (for both adults and young children) has been successful in helping to prevent transmission. Because hepatitis B is a viral strain, it cannot be reversed once a person is diagnosed as positive. Therefore, it is crucial to take the necessary steps to ensure the health of yourself and newborn child.

Herpes

According to the CDC, “It is important that women avoid contracting herpes during pregnancy because a newly acquired infection during late pregnancy poses a greater risk of transmission to the baby.” If an infant does become infected during the birthing process, he or she may acquire a deadly infection. Although the transmission of genital and anal herpes during delivery is rare, the baby can become infected if the woman has an active outbreak anywhere along the birth canal (the virus is most concentrated in broken blisters). In order to prevent the herpes from spreading to the child, the mother can take anti-viral pills and the doctor can perform a cesarean section.

HIV/AIDS

According to Avert.org, an online charity group dedicated to preventing the transmission of HIV/AIDS, “Nine out of ten children infected with HIV were infected through their mother either during pregnancy, labor and delivery or breastfeeding. Without treatment, around 15-30 percent of babies born to HIV positive women will become infected with HIV during pregnancy and delivery and a further 5-20 percent will become infected through breastfeeding.” In wealthy nations, the risk that the mother will pass HIV to her newborn child is extremely rare due to the development of effective antiretroviral drugs and highly trained medical personnel.

HPV (Genital Warts)

Human papillomavirus (HPV) is the most common sexually transmitted disease in the world, although transmission from mother to infant during childbirth is highly unlikely. If a woman is infected with HPV, the medicines that she receives may even make the warts on the vagina grow larger. If the warts are left untreated, they may become significant enough to block the woman’s vaginal opening and prevent the fetus from passing through the birthing canal. If this happens, the alternative option is to deliver the baby through a cesarean section (although this issue is highly debated; some medical practitioners believe performing a C-section has no benefit to the health of the child). Treatment of the mother's warts is typically delayed until after the child is born.

Syphilis

Syphilis a bacterial disease that can be transmitted from mother to child during and after pregnancy. The CDC reports, “Depending on how long a pregnant woman has been infected, she may have a high risk of having a stillbirth (a baby born dead) or of giving birth to a baby who dies shortly after birth.” Children who survive the birth must be treated immediately to avoid seizures, physical abnormalities in the brain, eyes, heart, ears, skin and bones and possibly death. Upon diagnosis, both the mother and child are treated with antibiotics in order to prevent further transmission.

Trichomoniasis

 Mothers with trichomoniasis have a higher chance of giving birth preterm. The child can contract the infection after birth and run a fever. Medication is given to both the mother and child to cure the infection.

In order to guarantee protection from sexually transmitted diseases during pregnancy, both viral and bacterial, it is important to get tested regularly, abstain from sexual activity with multiple partners, and always use protection. If you are currently pregnant and sexually active, be sure that you are in a strictly monogamous relationship with a partner who has also been tested and is free of infection.

Source: http://www.soc.ucsb.edu/sexinfo/article/effects-stis-pregnancy

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