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Chlamydia in pregnancy: How STDs affect your baby

Chlamydia is a sexually transmitted infection that can be passed on to your baby with serious consequences. Because there are usually no symptoms, it's important to be tested for it early in pregnancy. If you test positive, both you and your partner will be treated with antibiotics.

What is chlamydia?

Chlamydia is a curable bacterial infection that can be transmitted through genital, oral, or anal sex. It can also be passed from a woman to her baby during delivery.

The Centers for Disease Control and Prevention (CDC) estimates that 1.8 million people in the United States get chlamydia each year, making it the most common sexually transmitted bacterial infection. The rate increased 3 percent between 2017 and 2018. The highest rates are found in sexually active women under 30 years old, particularly those who are 20 to 24 years old.

How can chlamydia affect my pregnancy?

Prompt treatment may reduce the risk of these problems, but women who have chlamydia during pregnancy tend to have higher rates of:

• Infection of the amniotic sac and fluid
• Preterm premature rupture of the membranes (PPROM)
• Preterm birth

Some studies have linked chlamydia to an increased risk of miscarriage, although other studies have found no connection.

An untreated chlamydia infection also makes you more susceptible to HIV and some other sexually transmitted infections (STIs) if you're exposed to them. It also raises your risk of a uterine infection after you have your baby.

Can chlamydia in pregnancy affect my baby?

Yes, if you have a chlamydia infection when you go into labor, there's a chance that you'll pass the bacteria to your baby. In fact, up to half of babies born vaginally to mothers with untreated chlamydia (and even some babies born by c-section) will contract the infection.

Between 25 to 50 percent of these babies will develop an eye infection (conjunctivitis) a few days to a few weeks after birth. (The medicated drops or ointments put in your baby's eyes soon after birth to prevent gonorrheal conjunctivitis don't prevent chlamydial eye infections.) And 5 to 30 percent of babies who contract chlamydia during delivery develop pneumonia a few weeks to several months after birth.

Although these infections can be very serious, babies who are treated promptly with antibiotics generally do well. Of course, it's best to get treated before delivery to prevent your baby from becoming infected in the first place.

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What are the symptoms of chlamydia in pregnancy?

It's important to note that in the vast majority of chlamydia cases (up to 90 percent of women) there are no symptoms. If you do have symptoms, they're likely to show up about one to three weeks after you've been exposed. These symptoms may include:

• Burning or discomfort when you urinate
• Inflammation of your cervix
• Increased vaginal discharge or possibly spotting
• Abdominal pain
• Pain during sex
• If you engage in anal intercourse, you may also have inflammation of your rectum, rectal pain, and discharge.
• If you have oral sex with an infected partner, your throat can become infected and may feel sore.

Up to 70 percent of men infected with chlamydia have no symptoms. The most common symptoms include discharge from the penis, burning or pain while urinating, tender or swollen testicles, and inflammation of the rectum. It's important to let your caregiver know if either you or your partner has symptoms of chlamydia and make sure you both get tested and treated if necessary.

Can chlamydia in pregnancy cause pelvic inflammatory disease (PID)?

Yes. Before and after pregnancy, chlamydia can travel up from your cervix to infect your uterus or fallopian tubes, causing pelvic inflammatory disease (PID). In fact, up to 15 percent of women who aren't pregnant who have untreated chlamydia infections end up with PID. (It's possible to get PID during pregnancy, but it rarely happens.)

Symptoms of PID include:

• Pain in your lower abdomen or back
• Pain during sex
• Vaginal bleeding
• Fever
• Nausea

PID can result in permanent damage to your fallopian tubes and lead to chronic pelvic pain and infertility, as well as an increased risk of ectopic pregnancy if you do become pregnant.

Will I be screened for chlamydia during my pregnancy?

Most likely, yes. Because it's so important to detect and treat chlamydia during pregnancy, because it's a relatively common infection, and because the infection usually occurs without symptoms, the CDC recommends that all pregnant women be screened for chlamydia at their first prenatal visit.

To test for chlamydia, your practitioner will send either a swab from your vagina or cervix or a urine specimen to the lab for analysis. If your chlamydia test is positive and you weren't tested for other STIs at the same time, your caregiver will do so now.

If you're under 25 years old or otherwise at high risk for contracting chlamydia (you or your partner has a new sex partner or more than one sex partner), your practitioner might repeat the test during your third trimester, to make sure you're not infected as you prepare for delivery. You'll also be retested if you've contracted another STI during your pregnancy or if you or your partner develops symptoms of chlamydia.

How is chlamydia treated during pregnancy?

Chlamydia is treated with antibiotics that are safe to take during pregnancy. Your practitioner may prescribe an antibiotic that you take in a single dose or one that you take over the course of a week. (Be sure to take the medicine exactly as prescribed.) In most cases, one round of treatment will cure the infection.

Your partner should be treated at the same time, and both of you should abstain from sex until a week after completing treatment so you don't get reinfected.

The CDC recommends that pregnant women be tested again three to four weeks after completing treatment to make sure the infection is gone.

How can I avoid getting chlamydia in pregnancy?

