All patients should be tested for the following STDs at their initial prenatal visit:
For patients at high risk of STD acquisition during pregnancy, rescreening in the third trimester should be considered. Those at high risk include previous STD diagnosis during pregnancy, new sex partner during pregnancy, multiple partners, or a partner with concurrent partners.
If positive for chlamydia or gonorrhea during pregnancy, a test of cure should be done 3-4 weeks after treatment and retested again in 3 months.
Other tests that should be considered based on symptoms or history include Bacterial Vaginosis, Trichomonas, and HSV-2. Routine serologic screening for HSV-2 is not recommended
Most STDs can be easily treated in pregnancy with the recommended regimens. Consult the CDC’s 2015 STD Treatment Guidelines for additional information on all available treatment regimens for chlamydia and gonorrhea.
When treating syphilis in pregnancy, there is no known alternative to penicillin that is safe and effective. The patient will need to be desensitized and treated with Benzathine penicillin G. Consider skin testing first to confirm the allergy.
There is no approved treatment for HCV during pregnancy; those that test positive for HCV in pregnancy should be counseled on harm reduction strategies and treatment options after delivery. Women infected with HCV can breastfeed, but should be advised against breastfeeding if their nipples are cracked or bleeding.