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“IT WAS JUST ONCE!

Sexually Transmitted Infections (STIs) and Pregnancy

Heather Jordan, MPH Candidate


Tulane School of Public Health and Tropical Medicine
STIs and Pregnancy
According to the CDC, STIs during pregnancy can be
responsible for:

 Early labor
 Low birth weight
 Eye and respiratory infections
 Stillbirth
 STIs can infect a fetus in vitro or during delivery

www.cdc.gov
Bacterial Infections

 Chlamydia
 Gonorrhea

 Syphilis

Bacterial infections can easily be treated and cured with


antibiotics.
But you must know you are infected to receive treatment

www.cdc.gov
Chlamydia…

…it’s not a flower.


Chlamydia: Transmission

 Vaginal, oral and anal sex with an infected person


 Semen and vaginal fluids
 Bacteria can infect an infant during vaginal
delivery

*Teenage girls are especially at risk; the cervix is more


susceptible to infection when not fully matured

www.cdc.gov
Chlamydia: Symptoms
Called a “silent disease” as most people present no symptoms
and do not know they are infected

Women: Men:
•Possible abnormal vaginal •Possible discharge from
discharge penis
•Burning sensation when •Burning sensation when
urinating urinating
•Pain during sex •Burning, itching,
swelling, pain in penis and
testicles

*Symptoms may also appear in mouth or rectum after oral or anal sex with an infected person
www.cdc.gov
Chlamydia: Fertility
If left untreated, Chlamydia can lead to:
In Women:
Pelvic Inflammatory Disease (PID)

An infection of the uterus and fallopian tubes that can


cause:

• Ectopic pregnancy
• Infertility

www.cdc.gov
Pelvic Inflammatory Disease
Chlamydia: Fertility
In Men:
Epididymitis

Pain, swelling, and inflammation of the


epididymis, the tube in the testicles that stores
sperm
This can cause Infertility

www.cdc.gov
Epididymitis
Chlamydia: Pregnancy

• Bacteria can infect an infant during vaginal


delivery
• Premature delivery
• Pneumonia
• Conjunctivitis (pink eye) in newborns

www.cdc.gov
Conjunctivitis in an Infant

Image found at emedicine.medscape.com


Chlamydia: Detection and Treatment
Detection
 Urine Test

 Sample taken from cervix or penis

Treatment
 Easily treated and cured with antibiotics

 Ask for a test before getting pregnant and at your

first prenatal visit

www.cdc.gov
Chlamydia: Louisiana Statistics
Chlamydia rate: Top 5 by State, 2008
*Rate per 100,00

1. Mississippi (728.1)
2. Alaska (711.2)
3. South Carolina (597.2)
4. Alabama (535.0)
5. Louisiana (527.8)
www.cdc.gov
Gonorrhea
Gonorrhea: Transmission

 Vaginal, oral and anal sex with an infected person


 Contact with the genitals, mouth or anus of an
infected person
 Bacteria can infect an infant during vaginal
delivery

www.cdc.gov
Gonorrhea: Symptoms
Like Chlamydia, Gonorrhea is called a “silent disease” as most people
present no symptoms and do not know they are infected.

Women Men

•Painful or burning sensation •Burning sensation when urinating


when urinating •White, yellow or green discharge
•Increased vaginal discharge from penis
•Vaginal bleeding between periods •Painful or swollen testicles
•Often mistaken for a bladder or
vaginal infection

* Symptoms may also appear in mouth or rectum after oral or anal sex with an infected person
www.cdc.gov
Gonorrheal Discharge

In a Woman In a Man

But remember: symptoms are not always this obvious and you cannot
tell if someone has an STI just by looking!
Gonorrhea: Fertility
 If left untreated, Gonorrhea can lead to:
In Women: In Men:
Pelvic Inflammatory Epididymitis
Disease (PID)

•Infertility in both women and men

www.cdc.gov
Gonorrhea: Pregnancy
Affects in Infants:
 Bacteria can infect an infant during vaginal delivery

