STIs & Pregnancy Flashcards
How can STIs affect pregnancies? [3]
They can spread from the cervix or vagina into the uterine cavity causing chorioamnionitis leading to premature rupture of membranes, preterm delivery, and low birth weight.
Some infections cross the placenta causing intrauterine infection of the fetus
Others are transmitted to the infant during delivery, and some can cause postpartum infection in the mother
Women < 25 who are pregnant are given what specific screening recommendations?
Women < 25 yearss hould be directed to their local national chlamydia screening programme within England
How does infection from chlamydia spread from mother to fetus? [1]
What is the risk of having a chlaymdia infection during pregnancy? [3]
What is the treatment for chlaymdia in pregnant patients? [1]
Infection can spread from the cervix into the uterine cavity causing chorioamnionitis:
- premature rupture of membranes
- preterm delivery
- low birth weight
- postpartum infection
Treatment:
- azithromycin 1 g single dose or erythromycin 500mg twice a day for 14 days.
Doxycycline and ofloxacin are contraindicated in pregnancy.
What is the main presentation of chlaymdia in neonates? [2]
- The main presentation is conjunctivitis between days 5 and 12
Nasopharynx is also a common site of infection, leading to otitis
media or pneumonia in infants aged 4–12 weeks
What is the treatment of gonorrhoea infection in a pregnant person? [1]
Treatment is with cefixime 400mg single oral dose, cefriaxone 250 mg IM single dose, or spectinomycin 2 g IM single dose in
those with penicillin and/or cephalosporin allergy.
NB: Azithromycin 1 g single dose is often given at the same time in view of the high rate of co-infection with chlamydia.
What is the most common clinical presentation of gonorrhoea in neonates, after contracting from their mother? [1]
The main presentation is conjunctivitis 2–5 days after birth (Figure 11.2); may cause profuse purulent discharge, with oedema of the eyelids. If untreated it can lead to corneal ulceration and perforation causing blindness
Tx for trichomoniasis and BV in pregnancy? [1]
Treatment is with metronidazole 400 mg twice daily for 5–7 days.
There is no evidence of teratogenicity from metronidazole in the first trimester of pregnancy.
NB There are no direct infective complications to infants but they may develop vaginal infection.
Does treating syphilus in a pregnant mother treat the fetus? [1]
Treatment of the mother early in
pregnancy treats the fetus, preventing congenital syphilis
What is the tx for patient who is suffering from syphilis and is pregnant? [1]
What further management should be given? [1]
Treatment is with benzathine penicillin 2.4 MU IM weekly for up to three doses, or procaine penicillin 600 000 units IM daily for up to 17 days.
Follow-up syphilis serology should be performed, initially monthly. A fourfold drop in rapid plasma reagin/venereal disease research laboratory (RPR/VDRL) test results indicates an adequate response to treatment.
Describe how congenital syphilus presents (early [4]) and late (6)
Early syphilus:
* Rash
* Hepatosplenomegaly
* Periostitis
* Syphilitic snuffles
Late syphilus:
* Interstitial keratitis
* Hutchinson’s incisors
* Moon’s mulberry molars
* rhagades
* Saddlenose deformity, frontal bossing
* Deafness
Name this manifestation of late congenital syphilus [1]
Moon’s mullberry molars
How is positive infection of syphilus detected in a neonate? [2]
Infection is diagnosed by detection of Treponema pallidum from the infant’s lesions/body fluids, and positive immunoglobulin M enzyme immunoassay (IgM EIA) serology
During which trimester is HSV transmission to a fetus associated with the highest risk? [1]
What is the risk to the neonate? [1]
Higher risk of transmission if the HSV is acquired by the mother during the 3rd trimester.
Can cause neonatal fever, seizures, sepsis or vesicular blisters.
Describe how you treat the first episode of genital herpes in a pregnant person, if the infection is < 28 weeks of pregnancy [1]
How do you manage delivery method depending on the above? [1]
- Give oral or intravenous aciclovir depending on the clinical severity.(Aciclovir is not licensed for use in pregnancy but has been used extensively in pregnant women with no reported problems) Give therapy at that time, and then again from 36 weeks until the birth.
- Vaginal delivery should be planned
Describe how you treat the first episode of genital herpes in a pregnant person, if the infection is > 28 weeks of pregnancy [1]
How do you manage delivery method depending on the above? [1]
- Advise the mother to take antiviral treatment from then until the birth.
- If the first episode is within 6 weeks of the due date, offer an elective caesarean section to reduce the risk of neonatal herpes.
