Standard treatment for common STD doesn't eliminate parasite in some women

A new study led by an infectious disease epidemiologist at Tulane University School of Public Health and Tropical Medicine could change the way doctors treat a common sexually transmitted disease.

Professor Patricia Kissinger and a team of researchers found the recommended single dose of medication isn't enough to eliminate trichomoniasis, the most common curable STD, which can cause serious birth complications and make people more susceptible to HIV. Results of the research are published in Lancet Infectious Diseases.

Globally, an estimated 143 million new cases of trichomoniasis among women occur each year and most do not have symptoms, yet the infection is causing unseen problems. The recommended treatment for more than three decades has been a single dose of the antibiotics metronidazole or tinidazole.

The researchers recruited more than 600 women for the randomized trial in New Orleans; Jackson, Mississippi; and Birmingham, Alabama. Half the women took a single dose of metronidazole and the other half received treatment over seven days.

Kissinger and her team found the women who received multiple doses of the treatment were half as likely to still have the infection after taking all the medication compared to women who only took a single dose.

"There about 3.7 million new cases of trichomoniasis each year in the United States," Kissinger said. "That means a lot of women have not been getting inadequate treatment for many decades."

Trichomoniasis can cause preterm delivery in pregnant women and babies born to infected mothers are more likely to have low birth weight. The parasite can also increase the risk of getting or spreading HIV.

Kissinger believes the CDC will change its treatment recommendations because of the results of this study.

"We need evidence-based interventions to improve health," Kissinger says. "We can no longer do something because it's what we've always done. I hope that this study will help to change the recommendations so that women can get the proper treatment for this common curable STD."

Source: https://www.sciencedaily.com/releases/2018/10/181007084044.htm

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

STD 2018: Scientific Sessions

Session 1: Types of STDs

Sexually transmitted diseases (STDs) are infectious diseases that are transmitted from a person to another through sexual contact or blood of an infected person. The pathogens such as bacteria, virus, fungi, protozoa are responsible for the disease transmission. Bacterial STDs are Syphilis, Gonorrhoea, Chlamydia, Chancroid. Viral STDs include HIV/AIDS, Human papillomavirus, Hepatitis, Genital Herpes. Trichomoniasis is a STD caused by parasitic protozoan. Candidiasis is considered to be an fungal STD which is spread by fungus Candida albicans. Most of the sexually transmitted diseases such as viral STDs have no cure but the disease can be controlled with proper treatment while bacterial, fungal and protozoan STDs can be cured with antifungals and antibiotics.

• Bacterial STDs
• Viral STDs
• Protozoan STDs
• Fungal STDs

Session 2: Evolution of STDs

The evolution of the STD pathogens are caused by the selective pressures of the host-immune response, modern drugs, vaccines or by microbial competition. Through evolutionary phase, a pathogen can become more or less virulent. The phylogeny, epidemiology and origin studies on sexually transmitted diseases provides valuable data on the genetic transition traits in both host and pathogen. The evolutionary study of the disease-causing pathogen provides the disease transmission and diversity among the human population. The clinical epidemiologyand phylogenetic study paves way for new insights for the development of drugs and therapies against the multiple drug resistance.

• Origin
• Phylogenetics
• Epidemiology
• Diversity

Session 3: Immunopathogenesis

The immune system helps in elimination of the invading microbial pathogens in the body through a series of defense mechanism. The innate immune response of the body provides first line of defense against the pathogens which is fast and non-specific response while adaptive immune response is specific and slow. The study of immunopathogenesis allows us to explore the disease transmission process, pathogen-host interactions, immune defense against the STD pathogens. This allows us to understand the pathological condition and progression of the disease and also the genetic factors influencing the immune defense against STD transmission. The genetic factors influence can be used for the development of gene therapies that triggers immune reaction against the disease-causing pathogens in the body.

• Disease Transmission
• Pathogen-Host Interaction
• Innate Immune Response
• Adaptive Immune Response
• Genetic Factors

Session 4: Treatment Strategies

Antibiotics are used for treating the STDs caused by bacteria and protozoa. The bacterial STDs can be cured if the infection is properly diagnosed and treated. Several antibiotic resistant strains of pathogens have developed which pose a serious threat for health of the STD affected individuals. For viral STDs, there are no complete cure but progression of the disease can be controlled by antiretroviral therapies which use multiple antiretroviral drugs to decrease the disease proliferation and reduce other opportunistic infections. Gene therapy involves gene editing approaches which can provide a better and safer alternative to other existing drugs. Novel and emerging treatment strategies can provide a solution for the increasing drug resistance in the pathogens.