Can cause:
 Blindness

 Infections of the joints and blood

– this can be life-threatening to a newborn

Image found at www.soc.ucsb.edu

www.cdc.gov
Gonorrhea: Detection and Treatment
Detection
 Urine Test
 Samples taken from cervix, urethra, rectum or
throat

Treatment
 Easily treated and cured with antibiotics
 Ask for a test before getting pregnant and at your
first prenatal visit

www.cdc.gov
Gonorrhea: Louisiana Statistics
Gonorrhea rate: Top 5 by State, 2008
*Rate per 100,000

1. Mississippi (256.8)
2. Louisiana (220.2)
3. South Carolina (214.2)
4. Alabama (210.5)
5. North Carolina (176.3)
www.cdc.gov
Syphilis
Syphilis: Transmission

 Vaginal, oral and anal sex with an infected person


 Direct contact with a syphilis sore (chancre or
rash), which appears mainly on the genitals, but
also the anus, rectum or mouth of an infected
person
 Syphilis can pass through the placenta and infect
the unborn fetus
Syphilis: Symptoms
If syphilis is left untreated, it will pass through three
stages:
Primary Stage:
 10-90 days after exposure a chancre will appear

near the site of contact


 Usually firm, round, painless – can go unnoticed

 Can last 3 to 6 weeks, then will go away - even

without treatment
 Extremely contagious
Syphilis Chancre in a Man
Syphilis Chancre in a Woman

Image found at pathmicro.med.sc.edu


Syphilis: Symptoms
Secondary Stage:
 After the chancre heals, a skin rash and mucus

membrane lesions will develop


 Can be very visible, or can be so faint they go

unnoticed
 Fever, swollen lymph nodes, sore throat, head

aches, fatigue
 Symptoms will resolve themselves without

treatment – but the infection will persist

www.cdc.gov
Syphilis Rash

Image found at www.lib.uiowa.edu


Syphilis: Symptoms
Latent Stage:
 Primary and Secondary symptoms disappear

 An infected person can go for years without

symptoms
Late Stage:
 10-20 years after initial exposure to syphilis, the

infection will damage internal organs


 The nervous system is especially affected and will

eventually lead to death

www.cdc.gov
Syphilis: Pregnancy
 Syphilis can pass through the placenta and
infect the unborn fetus
 High risk of stillbirth, or death shortly after

birth
 Brain damage, developmental delays

 Seizures

 Because of the high risk of infant death, all

pregnant women should be tested for syphilis

www.cdc.gov
Syphilis in Infants

Image found at www.adhb.govt.nz


Syphilis in Infants
Syphilis: Detection and Treatment

Detection:
 Blood test

Treatment:
 Antibiotics can cure syphilis - but they cannot
undo any damage already done to the body

www.cdc.gov
Syphilis: Louisiana Statistics
Syphilis rate: Top 5 by State, 2008
*Rate per 100,000

1. Louisiana (16.5)
2. Alabama (9.7)
3. Georgia (9.6)
4. Arkansas (7.3)
5. Maryland (6.7)
www.cdc.gov
Viral Infections

 Herpes
 Hepatitis B,C
 HPV (Human Papillomavirus)
 HIV (Human Immunodeficiency Virus)

• There are no cures for these viral infections


• Vaccines are available for Hepatitis B and HPV
• There is treatment available, but you must know you are
infected – ask your doctor about a test

www.cdc.gov
Herpes
Herpes: Transmission

 Vaginal, oral and anal sex with an infected person


 Skin or genital contact with an infected person
 Contact with a herpes sore
 Transmission can occur even without visible sores

www.cdc.gov
Herpes: Symptoms

 Sores or lesions may appear within two weeks after


exposure and go away 2 to 4 weeks later
 Sores can be painful and can cause psychological
distress for those infected
 Sores can go unnoticed or never appear at all
 Many people do not know they are infected

www.cdc.gov
Herpes: Symptoms

You can get herpes anywhere on your body


Herpes: Pregnancy
 Infant more likely to contract herpes if the mother has an
outbreak at the time of delivery
 If the mother has an outbreak, a cesarean delivery can avoid
infection in the infant

