Sexually transmitted infections (STIs) also known as sexually transmitted diseases (STDs) have been on the rise in the U.S. for eight straight years. In 2022, more than 2.5 million cases of syphilis, gonorrhea, and chlamydia were reported with congenital syphilis (an STI that can pass from mom to baby during pregnancy or childbirth) experiencing an alarming 31% uptick.

This trend is particularly important for people who are pregnant or trying to become pregnant. Why?

• STIs are common.
• A pregnant person is just as likely to become infected with an STI as a non-pregnant person.
• Many people infected with STIs don’t know it.
• Letting an STI go undiagnosed and untreated can harm your health and your baby’s health, since many of these infections can be passed along during pregnancy, childbirth, and breastfeeding.
• With preventive measures and treatment, many STIs can be cured or managed to prevent passing them on.

Whether you’ve been diagnosed with an STI or are uncertain about your status and hope to get pregnant, this article aims to provide hopeful and helpful information about the complications of the most common STIs and the preventive measures and treatment options available to help protect you and your baby from harm.

The Complications of Common STIs During Pregnancy

Different STIs have different ways of impacting pregnancy, fetal development, and newborn health, but every STI can cause a few general complications that are worth keeping in mind.

The general complications of STIs and pregnancy include:

• Premature rupture of membranes
• This is when your “water breaks” before your body and baby are ready to go into labor. If it happens before 37 weeks of pregnancy, you risk giving birth preterm.
• Preterm birth
• This is the number one cause of infant death and can lead to long-term developmental and health problems in children.
• Infections in the uterus after birth
• These infections, while treatable with antibiotics, can get serious quickly.

The specific complications of STIs during pregnancy include:

Chlamydia

• The most frequently reported STI in the U.S., chlamydia often doesn’t cause symptoms.
• Chlamydia while pregnant puts you at risk for premature rupture of membranes, preterm labor, and a baby born with low birth weight. If left untreated, it can cause pelvic inflammatory disease (PID), which can impact fertility.
• If you are pregnant with chlamydia, you can pass the STI to your newborn during childbirth, even if you have a c-section.
• Babies exposed to chlamydia can develop eye infections and pneumonia.
• Chlamydia can be treated with azithromycin, a one-time antibiotic.

Gonorrhea

• Like chlamydia, this bacterial infection often doesn’t cause symptoms. If symptoms do arise, the vaginal irritation or burning associated with gonorrhea is frequently misdiagnosed as a urinary tract infection or yeast infection.
• Getting diagnosed with gonorrhea while pregnant could cause several complications including miscarriage, premature rupture of membranes, preterm birth, low birth weight, and chorioamnionitis – a bacterial infection of the membranes that surround the fetus and amniotic fluid.
• Babies exposed to gonorrhea can develop blindness, blood infections, eye infections, and joint infections.
• Gonorrhea can be treated with the one-drug antibiotic, ceftriaxone.

Syphilis

• This highly contagious infection can easily pass to your fetus during pregnancy, potentially resulting in congenital syphilis, which is on the rise.
• Congenital syphilis can cause fatal infections, developmental delays, deformities, and problems with eyes, ears, heart, skin, and bones.
• Because of these serious risks, your obstetrician (OB) will screen you for syphilis with a simple blood test during your first visit.
• Syphilis is treated with penicillin.

HIV

• Being pregnant with HIV can cause transmission from mom to baby during pregnancy, labor, delivery, and breastfeeding.
• Thanks to the development of antiretroviral therapy (ART), the risk of transmission can be significantly reduced.

Herpes (herpes simplex virus)

• Although having HSV while pregnant doesn’t impact fetal development, the virus can be transmitted to baby if mom has an active outbreak during delivery.
• Taking antiviral medications during pregnancy can help manage outbreaks and reduce this risk of transmission. A c-section might also be recommended.

HPV (human papillomavirus)

• Having HPV while pregnant doesn’t directly impact pregnancy, but certain strains of this virus can cause genital warts, which can (rarely) complicate delivery.

Trichomoniasis

• Trichomoniasis is a parasite that causes vaginal discharge and other symptoms.
• This STI puts you and your baby at risk for premature birth and low birth weight.
• Trichomoniasis is easily treated with the antibiotic, metronidazole.

Hepatitis B (HBV)

• HBV is a viral infection (transmitted through bodily fluids) that affects the liver.
• If mom has hepatitis B while pregnant, she can transmit the virus to her fetus through the placenta.
• There is no cure for HBV, but antiviral medications can reduce the risk of complications during pregnancy.
• Babies born to moms with Hep B will receive antibodies and a vaccine to prevent them from becoming infected.

Preventing and Treating STIs During Pregnancy

Now that we’ve covered the complications of the most common STIs during pregnancy, let’s look at some of the ways you can prevent and treat STIs if you’re pregnant or trying to get pregnant.

Screening and Testing

• Regular prenatal screenings for STIs are crucial. Early detection allows for timely treatment and reduces the risk of complications. A person should undergo screenings for STIs before and during pregnancy and make sure new sex partners are free from STIs.

Safe Sex Practices

• Using condoms and having a mutually monogamous relationship with an uninfected partner can lower the risk of contracting STIs before and during pregnancy. A person should wear a condom and use it correctly before any genital, oral, or anal contact.

Proper Treatment

• As mentioned, many STIs are curable and manageable with appropriate antibiotics and antiviral medications that are safe to use during pregnancy. For incurable infections, like HIV and hepatitis B, ongoing treatment can manage the infection and reduce transmission risks.

Vaccines

• Certain STIs, like HBV and hepatitis B, can be prevented with a vaccine. Since providers don’t recommend getting these vaccines during pregnancy, it’s important to get vaccinated before becoming pregnant.

Education and Counseling

• Knowledge is power, so pregnant people should receive education about STIs and their potential impact on pregnancy as early as possible. The more you know about STI symptoms and prevention, the better you can protect yourself.

STIs and Breastfeeding

Many new moms are curious about whether it’s safe to breastfeed after being diagnosed with an STI. The short answer: Some STIs affect breastfeeding and some don’t. Thankfully, most treatments for STIs are safe to take while breastfeeding. But it’s important to ask your provider or lactation consultant about the risk of passing an STI to your baby while breastfeeding. In general:

• If you have chlamydia, gonorrhea, or HPV, it’s safe to breastfeed.
• If you have trichomoniasis, you should take the antibiotic, metronidazole, before breastfeeding.
• If you have syphilis or herpes, it’s safe to breastfeed as long as your baby or pumping equipment doesn’t come into contact with sores, which can spread to the breasts.
• If you have HIV, it isn’t safe to breastfeed, since this virus is transmissible through breast milk. Using a breast milk substitute, like formula, is recommended instead.

STIs pose serious risks during pregnancy, but with proper education, screening, preventive measures, and treatment plans, many of these risks can be reduced and managed effectively. Pregnant women need to work closely with their healthcare providers to receive appropriate prenatal care, including routine and regular STI screenings, to ensure the safest and healthiest pregnancy possible for themselves and their unborn/newborn babies.