Can you have an STI and a safe pregnancy?
If you have a sexually transmitted infection (STI) or had one in the past, will it affect your chances of having a baby?
It’s a question many Canadian women have asked their doctors — or quietly to themselves — when planning a pregnancy or dealing with an unplanned pregnancy.
STI screening rates across the country are unknown, but Dr. Vanessa Poliquin, obstetrician and gynecologist at the Winnipeg Regional Health Authority, says the medical community suspects that not enough pregnant women are doing it — and it could have dire consequences on the health of a baby.
According to the Public Health Agency of Canada, national infection rates have skyrocketed since the late 1990s. Some of those infections have come back from near eradication.
Between 1998 and 2015 (the most recent national data available), chlamydia — the most commonly reported STI in Canada — has risen from 39,372 to 116,499 annual cases among all ages and genders, and gonorrhea rates increased from 5,076 to 19,845 in the same time period. Infectious syphilis rates rose dramatically from 501 to 4,551 cases.
But when 20 per cent of pregnant women on average in Manitoba, for example, are still not being screened for gonorrhea and chlamydia during this already sensitive time, physicians worry that not every woman’s important prenatal needs are being met.
These are missed opportunities for treatment of expectant mothers, Poliquin says. Not only for prevention and treatment of an STI between baby and mom, but also for prevention of poor pregnancy outcomes like preterm birth and preterm premature rupture of membranes (PPROM).
Dr. Jennifer Blake, CEO of the Society of Obstetricians and Gynaecologists of Canada, says universal screening of STIs and HIV is recommended in Ontario, but it’s not mandatory.
“Some practitioners may only screen those who are at high risk for an infection,” she says. “Unfortunately, most people who are in a stable, committed relationship don’t feel at risk for STIs because they’re having sex with someone they trust, and it’s a hard thing to ask that person if they could have given you an infection.” As a result, it’s not common for a woman to take it upon herself to request STI screening.
Poliquin says she routinely screens for HIV, hepatitis B, syphilis, gonorrhea, chlamydia and depending on the risk factors, hepatitis C.
“We’ll also usually try to elicit a history to see if someone has the herpes simplex virus. But how common it is depends on the kind of infection you’re talking about,” she says.
HIV, for example, is much less common; not surprisingly, chlamydia is the most frequently seen STI.
Planning to conceive with an STI
When getting pregnant is the goal but mom acquired an STI before her pregnancy, it can lead to difficulties conceiving or infertility, Poliquin explains.
For example, gonorrhea infections have the potential to damage the fallopian tubes and lead to tubal-factor infertility (also known as blocked tubes).
“Generally speaking, STIs only impact on the ability to conceive if they have damaged the organs necessary for conception,” Poliquin says. “Gonorrhea and chlamydia, in particular, are bacteria with excellent adhesion properties and infection can spread up into the uterus and fallopian tubes. This has the potential to damage and scar the fallopian tubes permanently, which can make it challenging to conceive without assisted reproductive technologies even many years after a serious [gonorrhea] or [chlamydia] infection.”
Poliquin adds that a gonorrhea or chlamydia infection that is limited to the cervix and has not ascended higher up the reproductive tract will usually not impact on the ability to conceive in the immediate term.
The impacts on mom
Going through a pregnancy with an STI can impact women in several ways.
First, several STIs like gonorrhea, syphilis and chlamydia have been linked to complications like preterm birth, miscarriages and stillbirths, according to the Public Health Agency of Canada’s Guidelines on Sexually Transmitted Infections.
They may also cause PPROM, a condition where the amniotic membrane surrounding the baby breaks before week 37, thus increasing the risk for infection and an early birth, Poliquin adds.
And depending on the STI, there can be a wide range of effects on mom, Poliquin says.
One of those complications is inflammation of the cervix (or cervicitis), which for the mom is a simple issue — but for baby, it can trigger bigger problems (more about that later on).
Gonorrhea and chlamydia can cause cervicitis, and as many women can be asymptomatic, this is especially dangerous, Poliquin explains. Complications include vaginal discharge, discomfort and sometimes more aggressive infections for the mom.
