STDs During Pregnancy
Can pregnant women become infected with STDs?
Women who are pregnant can become infected with the same sexually-transmitted diseases (STDs) as women who are not
pregnant. Pregnancy does not provide women or their babies any additional protection against STDs. Many STDs are
‘silent,’ or have no symptoms, so women may not know they are infected. A pregnant woman should be tested for STDs,
including HIV (the virus that causes AIDS), as a part of her medical care during pregnancy. The results of an STD
can be more serious, even life-threatening, for a woman and her baby if the woman becomes infected while pregnant.
It is important that women be aware of the harmful effects of STDs and how to protect themselves and their children
against infection. Sexual partners of infected women should also be tested and treated. Positive Singles
How do STDs affect a pregnant woman and her baby?
STDs can complicate pregnancy and may have serious effects on both a woman and her developing baby. Some of these
problems may be seen at birth; others may not be discovered until months or years later. In addition, it is well
known that infection with an STD can make it easier for a person to get infected with HIV1. Most
of these problems can be prevented if the mother receives regular medical care during pregnancy. This includes
tests for STDs starting early in pregnancy and repeated close to delivery, as needed.
Human Immunodeficiency Virus
Human immunodeficiency virus (HIV) is the virus that causes acquired immune deficiency syndrome, or AIDS. HIV
destroys specific blood cells that are crucial to helping the body fight diseases. According to CDC’s 2011 HIV
surveillance data, women make up 25% of all adults and adolescents living with diagnosed HIV infection in the
United States2. The
most common ways that HIV passes from mother to child are during pregnancy, labor and delivery, or through
breastfeeding. However, when HIV is diagnosed before or during pregnancy and appropriate steps are taken, the
risk of mother-to-child transmission can be lowered to less than 2%3.
HIV testing is
recommended for all pregnant women. A mother who knows
early in her pregnancy that she is HIV-positive has more time to consult with her healthcare provider and decide
on effective ways to protect her health and that of her unborn baby.
Syphilis is primarily a sexually transmitted disease, but may be passed to a baby by
an infected mother during pregnancy. Passing syphilis to a developing baby can lead to serious health problems.
Syphilis has been linked to premature
and, in some cases, death shortly after birth7.
Untreated infants that survive tend to develop problems in multiple organs, including the brain, eyes, ears,
heart, skin, teeth, and bones. Screening for syphilis should be performed in all pregnant women during their
first prenatal medical visit and repeated in the third trimester, if the patient is considered to be at high
Hepatitis B is a liver infection
caused by the hepatitis B virus (HBV). A mother can pass the infection to her baby during pregnancy. While
the risk of an infected mother passing HBV to her baby varies depending on when she becomes infected, the
greatest risk happens when mothers become infected close to the time of delivery14
Infected newborns also have a high risk (up to 90%) of becoming
chronic (lifelong) HBV carriers themselves15.
Infants who have a lifelong infection with HBV are at an increased risk for developing chronic liver disease or
liver cancer later in life. Approximately one in four infants who develop chronic HBV infection will eventually
die from chronic liver disease13.
Mother-to-child transmission of HBV can be prevented by screening pregnant women for the infection and providing
treatment to at-risk infants shortly after birth. Information on mother-to-child transmission of HBV can be
found at http://www.cdc.gov/hepatitis/HBV/PerinatalXmtn.htm.
Hepatitis C is a liver
infection caused by the hepatitis C virus (HCV), and can be passed from an infected mother to her child during
pregnancy. Overall, an infected mother will pass the infection to her baby 10% of the time, but the chances are
higher in certain subgroups, such as women who are also infected with HIV16.
Regular testing of pregnant women for HCV is not recommended, however, it should be considered for individuals
who have risk factors known to be linked to HCV, including injection drug use. In some studies, infants born to
HCV-infected women have been shown to have an increased risk for being small for gestational
age, premature, and
having a low birth
Newborn infants with HCV infection usually do not have symptoms, and a majority will clear the infection without
any medical help. Liver disease tends to move forward more slowly in children infected with hepatitis C and they
respond slightly better to treatment compared to adults. Positive Singles
Chlamydia is the most common sexually transmitted bacterium in the United
Although the majority of chlamydial infections do not have symptoms, pregnant women may have abnormal vaginal
discharge, bleeding after sex, or itching/burning with urination. Untreated chlamydial infection has been linked
to problems during pregnancy, includingpreterm
labor, premature rupture of the
membranes surrounding the baby in the uterus,
newborn may also become infected during delivery as the baby passes through the birth canal. Neonatal (newborn)
infections lead primarily to eye and lung infections. All pregnant women should be tested for chlamydia at their
first prenatal visit. Repeat testing in the third trimester should be done for women at high risk.
Gonorrhea is a common STD in the United States. Untreated gonococcal infection in
pregnancy has been linked to miscarriages,
birth and low birth
weight, premature rupture of the
membranes surrounding the baby in the uterus, and infection
of the fluid that surrounds the baby during pregnancy6.
