Genito-urinary infections in pregnancy

Infections in the genitourinary tract can have several adverse effects in pregnancy, causing congenital abnormalities, premature birth, neonatal infection and postnatal morbidity in the mother. Chlamydia and gonorrhoea can cause ophthalmia neonatorum and can be managed by standard antibiotic treatment, although tetracycline should be avoided during pregnancy. The incidence of syphilis is rising in the UK. All pregnant women should be screened at booking and referred for specialist treatment if the serological tests are positive. This chapter will focus on other infections, which are important in pregnancy. Bacterial vaginosis is a common cause of abnormal vaginal discharge and has been associated with second trimester loss and premature labour in pregnancy. Randomised controlled trials of antibiotic therapy during pregnancy have yielded conflicting results on the potential benefit in reducing adverse outcomes of pregnancy, but treatment is indicated for symptomatic women and maybe offered to those with a history of prior preterm birth or second trimester miscarriage. Trichomoniasis should be treated with Metronidazole to control symptoms. Vaginal candidiasis should be treated with topical antifungal agents again to control symptoms. Genital warts commonly grow larger and difficult to treat in pregnancy. Podophyllin and Podophyllotoxin are contraindicated and therefore cryotherapy and surgical procedures are the preferred treatments. However relapse after treatment is common and often the warts do not fully resolve until after the baby is delivered. Genital herpes is common affecting up to 20% of young women although less than half have been diagnosed. The main importance is the risk of devastating congenital herpes, which affects approximately 1 in 5000 neonates in the USA and 1 in 33,000 in the UK. Current expert opinion advises performing a Caesarean section if there are active lesions detected when a mother presents in labour.