68. SEXUALLY TRANSMITTED INFECTIONS [STIs] AND PREGNANCY

Abstract

Routine antenatal screening tests currently recommended in Australasia and endorsed by the Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG) include rubella, varicella-zoster, group b streptococcus [GBS], asymptomatic bacteriuria, as well as the following STIs: Treponema pallidum (syphilis), Human immunodeficiency virus (HIV), Hepatitis B virus (HBsAg), Chlamydia trachomatis (adolescent pregnancies) and offer of hepatitis C virus (HCV).

Infections can infect the foetus or neonate by various routes (intrauterine, intrapartum and /or postnatal) and cause potentially serious disease. Such infections in the mother may be mild or commonly subclinical, yet can result in miscarriage, preterm birth, foetal damage, or even death, depending on the pathogen and stage of pregnancy. Consequently, diagnoses should be made definitively by instituting appropriate laboratory tests to ensure effective treatment and follow-up of the woman and her infant, as well as her contact(s). Specific treatment of the mother, where applicable, can prevent most of the impact on the fetus and newborn. The principles for the use and choice of screening tests are (1) if maternal infection occurs, there is a significant risk of fetal or neonatal infection and damage, or other adverse pregnancy outcome; (2) there are sensitive, specific, and inexpensive screening and confirmatory tests; (3) there is a safe, effective intervention and/or treatment regimen which can reduce morbidity and mortality in the fetus and/or the mother.