Gonorrhea can also infect an infant during delivery as the infant passes through the birth canal. If untreated,
infants can develop eye infections. Because gonorrhea can cause problems in both the mother and her baby, it is
important to accurately identify the infection, treat with effective antibiotics, and closely follow up to make
sure that the infection has been cured.
Bacterial vaginosis (BV), a common cause of
vaginal discharge in women of childbearing age, is a condition in which the ‘good’ and ‘bad’ bacteria in the
vagina are out of balance. BV is often not considered an STD, but it is linked to sexual activity. There may be
no symptoms or a woman may complain of a foul-smelling, fishy, vaginal discharge. BV during pregnancy has been
linked to serious pregnancy complications, including premature rupture of the
membranes surrounding the baby in the
labor, premature birth,
infection of the fluid that surrounds the baby, as well as infection of the mother’s uterus after
Testing all pregnant women for bacterial vaginosis is not currently recommended. However, there is some evidence
to support testing and treating BV among women at high risk for preterm delivery9-11.
There are no known direct effects of BV on the newborn.
Vaginal infection due to the parasite Trichomonas
vaginalis is a very common STD. Symptoms can vary
widely among those women infected. Although some women report no symptoms, others complain of itching, foul
odor, discharge, and bleeding after sex. Pregnant women are not usually screened for the infection. However,
pregnant women with abnormal vaginal discharge should be evaluated for Trichomonas
vaginalis and treated appropriately. Infection in
pregnancy has been linked to premature rupture of
the membranes surrounding the baby in the
uterus, preterm birth,
and low birth
Rarely, the female newborn can get the infection when passing through the birth canal during delivery and have
vaginal discharge after birth.
Herpes Simplex Virus
Herpes Simplex Virus (HSV) is a virus that has two distinct types, HSV-1 and HSV-2. Infections of the
newborn can be of either type, but most are caused by HSV-2. Overall the symptoms of genital herpes are similar
in pregnant and non-pregnant women; however, the major concern regarding HSV infection relates to complications
linked to infection of the newborn. Although transmission may occur during pregnancy and after delivery, 80 -
90% of HSV infections in newborns occur when the baby passes through the mother’s infected birth canal18. HSV
infection can have very serious effects on newborns, especially if the mother’s first outbreak occurred late in
pregnancy (third trimester). Women who are infected for the first time in late pregnancy have a high risk of
infecting their baby. Cesarean section is recommended for all women in labor with active genital herpes lesions
or early symptoms, such as vulvar pain and itching19-20.
Human papillomaviruses (HPV) are viruses that most commonly involve the lower genital tract, including
the cervix (opening to the womb), vagina, and external genitalia. Genital warts are symptoms of HPV infection
that can be seen, and they frequently increase in number and size during pregnancy. Genital warts often appear
as small cauliflower-like clusters which may burn or itch. If a woman has genital warts during pregnancy,
treatment may be delayed until after delivery. When large or spread out, genital warts can complicate a vaginal
delivery. In cases where there are large genital warts that are blocking the birth canal, a cesarean section may
be recommended. Infection of the mother may be linked to the development of laryngeal papillomatosis in the
newborn. This is a rare growth in the larynx (voice box) that is not cancer17.
Should pregnant women be tested for STDs?
Screening and treating pregnant women for STDs is a vital way to prevent serious health complications to both
mother and baby that may otherwise happen with infection.
The sooner a
woman begins receiving medical care during pregnancy, the better the health outcomes will be for herself and her
unborn baby. The Centers for Disease Control and Prevention’s
2010 STD Treatment Guidelines recommend screening pregnant women for STDs1. The
CDC screening recommendations are incorporated into the recommendations below. Positive Singles
Screen all pregnant women at first prenatal visit; 3rd trimester rescreen if younger than 25 years of
age and/or high risk group
Screen all pregnant women at
risk at first prenatal visit; 3rd trimester
rescreen women at continued high risk
Risk factors include: women younger than 25 years, living in a high morbidity area, previous GC
infection, other STDs, new or multiple sex partners, inconsistent condom use, commercial sex work,
Screen all pregnant women at first prenatal visit; during 3rd trimester rescreen women who are at high
risk for syphilis or who live in areas with high numbers of syphilis cases, and/or those who were not
previously tested or had a positive test in the first trimester
Test pregnant women who have symptoms or are at high risk forpreterm
Test pregnant women with symptoms
Test pregnant women with symptoms
Screen all pregnant women at first prenatal visit; rescreening in the third trimester recommended for
women at high risk for getting HIV infection
Screen all pregnant women at first prenatal visit
Retest those who were not screened prenatally, those who engage in behaviors that put them
risk for infection and those with signs or
symptoms of hepatitis at the time of admission to the hospital for delivery
Risk factors include: having had more than one sex partner in the previous six months, evaluation
or treatment for an STD, recent or current injection-drug use, and an HBsAg-positive sex
There is not enough evidence to make a recommendation
All pregnant women at high risk should be tested at first prenatal visit
Pregnant women should ask their doctors about getting tested for these STDs. It is also important that pregnant
women discuss any symptoms they are experiencing and any high-risk sexual behavior that they engage in, since some
doctors do not routinely perform these tests. Even if a woman has been tested in the past, she should be tested
again when she becomes pregnant.