• Antibiotic Therapy
• Antiretroviral Combination Therapy
• Immunotherapy
• Gene Therapy

Session 5: STDs Prevention

Sexually Transmitted Diseases are transmitted from a person to another through sexual contact or blood transfusions from an infected person or needle sharing, or from mother to infant during pregnancy, labor and breastfeeding. STDs can be prevented through vaccination, screening and through promoting safer sexual behaviour, early health-care seeking behaviour, prevention and care activities. Pregnant women affected with STD must take proper treatment to prevent the vertical transmission of STD. Most STDs cannot be cured and leads to infertility, birth defects in infants, co-infections, opportunistic infections and many other health issues.

• Effective Healthcare Systems
• Vaccination
• Preconception Care
• Prenatal Care

Session 6: Advanced Diagnostic Tools

Diagnosis of STDs are done by serological assays, amplification techniques, immunological diagnosis attains accurate result of the diagnosis. Point-of-care test enables rapid screening of Syphilis and allows treatment without delay. Nucleic acid amplification tests monitor the infection trends and helps in the adaptation of treatment protocols. Drug-resistance test provides the provisions for identifying drug resistance in the STDswhich aids in overcoming the resistance and provide a better treatment. Further improvements in the diagnosis method can help in rapid and cost-effective method for screening of the STDs.

• Nucleic acid Tests
• Serological Assays
• Amplification Techniques
• Immunological Diagnosis
• Drug-Resistance Testing
• Point- of-Care Test

Session 7: Drug Development and Research

Drug development and research is the development and invention of new drugs and improvement of existing drugs. Continuous progress in drug development and research field is necessary for invention of new drugs and drug targets for STDs. Identification of the drug target is the basis of the drug development process, this can be done through various computational approaches. Gene editing technology such as CRISPR seeks to eliminate the latent as well active HIV infection in the human which would be more effective in the treatment of AIDS. Various viral inhibitors such as entry inhibitors, maturation inhibitors are designed to inhibit the replication of the virus inside the host cell.

• New Drugs and Drug Targets
• Integrase Inhibitors
• Entry Inhibitors
• Maturation Inhibitors
• Gene Editing

Session 8: Vaccines Development

A highly effective method for controlling infectious diseases is vaccination, it helps in prevention of high risk health issues. Prophylactic vaccines are those used for prevention while therapeutic vaccines are used for treatment of the specific disease. Sexually transmitted diseases are spread by pathogens such as bacteria, virus, fungi and protozoa. Many viral STDs doesn't have cure hence preventing the infection through vaccination is a best method. Vaccines are developed for Hepatitis and Human Papillomavirus (HPV) infection and for HIV and Herpes virus vaccines are being developed. Vaccination is the primary solution for eradication of sexually transmitted diseases in human.

• Pre-Exposure Prophylaxis
• Post-Exposure Prophylaxis
• Therapeutic Vaccines
• Advancements in Vaccine Technology
• HIV and Genital herpes Vaccine Development

Session 9: Nanotechnology in HIV Treatment

Nanotechnology is the science and engineering of structures that are 1–100 nm in size. Nanomedicine is a branch of medicine which is employed in preventive, diagnostic and therapeutic purposes. Using nanoparticles, effective timely release of drugs to the infected areas/organs are possible which improves specificity of drug action. HIV/AIDS patients face a major problem where the virus resides in latent reservoirs makes it hard to reach for drugs. Nanoparticles has the ability to travel through the body with less interruption which aids in effective release of drugs at HIV virus reservoirs at the specific target. Therapeutic nanoparticles have higher specificity for the drug targets which enhances the treatment efficiency and better cure for the affected individual.

• Drug Delivery System
• Drug Nanosuspension
• Therapeutic Nanomaterials
• Nanoparticle Based Vaccines

Session 10: Phytochemicals in STDs Treatment

Plants contain a wide range of substances that are used for treating chronic as well as acute infectious diseases. Many modern drugs in use have been developed from the medicinal plants which has been used by indigenous people. Phytochemicals are chemicals secreted by plants that have disease preventive properties that is used by the plants to protect itself from diseases. Antimicrobial activity of the plant sources can act as a better drug for the strains that has developed multiple drug resistance to antibiotics. Many bacterial STDs can be combated using phytochemicals produced by the medicinal plants. Pharmacological effects of the bio active compounds in the plants must be explored to produce a cure for the multiple drug resistant bacterial STDs.

• Antimicrobial Effect of Phytochemicals
• Phytoconstituents and its Effects on STDs
• Novel Therapeutic Drugs
• Multi-Drug Resistance and Phytochemical Drugs

Session 11: Drug Resistance and Mutation

The infectious pathogens mutate under certain circumstances to overcome the pressure inflicted upon them. Such organisms develop resistance to the drug in use. This proves to be a major problem in the treatment of sexually transmitted diseases. Human immunodeficiency virus has developed resistance to the antiretroviral drug provided. Hence combination antiretroviral therapies are used for treating AIDS which involves using two or more antiretroviral drugs together. Several bacterial species has also developed resistance to the antibiotics provided for the treatment. The mutation of the pathogens has led to development of drug resistance against many antibiotics and antiretroviral drugs.