Have sex only with a long-term partner who has sex only with you. Otherwise, use latex condoms during intercourse, and a dental dam during oral sex, to reduce your risk of getting chlamydia and certain other STIs.

Again, if it's possible that you've been exposed to chlamydia (or any other STI) during pregnancy, or you develop any symptoms, tell your practitioner right away so that you can be tested and treated if necessary.

The test for chlamydia is one of the many tests you'll have during pregnancy. Here's an overview of what tests you can expect in each trimester.

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Chlamydia and pregnancy

Their favorite habitat is the cervix (more precisely, the mucous membrane of the cervical canal). It is there that they are located in colonies, i.e. are not found throughout. Such frequent cases are associated with this fact, when one doctor takes a smear from the cervical canal and chlamydia is found in it, and the other one also takes a smear a day later, but chlamydia is not found again. That is why the diagnostic value of swabs for chlamydia is quite low - about 30%.

How chlamydia manifests itself

During an exacerbation of the infectious process, women's complaints may be different, depending on the level of chlamydia spread.

When chlamydia is found in the cervix, there may be slight discharge from the vagina, accompanied by moderate pulling pains in the lower abdomen, which is typical with local exacerbation of the process (there are practically no complaints in the chronic form). If the infection spreads higher (uterine cavity, tubes), then the complaints are more pronounced, because, for example, inflammation of the appendages may begin.

Exacerbation of chlamydial infection is especially dangerous during pregnancy, as it can lead to various complications.

Possible complications:

• early miscarriages are possible,
• late term premature amniotic fluid and preterm labor,
• in childbirth, there is a high probability of infection of the fetus (conjunctivitis, pharyngitis, otitis and even pneumonia).

Chlamydia diagnostics

The most informative method is a blood test for antibodies (immunoglobulins) to chlamydia. If a small concentration of these antibodies is detected, then they speak of a chronic carriage of chlamydia. If the concentration is high, there is an exacerbation of chlamydial infection.

The diagnosis of "chlamydia" is legitimate when it is confirmed by two fundamentally different diagnostic methods: smear (microscopy) and blood for antibodies to chlamydia (biochemical method). Only when the titer (concentration) of antibodies is high and / or in the presence of complaints specific to this infection, a course of treatment is indicated.

Digits must be multiples, i.e. more or less than twice, from the previous one (IgA 1:40 and IgG 1:80). Titers of 1:5 and less are doubtful and negative. Elevated IgG numbers indicate that the process is chronic. In this case, treatment is indicated if there are certain complaints, or if before that, the person has never been treated for this infection. High numbers of IgA are mainly found in an acute process (primary infection) or during an exacerbation of a chronic one that needs treatment.

What to do if the test is positive?

It must be remembered that today there are almost no 100% reliable methods, including the ELISA method (enzymatic immunoassay) is no exception. Quite often there are “false positive” results - you have to do either repeated tests or use other, fundamentally different methods.

These can be:

• taking smears for the PIF method (examination with a luminescent microscope) - where there may also be “false positive” answers,
• PCR blood test (based on the principle of genetic engineering, the study of DNA or its fragments) - today, its reliability is very high.

In the search for the truth of the diagnosis, quite often, everything can rest either on the financial capabilities of patients, or on the insufficient equipment of a particular laboratory. The better the body's defenses, the less likely it is to contract chlamydia. In which case, only “carriage” threatens you, it is not dangerous for you (only IgG, in low titers, will be determined in the blood test).

It is considered optimal if the whole family is examined at the same time (all interested persons, including children), because in this case, it is possible to identify who is at what stage and monitor the effectiveness of treatment.

In most cases, the pathogens of ureplasmosis and mycoplasmosis do not manifest themselves (hidden bacteriocarrier), and only when the process is exacerbated, they cause pregnancy complications similar to chlamydia and infection of the fetus. Therefore, when examining women who have had the above problems in the past, swabs and blood are taken at least immediately for these three pathogens. By the way, studies have shown that taking hormonal birth control pills reduces the risk of chlamydia infection, this effect is associated with an increase in the protective properties of cervical mucus (its permeability to bacteria decreases). As mentioned above, chlamydia is dangerous for pregnant women.

What to do?

But what to do if, after all, doctors found chlamydia in the acute stage in the expectant mother?

The placenta can be thought of as a mesh filter through which large molecules cannot pass (they remain in the mother's body). Therefore, in the treatment of a pregnant woman, antibiotics are used that are harmless to the fetus (i.e. those that do not pass through the placenta). These include drugs whose molecular weight is greater than the "capacity" of the capillaries. However, when taking these drugs, the effect on the fetus is still possible. The antibiotic acts primarily on the mother's body, however, during the period of treatment, it changes the metabolism in the body, which in turn affects the metabolism of the fetus. Antibiotics are always prescribed in short courses so that the effects are minimal.

