Gonorrhea in Pregnancy

Gonorrhea in Pregnancy

What do I have?

Gonorrhea is a sexually transmitted disease (STD) commonly known as "the clap." It’s contracted through vaginal, oral, or anal sex with a person infected with the Neisseria gonorrhoeae bacterium. However, not every exposure leads to infection.

Gonorrhea bacteria have proteins on their surface that attach to cells in the cervix or urethra. After the bacteria attaches, they invade the cells and spread. This reaction makes it hard for your body to defend itself against the bacteria, and your cells and tissue may be damaged.

In childbirth, gonorrhea can cause serious issues for your baby. Gonorrhea can be passed on from mother to baby during delivery, so it’s important to diagnose and treat gonorrhea before you have your baby.

How common is gonorrhea?

Gonorrhea is more common in men than in women, according to the Centers for Disease Control and Prevention (CDC). In women, gonorrhea infection usually occurs in the cervix, but the bacteria can also be found in the urethra, the opening of the vagina, the rectum, and the throat.

Gonorrhea is the second most commonly reported disease in the United States. In 2014, there were about 350,000 cases of gonorrhea reported. This means that there were about 110 cases per 100,000 people. This statistic was lower in 2009 when there were about 98 cases reported per 100,000 people.

Actual statistics for gonorrhea can be difficult to locate because some cases may be unreported. There are people who are infected but don’t show symptoms. Also, some people who do have symptoms may not see a doctor.

Overall, the incidence of gonorrhea in the United States has declined dramatically since 1975. This is mostly due to people changing their behavior because of fear of contracting HIV. Today there is also better screening and testing for gonorrhea.

Are some people more at risk than others?

High-risk factors for gonorrhea include:

  • being between the ages of 15-24
  • having a new sex partner
  • having multiple sex partners
  • having been previously diagnosed with gonorrhea or other sexually transmitted diseases (STDs)

Many infections in women do not produce symptoms until problems occur. For this reason, the CDC recommends regular testing of high-risk women, even if they don’t have symptoms.

What are the symptoms and complications of gonorrhea

Symptoms that some women may experience include:

  • discharge of yellow mucus and pus from the vagina
  • painful urination
  • abnormal menstrual bleeding

Rectal pain and swelling may occur if the infection spreads to that area.

Because so many women don’t show symptoms, infections often go untreated. If that happens, the infection can spread from the cervix to the upper genital tract and infect the uterus. The infection can also spread to the fallopian tubes, which is known as salpingitis, or pelvic inflammatory disease (PID).

Women with PID due to gonorrhea typically get a fever and have abdominal and pelvic pain. Bacteria that cause PID can damage the fallopian tubes, which can cause infertility, ectopic pregnancy, and chronic pelvic pain.

If gonorrhea isn’t treated it can also spread to the blood and cause disseminated gonococcal infection (DGI). This infection usually happens seven to ten days after the start of menstruation.

DGI can cause fever, chills, and other symptoms. Live gonococcal organisms can also invade joints and cause arthritis in the knees, ankles, feet, wrists, and hands.

Gonorrhea can also affect the skin and cause a rash on the hands, wrists, elbows, and ankles. The rash starts out as small, flat, red spots that progress into pus-filled blisters.

In rare cases inflammation of the tissues in the brain or spinal cord, infection of the heart valves, or inflammation of the lining of the liver, may happen.

Additionally, gonorrhea infection may make it easier to contract HIV. This happens because gonorrhea inflames your tissues and weakens your immune system.

What concerns are there for pregnant women?

Most pregnant women with gonorrhea don’t show symptoms, so you may not know if you’re infected. Pregnant women actually have some degree of protection against possible problems. For example, fetal tissues can help protect the uterus and fallopian tubes from infection.

However, pregnant women with gonorrhea can transmit the infection to their babies during vaginal delivery. This happens because the baby comes into contact with the mother's genital secretions. Symptoms in infected infants usually appear two to five days after delivery.

Infected infants may develop scalp infections, upper respiratory infections, urethritis, or vaginitis. They can also develop a serious eye infection.

The infection could also enter an infant's blood, causing generalized illness. As in adults, when the bacteria spreads throughout the body, it may settle in one or more joints, causing arthritis or inflammation of the tissues in the brain or spinal cord.

Eye infections in a newborn are rarely caused by gonorrhea. If this does happen, though, it can result in permanent blindness.

However, blindness caused by an eye infection from gonorrhea can be prevented.  Newborns are routinely given erythromycin ophthalmic ointment to prevent eye infections. The best way of preventing infection in infants less than 28 days old is to screen and treat the mother before labor.

Treatment, prevention, and outlook

Early diagnosis and treatment of gonorrhea is very important to prevent the disease from spreading. If your sexual partner(s) is infected you should be tested and treated.

Practicing safe sex and using a condom will reduce your chances of contracting gonorrhea or any STD. You can ask your partner to get tested and be sure to avoid sex with someone who has unusual symptoms.

Passing gonorrhea onto your newborn baby can cause serious infections. It’s important to remember that often there are not symptoms until problems have developed. Fortunately, antibiotic medication can cure most gonorrhea cases.

Having regular screenings when you find out you’re pregnant can reduce the risk of complications during your pregnancy. Talk to your doctor about screenings and be sure to tell them about any infections you have.

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