• Nucleoside Reverse Transcriptase Inhibitors Resistance
• Non-Nucleoside Reverse Transcriptase Inhibitors Resistance
• Protease Inhibitors Resistance
• Antibiotic Resistance
• Antiviral Drug Resistance

Session 12: STDs and Cancer

Sexually transmitted diseases increases the risk of being affected by cancer. Among the STDs which lead to cancer, human papillomavirus infection is found to cause cervical cancer in women and penile cancer in men. It is also responsible for the development of oropharyngeal cancer in both sexes. Untreated STDs has a higher risk for leading to development of cancer. The progression of cancer in people affected by STD must be analyzed to understand the causative agents of the cancer.

• Oropharyngeal Cancer
• Cervical Cancer
• Penile Cancer
• Prostate Cancer

Session 13: Co-Infection of STDs

Gonorrhoea, chlamydia and trichomoniasis cause immune reactions which leads to inflammation that can easily be infected with HIV. Co-infection is a condition where a person actively infected with STD is infected with another STD. when a STI infected individual is prone to another infection due to immune compromise they are less able to mount a protective response against sexually transmitted pathogens. Treating co-infected individuals can be challenging and the treatment methods must be analyzed and modified to their needs.

• HIV and Gonorrhea
• HIV and Hepatitis
• HIV and Kidney disease
• HIV and Tuberculosis

Session 14: Infertility and Birth Defects

When an STD infection is left untreated in women, it may be lead to pelvic inflammatory disease (PID). Being affected by pelvic inflammatory disease may lead to infertility or ectopic pregnancy in pregnant women. When the mother is infected by STD, the fetus or new born is mostly infected. STDs during pregnancy can lead to miscarriage, birth defects including blindness, deafness, bone deformities, and intellectual disability, stillbirth, premature birth. In males, reduced fertility or infertility is most common side effect of the disease.

• Ectopic Pregnancy
• Premature Birth
• Neonatal Sepsis
• Neurological Defects

Session 15: Vertical STD Transmission

Vertical STD transmission is the process of transfer of STD from a mother to infant perinatally or postnatally. During delivery, when the baby passes through the infected canal, it can contract the STDs such as chlamydia, gonorrhoea, genital herpes from the infected mother. Syphilis and HIV can be contracted from the mother during fetus development. Postnatal transmission of the disease is possible through breastfeeding the baby. Vertical STD transmission poses serious threat to the health of the baby.

• Perinatal Transmission
• Postnatal Transmission
• Prevention of STD Transmission
• Pregnancy Care and Treatment

Session 16: Paediatric STDs

Sexually Transmitted Diseases are an important cause of morbidity in paediatric patients. The transmission occurs via transplacental, intrapartum, and postpartum exposure. When an infant contracts STD from mother, it can affect the skin, eyes, mouth, central nervous system, and can also lead to organ failure. With treatment, the chances of transmitting HIV from mother to infant is low. Proper awareness, treatment and diagnosis is needed to prevent the transmission of STDs among young people.

• Clinical Manifestation
• Early Diagnosis
• Risk Factors
• Preventive Measures

Session 17: Multimorbidities and complications

Multi-morbidities is the presence of two or more chronic diseases at the same time. Super infection or re-infection is the condition where a person with HIV infection acquires infection with the sub-type of HIV. Re-infection affects the treatment which can deteriorate the health of the affected individual. The STDs affected individual suffers from other social and emotional complications which may also have adverse effects in the health of the individual. Multiple morbidities associated with the disease causes more damage to the health as the immune system would be compromised by the STD.

• Opportunistic Infection
• Superinfection/Reinfection
• Behavioral Complications
• Social Complications

Session 18: Public Awareness and Knowledge of STDs

Educational and awareness programs must be conducted to improve the public knowledge about the sexually transmitted diseases. People affected by sexually transmitted diseases have dramatically increased, millions of people are affected by the disease due to lack of awareness. Public must be aware about the impact of STDs on the lives of the affected people and the importance of preventing, screening and treating STDs. Poor knowledge about the STDs lead to increased health issues such as ectopic pregnancies, infertility and other complications. STDs are a major health issue that affects mostly young people, not only in developing countries but in developed countries also.

• Impact of STDs
• STD Screening
• Risk Awareness
• Prevention Education
• Community Awareness

 

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

To submit abstracts for STD 2018, visit: http://bit.ly/stdabst2018

For registration, visit: http://bit.ly/stdreg2018