Pregnancy - STIs and group B (GBS) streptococcal colonisation

Many STIs (Sexually Transmitted Infections) can adversely affect the fetus and be more troublesome in pregnancy.

This guidance is designed to:

• highlight important issues about the impact of common STIs on the pregnant woman and her child who may be exposed either in utero or during the birthing process.
• highlight any management recommendations which may be different in pregnancy compared to the non pregnant state. This guideline should be used in conjunction with the guideline specific to the STI in question.

It is beyond the remit of this guideline to advise on the management of HIV and hepatitis B during pregnancy.

Group B Streptococcus (GBS) is recognised as the most important cause of severe early onset infection in newborn babies. GBS is not a sexually transmitted infection but since maternal Group B Streptococcal carriage in pregnancy is 50% guidance is included to assist with the management of pregnant woman in whom GBS is considered to be an incidental finding.

General points

• Discuss with the client the advantages of details regarding a diagnosis of an STI being included within her maternity record and where permission is granted inform her obstetric team.
• The physiology of pregnancy can alter the natural history of an STI.
• It is safe to perform vaginal examination in the pregnant woman, and to take cervical swabs.
• No woman should be given doxycycline, quinolones (for example ciprofloxacin, ofloxacin) or treated with podophyllotoxin or imiquimod preparations unless the clinician is assured she is at no risk of pregnancy.
• Partner notification is essential to reduce the possibility of re-infection of a pregnant woman (and unborn child).
• It should not be assumed that every women presenting with a diagnosis or symptoms suggestive of an STI in pregnancy has had HIV/syphilis testing as part of antenatal testing. She may have opted out of testing or not yet had her booking bloods and testing should be offered. Even for women tested earlier in the pregnancy for HIV and syphilis the diagnosis of an STI may indicate repeat HIV and syphilis testing is warranted.
• Patients planning a pregnancy should also be encouraged to be tested for HIV and syphilis.
• The finding of GBS in the vagina or urine of a woman who is pregnant is significant and this information needs to be shared with the obstetric team involved in her care.