However, Blake says these issues can all be treated with antibiotics that are specifically selected for safety during pregnancy.
If an expectant mom has HIV, she should have regular consultations with a specialist as soon as possible, according to the Public Health Agency, since early management creates the greatest chance for viral suppression.
“If we manage to keep [the woman’s] viral load well suppressed, her prenatal care looks a lot like anybody else’s but with a little bit more blood work to monitor her HIV viral load,” Poliquin says. “And honestly, if someone has a very well-controlled viral load at delivery, she’ll get to have a normal vaginal delivery. It’s uncommon these days for somebody to have a viral load high enough that would make us alter our plan of delivery to a C-section.”
Impacts on baby
Infections can be passed from mother to baby, Poliquin says, and it can happen through a few different avenues, including via the placenta or during labour and delivery.
With gonorrhea and chlamydia in particular, if left untreated, the baby is at risk of contracting both STIs. And if the baby acquires the infection, they’re at risk of having eye issues — basically, the gonorrhea or chlamydia can infect the baby’s eyes — Poliquin says.
These eye infections can cause long-term consequences, too. With gonorrhea, the baby is at risk of getting ulcerations of the cornea, while chlamydia could lead to aggressive pneumonia for the first three to four months of their life.
“Eye infections are a very serious complication as they can lead to loss of vision,” Blake says. “In spite of screening, it’s a common practice to use an ointment or drops at birth to protect the baby’s eyes from an infection that could have been acquired recently and could have been missed during screening.”
For genital infections with the herpes simplex virus, which the Centers for Disease Control and Prevention (CDC) says is extremely common, the baby is at risk of developing pulmonary disease, seizures and fever. There is also a high fatality rate following contact with infected genital secretions during delivery, the CDC states.
As well, the risk of transmission from mom to baby is highest when mom has genital lesions during the delivery, especially if the infection was acquired toward the end of her pregnancy.
With syphilis, consequences of infection transmission from mom to baby include fetal death and congenital infection, which can result in both physical and mental developmental disabilities.
If mom has HIV, however, the biggest risk is the transmission of HIV from mom to baby, Poliquin says. That risk of transmission can be as high as 25 to 40 per cent if mom isn’t receiving the right treatment.
But because antiretroviral therapy is available in Canada, physicians are able to monitor the mother’s virologic response, Poliquin says. This makes it possible to have a safe delivery and drops the risk of HIV transmission to around 0.5 per cent. Mothers with HIV are also advised against breastfeeding as it can transmit the infection from mom to baby.
Treating an STI
According to Poliquin, both baby and mom can be treated for STIs with antibiotics.
Medications like erythromycin, amoxicillin and azithromycin may be used to treat chlamydia, and cefixime, ceftriaxone and spectinomycin may be used to treat gonorrhea, the Public Health Agency says.
If there are ulceration or eye issues for baby, however, an ophthalmologist would become involved in the care, Poliquin explains.
If mom has HIV, Poliquin says the best thing to do is to keep mom on a pregnancy-safe treatment that is effective. Her care team has to ensure that mom continues on a regimen she can tolerate and that is effective in treating the HIV infection, as well as one that is safe for the pregnancy.
Testing for STIs before and during pregnancy is done through blood work, Poliquin says.
“Our ideal is that they get tested before they get pregnant, that way we can offer them the best chance of success in pregnancy, and it also gives us the widest diversity of antibiotics to use,” Poliquin says. “That’s especially important for things like gonorrhea where we’re seeing increasing rates of resistance.”
But since about 50 per cent of births in Canada are unplanned, Poliquin says, many women don’t necessarily have that window before pregnancy.
“That’s why we screen for it during the first prenatal visit,” she says. “It allows us to ensure that we treat the infection upfront, so we can try to prevent any adverse pregnancy outcomes and we can prevent the transmission to baby if there is an untreated infection.”
Read more from our series Below the Belt: Canada’s STI Problem.Follow @danidmedia
© 2017 Global News, a division of Corus Entertainment Inc.