STDs in Pregnancy and Breastfeeding

Women who are with a child, or are breastfeeding are not protected against acquiring sexually transmitted diseases (STDs). While most STDs are treatable, some of the STDs can be transmitted vertically from the pregnant mother to the unborn child or during breastfeeding. If a baby has STD, it can harm the baby’s health and long term development.

Most STDs are without any tell-tale signs or symptoms. Both yourself or your partner can have STDs without knowing. The only way to determine a person’s status is through STD testing.

Majority of antenatal follow up do involve sexual health checkup. Nonetheless, it is still paramount to consider STD screening before pregnant or during pregnancy/ breastfeeding if you are concerned of possible exposure to STD infections.

Implications of having an STD when I am pregnant

Both women who are not pregnant and women who are pregnant can develop similar health complications from untreated STDs. However, in one who is pregnant, persistent STDs can be detrimental to the unborn child’s wellbeing.

STDs in pregnancy can be associated with:

Pretermed and premature labour (delivery before 37 weeks of pregnancy)
Still birth
Infant death
Long standing developmental and health complications in the borne child

How is STDs spread during pregnancy or breastfeeding?

Mother who is pregnant or lactating can acquire STDs through vaginal, oral or anal intercourse. In some STDs, the infections can also be passed on via skin-to-skin contact of the genital region.

What are the types of STDs that can be passed on to my baby?

STDs that can be passed on to babies during pregnancy include:

HIV
Syphilis
Hepatitis B and C
Chlamydia
Gonorrhea
Trichomoniasis
Herpes Simplex Virus
Human Papilloma Virus

STDs that can be passed on to babies during breastfeeding include:

HIV
Herpes Simplex Virus
Syphilis
Human Papilloma Virus (HPV)

How can STDs pass to my baby?

The unborn child can be infected with STDs when he is in the placenta of the pregnant mother. Infections such as HIV and syphilis can pass through the placenta during pregnancy and infect the baby.

STDs such as chlamydia, gonorrhea, genital herpes or genital warts, can be transmitted to the baby during delivery when the baby passed through the birth canal. HIV is also able to infect a baby during delivery.

What will happen to my baby if I have STD and I am pregnant?

Babies who acquired STDs via vertical transmission from pregnant mother can be associated with serious long term health complications such as:

Low birth weight
Blindness
Eye infection
Deafness
Lung infection
Septicemia (blood infection)
Meningitis and brain infection
Hepatitis
Poor coordination of the body and developmental delay
Death

What can I do to prevent complication from STDs?

Firstly, prevent and lower your risk of acquiring STDs

Abstain from sex (oral, anal, vaginal intercourse).

If you are sexually active:
- Consider barrier contraception and use it the correct method every time when having sex
- Minimise sexual partners, and strive towards long term monogamous relationship
- Regular STD testing
- Ensure STDs are treated or controlled before planning for pregnancy
- Ensures partner(s) are tested and free from STDs.

Be proactive if you have an exposure to possible STDs

To prevent health complications from STDs during and after pregnancy, regular antenatal care with your gynaecologist is imperative.
Furthermore, STDs tests should be offered during early part/before pregnancy or any time during pregnancy if there is a risk of exposure that is concerned of.
Antibiotics that are suitable for pregnancy can be offered to treat bacterial STDs such as chlamydia gonorrhea, trichomoniasis and etc.
Antiviral medication may be offered to alleviate and manage active herpes symptoms if required.
In those with HIV infection, antiviral medication can be offered to reduce the risk of transmitting HIV to the baby.
Your gynecologist may advise you for caesarean section to reduce risk of passing STDs infection to your unborn child.

If I have STDs, can I still breastfeed?

In some of the STD conditions, breastfeeding may be possible. You are advised to speak to your healthcare professionals if you are lactating and you are having STDs.

STDs	Should I still breastfeed?
HIV	You should not breastfeed as the virus can be passed on through breastmilk to your infant.
Syphilis	Breastfeeding is okay as long as there is no active syphilis lesions on the breasts/nipple/areola and the infant or breast pump equipment is not in contact with the affected area.
Chlamydia	Can breastfeed
Gonorrhea	Can breastfeed
Trichomoniasis	Can breastfeed. You may discuss with your doctor on timing of breastfeeding when you are on antibiotics treatment
HPV	Can breastfeed as long as there is no warts on the breasts/nipple/areola
Herpes	Breastfeeding is okay as long as there is no active herpes lesions on the breasts/nipple/areola and the infant or breast pump equipment is not in contact with the affected area.
Hepatitis B	Breastfeeding is possible, as long as the infant born from known Hep B positive mothers receive immunoglobulin/vaccine at birth ( this is within current hospital guidelines)
Hepatitis C	Can breastfeed. Based on CDC guidelines, as HSV is a blood-borne disease, no clinical evidence to prove breastfeeding can spread HCV

Some of the STDs medication can be excreted into the breastmilk, though most of them are safe. It is important to discuss with your physician as well when you are on any medication treatment to ensure it is safe during breastfeeding.

Salient points to take note of:

Pregnancy and breastfeeding state are not immunity against sexually transmitted diseases.
STDs can complicate pregnancy and if left unattended can cause grave long term health complications in babies.
Early STD screening and early STD treatment can prevent the long term health risks to both the mother and the baby.

References:

Fontenot HB, George ER. Sexually transmitted infections in pregnancy. Nurs Womens Health. 2014 Feb-Mar;18(1):67-72.
Gao R, Liu B, Yang W, et al. Association of Maternal Sexually Transmitted Infections With Risk of Preterm Birth in the United States. JAMA Netw Open. 2021;4(11):e2133413.
Reekie J, Roberts C, Preen D et al. Chlamydia trachomatis and the risk of spontaneous preterm birth, babies who are born small for gestational age, and stillbirth: a population-based cohort study. Lancet Infect Dis. 2018; 18: 452-460.
Ament LA, Whalen E. Sexually transmitted diseases in pregnancy: diagnosis, impact, and intervention. J Obstet Gynecol Neonatal Nurs. 1996 Oct;25(8):657-66.