Complications from herpes can result in:


• Developmental delays

• Bleeding disorders

• Stomach and lung diseases

• Death

www.cdc.gov
Herpes in Infants

Image found at www.herpesdiagnosis.com


Herpes: Detection and Treatment
Detection
• Visual inspection of sores

• Sample taken from sores

• Blood test

Treatment
• There is no cure for herpes

• There are antiviral medications to control outbreaks

• Herpes can be spread, even when on medication

www.cdc.gov
Hepatitis A, B, C
Hepatitis A, B, C Transmission

 Hepatitis: a group a viruses that cause


inflammation to the liver
 Hepatitis A: spread by fecal contamination
 There are vaccines against Hepatitis A and B, but
not Hepatitis C

www.cdc.gov
Hepatitis A, B, C Transmission
 Hepatitis B and C: spread by vaginal, anal or oral
sex with an infected person
 Infants can be infected through delivery
 Contact with infected blood, including through
unsterilized tattoo, piercing and acupuncture
needles

www.cdc.gov
Hepatitis B,C: Symptoms
 Jaundice
 Fatigue
 Abdominal pain
 Nausea, vomiting
 Inflammation of the liver
 Cirrhosis
 There is no cure for Hepatitis B or C

Image found at www.saddleback.edu


www.cdc.gov
Hepatitis B: Pregnancy

 Infant can be infected in vitro or during delivery


 Infection can cause liver damage and health
problems later in the child’s life
 Treatment within 12 hours after birth can prevent
chronic infection in the infant
 Hepatitis B vertical transmission is more common
than Hepatitis C

www.cdc.gov
Hepatitis B: Detection and Treatment

Detection
 Blood test

Treatment
 There is no cure

 There is treatment available for symptoms

 Treatment within 12 hours of birth can prevent

chronic infection in infants

www.cdc.gov
HPV (Human Papillomavirus)
The Most Common Sexually Transmitted Infection in America

50 percent of all sexually active adults will have HPV at some point in their lives
HPV: Transmission and Symptoms

Transmission
 Vaginal and anal sex with an infected person

 Genital contact

Symptoms
 Over 40 strains of HPV, various symptoms

 Genital warts (1 percent of U.S. population)

 Cervical cancer (10,000 women every year)

 Rarely: cancer of the penis, anus, vulva, vagina

www.cdc.gov
HPV: Pregnancy

 Perinatal infection is possible, but rare


 RRP (Recurrent Respiratory Papillomatosis) rare
but serious infection of the respiratory tract in
infants due to HPV infection during delivery

www.cdc.gov
HPV: Detection and Treatment
Detection:
 Women: Annual Pap smear

 Men: There is no test for HPV in men

Treatment:
 There is no cure for HPV

 Most strains of HPV will go away on their own in a few

years
 Warts can be removed or can disappear on their own

 Cervical cancer is treatable if detected early

www.cdc.gov
HPV: Gardasil Vaccine

 The Gardasil vaccine prevents some strains of HPV


that cause warts and cervical cancer
 Recommended for females 9 through 26
 Most effective if taken before sexual debut

www.gardasil.com
HIV (Human Immunodeficiency Virus)
HIV and AIDS: What’s the difference?

 HIV stands for Human Immunodeficiency Virus


and is the virus that causes AIDS
 AIDS stands for Acquired Immune Deficiency
Syndrome
 AIDS is the final stage of an HIV infection, when
cd4 count has dropped below 200
 Someone can have HIV for many years before
being diagnosed with AIDS

www.cdc.gov
HIV: Transmission

 Vaginal, oral and anal sex with an infected person


 Semen and vaginal fluids
 Contact with infected blood, often through needles
 Mother-to-child transmission before or during
delivery or through breastfeeding

www.cdc.gov
HIV: Transmission

Remember, HIV is spread through:


• Semen

• Vaginal Fluids

• Blood

• Breast milk

*Other STIs greatly increase your susceptibility to HIV!