Can STDs be treated during pregnancy?
STDs, such as chlamydia, gonorrhea, syphilis, trichomoniasis and BV can all be treated and cured with antibiotics
that are safe to take during pregnancy. STDs that are caused by viruses, like genital herpes, hepatitis B,
hepatitis C, or HIV cannot be cured. However, in some cases these infections can be treated with antiviral
medications or other preventive measures to reduce the risk of passing the infection to the baby. If a woman is
pregnant or considering pregnancy she should be tested so she can take steps to protect herself and her baby.
How can pregnant women protect themselves against infection?
Latex male condoms, when used consistently and
correctly, can reduce the risk of getting or giving STDs and HIV. The surest way to avoid STDs and HIV is to
abstain from vaginal, anal, and oral sex or to be in a long-term mutually monogamous relationship with a partner
who has been tested and is known to be uninfected.
Where can I get more information?
Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
Congenital Syphilis Fact Sheet
In English, en Español
CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
American Sexual Health Association (ASHA)
P. O. Box 13827
Research Triangle Park, NC 27709-3827
Centers for Disease Control and Prevention. Sexually Transmitted
Diseases Treatment Guidelines, 2010. MMWR 2010;59(no.
1. Institute of Medicine. The Hidden Epidemic: Confronting Sexually Transmitted
Diseases. Eng TR, Butler WT, eds. Washington: National Academy
2. Centers for Disease Control and Prevention. HIV Surveillance
Report, 2011; vol. 23.
3. Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission.
Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and
interventions to reduce perinatal HIV transmission in the United States; 2012 Jul 31:1-235.
4. Centers for Disease Control and Prevention. Sexually Transmitted
Disease Surveillance 2013. Atlanta: U.S. Department of Health and Human Services; 2014.
5. Andrews WW, Goldenberg RL, Mercer B, Iams J, Meis P, Moawad A et al. The Preterm Prediction
Study: association of second-trimester genitourinary Chlamydia infection with subsequent spontaneous preterm
birth. Am J Obstet Gynecolo 2000;183;662-8.
6. Alger LS, Lovchik JC, Heel JR, Blackmon LR, Crenshaw Mc. The association of Chlamydia
trachomatis, Neisseira gonorrhoeae, and group B streptococci with preterm reupture of the membranes and
pregnancy outocme. Am J Obstet Gynecol 1988;159(2):397-404.
7. Genc M, Ledger WJ. Syphilis in pregnancy . Sex
Transm Inf 2000;76:73.
8. Nelson DB, macones G: Bacterial vaginosis in pregnancy: current findings and future
directions. epidemiolo Rev 2002;24(2):102-8.
9. Hauth Jc, Goldenberg RL, Andrews WW, Dubard MB, Copper RL. Reduced incidence of preterm
delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med
10. McDonald HM, O’Loughlin JA, Vigneswaran R, Jolley PT, Harvey JA. Impact of metronidazole
therapy on preterm birth in women with bacterial vaginosis flora (Gardnerella vaginalis): a randomized, placebo
controlled trial. Br J Obstet Gynaecol 1997;104:1391-7.
11. Morales WJ, Schorr S, Albritton J. Effect of metronidazole in patinets with preterm birth
in preceding pregnancy and bacterial vaginosisi: a placebo-controlled, double blind study. Am J Obstet Gynecol
12. Cotch MF, Pastorek JG II, Nugent RP, Hillier SL, Gibbs RS, Martin DH, et al: Trichomonas
vaginalis associated with low birth weight and preterm delivery. Sex Transm Dis 1997;24(6):353-60.
13. Hutto C, Arvin A, Jacobs R, Steele R, Stagno S, Lyrene R et al. Intrauterine herpes
simplex virus infections. J Pediatr 1987:110:97-101.
14. Sookoian S. Liver disease during pregnancy: acute viral hepatitis. Ann Hepatol 2006;
15. Stevens CE, Toy PT, Tong MJ, et al. Perinatal hepatitis B virus transmission in the United
States. Prevention by passive-active immunization. JAMA 1985; 253:1740.
16. Yeung LT, King SM, Roberts EA. Mother-to-infant transmission of hepatitis C virus.
Hepatology 2001; 34:223.
17. Silverberg MJ, Thorsen P, Lindeberg H, Grant LA, Shah KV. Condyloma in pregnancy is
storngly predictive of juvenile-onset recurrent respiratory papillomatosis. Obstet Gynecolo
18. JAIYEOBA, O., AMAYA, M. I., SOPER, D. E., & KILBY, J. M. (2012). Preventing Neonatal
Transmission of Herpes Simplex Virus. Clinical Obstetrics and Gynecology, 55(2), 510.
19. American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin.
Clinical management guidelines for obstetrician-gynecologists. No. 82 June 2007. Management of herpes in
pregnancy. Obstetrics and Gynecology, 2007. 109(6): 1489–1498.
20. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines,
2010. MMWR. Morbidity and Mortality Weekly Report, 2010. 59(RR-12): 21–22.