References

• Zofkie AC., Fomina YY., Roberts SW., McIntire DD., Nelson DB., Adhikari EH. Effectiveness of Chlamydia Trachomatis expedited partner therapy in pregnancy. // Am J Obstet Gynecol - 2021 - Vol - NNULL - p.; PMID:33894150
• Zofkie AC., Fomina YY., Roberts SW., McIntire DD., Nelson DB., Adhikari EH. Effectiveness of Chlamydia Trachomatis expedited partner therapy in pregnancy. // Am J Obstet Gynecol - 2021 - Vol - NNULL - p.; PMID:33894147
• Shilling HS., Garland SM., Costa AM., Marceglia A., Fethers K., Danielewski J., Murray G., Bradshaw C., Vodstrcil L., Hocking JS., Kaldor J., Guy R., Machalek D.A. Chlamydia trachomatis and Mycoplasma genitalium prevalence and associated factors among women presenting to a pregnancy termination and contraception clinic, 2009-2019. // Sex Transm Infect - 2021 - Vol - NNULL - p.; PMID:33782146
• Vercruysse J. , Mekasha S., Stropp LM., Moroney J., He X., Liang Y., Vragovic O., Valle E., Ballard J., Pudney J., Kuohung W., Ingalls RR. Chlamydia trachomatis Infection, when Treated during Pregnancy, Is Not Associated with Preterm Birth in an Urban Safety-Net Hospital. // Infect Dis Obstet Gynecol - 2020 - Vol2020 - NNULL - p.8890619; PMID:33082702
• Olaleye AO., Babah OA., Osuagwu CS., Ogunsola FT., Afolabi BB. Sexually transmitted infections in pregnancy - An update on Chlamydia trachomatis and Neisseria gonorrhoeae. // Eur J Obstet Gynecol Reprod Biol - 2020 - Vol255 - NNULL - p.1-12; PMID:33059307
• Hoenderboom BM., van Bergen JEAM., Dukers-Muijrers NHTM., Götz HM., Hoebe CJPA., de Vries HJC., van den Broek IVF., de Vries F., Land JA., van der Sande MAB., Morré SA., van Benthem BHB. Pregnancies and Time to Pregnancy in Women With and Without a Previous Chlamydia trachomatis Infection. // Sex Transm Dis - 2020 - Vol47 - N11 - p.739-747; PMID:32701764
• He W., Jin Y. , Zhu H., Zheng Y., Qian J. Effect of Chlamydia trachomatis on adverse pregnancy outcomes: a meta-analysis. // Arch Gynecol Obstet - 2020 - Vol302 - N3 - p.553-567; PMID:32643040
• Freeman J., Pettit J., Howe C. Chlamydia test-of-cure in pregnancy. // Can Fam Physician - 2020 - Vol66 - N6 - p.427-428; PMID:32532724
• Rajabpour M., Emamie AD., Pourmand MR., Goodarzi NN., Asbagh FA., Whiley DM. Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis among women with genitourinary infection and pregnancy-related complications in Tehran: A cross-sectional study. // Int J STD AIDS - 2020 - Vol31 - N8 - p.773-780; PMID:32517577
• Goggins ER., Chamberlain AT., Kim TG., Young MR., Jamieson DJ., Haddad LB. Patterns of Screening, Infection, and Treatment of Chlamydia trachomatis and Neisseria gonorrhea in Pregnancy. // Obstet Gynecol - 2020 - Vol135 - N4 - p.799-807; PMID:32168225

Chlamydia during pregnancy | Lisa.ru

Chlamydia: causes and symptoms

The causative agents of chlamydia are small rounded bacteria - chlamydia, which affect the mucous membranes of the organs and, above all, the organs of the genitourinary system. Chlamydia is considered one of the most common sexually transmitted diseases. According to statistics, about 100 million people fall ill with chlamydia every year in the world. There are acute and chronic forms of infection.

Chlamydia: acute

In 80% of cases, there are no symptoms of the disease, so reliable information can only be obtained after passing a urine test or a vaginal smear. Minor symptoms of chlamydia can occur in a woman within three weeks after infection - these are mucous or purulent discharge with a yellowish tinge and an unpleasant odor, itching in the perineum, pain during urination.

Chlamydia: chronic

In chronic chlamydia, pathogens enter the uterus through the cervix. 15-20% of all infected are carriers of the chronic form of the disease. Chlamydia, which has taken a chronic form, can be detected by short-term and minor bleeding between periods, pain in the lower abdomen and fever.

Chlamydia: complications

Without proper and timely treatment of chlamydia, inflammation in the uterus can spread to other organs. If during the illness the fallopian tubes and the fetal membrane were affected, then after recovery, adhesions may form in them. And adhesive processes increase the risk of infertility and ectopic pregnancy. Chlamydia during pregnancy can cause premature birth and rupture of the amniotic sac. Why chlamydia causes this effect is still unknown. Of particular danger is infection with chlamydia in late pregnancy, since in 60-70% of cases the disease is transmitted to the fetus. As a result, chlamydia can cause severe lung and eye disease.
For the safety of the child during pregnancy, a woman is tested for chlamydia. If the disease was detected on time, then, as a rule, it can be effectively treated.

Chlamydia: prevention and treatment

Timely treatment of chlamydia in a pregnant woman before delivery is of particular importance, as this will reduce the chance of infection of the child. For this, an analysis for chlamydia in the early stages (as part of the planned management of pregnancy) is provided.

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