HIV: Transmission

HIV is not spread through:


• Saliva

• Kissing

• Hugs

• Mosquitoes

• Public Toilets
HIV: Symptoms

 The only way to know if you are infected is to be


tested for HIV infection.
 You cannot rely on symptoms to know whether or
not you are infected.
 Many people who are infected with HIV do not
have any symptoms at all for 10 years or more.
HIV: Pregnancy

 HIV can cross the placenta during pregnancy


 HIV can infect an infant during delivery
 HIV can be transmitted through breast milk –
breastfeeding is not recommended for HIV positive
mothers

www.cdc.gov
HIV: Pregnancy
Mother-to-child transmission can be reduced from
30% to 2% with medical interventions:
• The mother should be on antiretroviral treatment

• Cesarean delivery can reduce the infant’s exposure

to HIV
• All pregnant women should be tested for HIV

early to allow time to plan for such interventions

www.cdc.gov
HIV: Detection and Treatment
Detection
• Blood test

• Oral swab

Treatment
• There is no cure for HIV

• Antiretroviral treatment is available, which can

greatly improve life expectancy and quality of life

www.cdc.gov
HIV: Louisiana Statistics

 2007 - New Orleans ranked second and Baton


Rouge ranked third in AIDS diagnosis rates among
the large metropolitan areas in the U.S. 
 2007 - Louisiana ranked fifth highest in state AIDS
case rates
  2008, 1,168 persons were diagnosed with HIV in
Louisiana

www.hiv411.org
STI Prevention

How can I protect myself from STIs?

ABC
STI Prevention

Abstinence
• Not having sex is the only 100% way to
protect yourself from STIs
• Prolonging sexual debut can reduce risk for
STIs
• But it is not reasonable to expect people to
remain abstinent their entire lives
STI Prevention
Abstinence
Remember:
• Oral and anal sex are still sex

• “Almost” having sex without protection can still

put you at risk for STIs like HPV and herpes,


which only require skin-to-skin contact
• You don’t have to be sexually active to make a

reproductive plan, make one before you start!


STI Prevention

Be faithful
• Be in an exclusive, monogamous
relationship
• Get tested, as a couple, before you have
sex
• If you’re not in an exclusive relationship,
use a condom every time
STI Prevention

Condoms
According to the CDC, when used consistently
and correctly, condoms are highly effective in
preventing the sexual transmission of HIV
infection and reduce the risk of other STDs
STI Prevention
How to use a Condom:
• Check the expiration date
• Put the condom on before any genital contact occurs

• Use enough lubrication

Never
• Use two condoms at once

• Re-use a condom

The Female Condom


STI Prevention
What will not protect me from STIs?
Contraceptives like:
• Birth control pills

• Diaphragms

• Spermicidal gels

• IUDs

will help avoid pregnancy, but offer no


protection against STIs.
STI Prevention
If you find out you have an STI, you should
• Tell your current partner to get tested

• Tell your past partners to get tested

www.inspot.org
STI Prevention
Where can I get tested for STIs?
In New Orleans:

Delgado Sexually Transmitted NO/AIDS Task Force


Disease Clinic Main Office
517 N. Rampart Street 2601 Tulane Ave, 5th Floor
New Orleans, LA 70112 Wednesday 5:00 - 7:00 pm
504-658-2540 Friday 1:00 pm - 3:00 pm
Hours: Monday-Friday HIV rapid testing
8:00 am-4:00 pm
STI testing and treatment
STI Prevention
Where can I get tested for STIs?
Elsewhere in Louisiana:

Louisiana HIV/AIDS Hotline


1 -800-992-4379

www.inspot.org
STIs and Pregnancy
STIs are preventable
Get tested before you get pregnant
Get tested again early in your pregnancy
A Healthy Baby Begins with You.
Questions or Comments?

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