STD's and Pregnancy

Are STD's in pregnant women common a common occurance? According to the Center for Disease Control there are an estimated 800,000 pregnant women infected with Bacterial Vaginosis, 800,000 infected with Herpes Simplex, and 80,000 infected with Chlamydia each year. An estimated 2 million pregnant women are infected with an STD each year.
If you are pregnant, think you may be pregnant, or trying to become pregnant, keeping the following list for your first maternity appointment might be a good idea. Additionally, if you know that you are pregnant you should ask your doctor about getting tested for the following sexually transmitted diseases: Chlamydia, Gonorrhea, Hepatitis B, Hepatitis C, HIV, Syphilis, and Bacterial Vaginosis. Some doctors do not routinely screen for the STD's listed here therefore you may have to specifically request to be tested for them, most health care providers are more than happy to accommodate your request.
Women who are pregnant can contract STD's during their pregnancy, therefore it is suggested that not only should you be tested for the STD's listed above when you become pregnant, usually during your first prenatal visit, but also later in your pregnancy as your due date approaches. Complications related to acquiring an STD while a woman is pregnant may actually be more severe for both the mother and the baby. These complications can be life threatening both for mother and baby! A pregnant woman with an STD may experience premature labor, early rupture of the membrane that protects the baby inside the womb, and infection of the uterus after she has delivered the baby.
HIV can infect the baby as it moves through the birth canal during delivery, or while the baby is still in the womb. HIV may also be passed from mother to infant during breast feeding as well. Some STD's such as Gonorrhea,Chlamydia,Hepatitis B, or Herpes can be passed from to mother to baby during vaginal child birth. Syphilis may be passed from mother to baby through the placenta while the baby is still in the womb. Women with pre-existing Genital Herpes should inform their doctor that they have been diagnosed with Herpes. Frequently, the doctor who delivers the baby will choose to perform the delivery by cesarean section or C-Section to avoid having the baby potentially exposed to Herpes.
If a pregnant woman is diagnosed with Chlamydia, Gonorrhea, Syphilis, Trichomoniasis or Bacterial Vaginosis both the mother and the baby can be treated with antibiotics during the pregnancy. However, a follow up test for STD's is often performed after the antibiotic treatment is complete to ensure the antibiotic was effective.
The best way to protect you and your baby from sexually transmitted diseases during pregnancy is through abstaining from unprotected sexual contact with non-monogamous sexual partners. Latex condoms can reduce your risk of contracting Gonorrhea, Chlamydia, Trichomoniasis, and HIV. However, condoms are only effective deterrents to contracting STD's with consistent and correct use. It is believed that condoms may not provide adequate protection against the transmission of Human Papillomavirus or Herpes. If you have questions or concerns regarding sexually transmitted diseases, their transmission, or testing related to STD's during pregnancy it is recommended that you seek the advice of your doctor.

HPV, Pap Tests, and Cervical Cancer

So you've put off your Pap test again, why? It's like driving down the interstate doing 85 mph while not wearing your seatbelt, it's so easy not to reach over, pull that seat belt over you and hear that comforting click. We know we shouldn't do it (not wear a seat belt), but somehow we still do. As you well know that type of avoidant behavior can be dangerous, there are thousands killed in auto accidents each year, many of which were not wearing their seatbelts. When we hear the news person tell us, "It is believed she wasn't wearing her seat belt", we look at each other with that knowing gaze, the question poised on our face. Why?
Why indeed? Don't we continually remind teenagers, loved ones, even ourselves, don't forget your seatbelt'! Putting off your Pap test can be an avoidant behavior similar to not wearing a seatbelt and nearly as dangerous. We know we shouldn't do it but somehow we still do. Approximately 20 million people or 15% of the U.S. population currently are infected with Human Papilloma Virus (1), a virus that is known to be attributable to cervical cancer. Not being medically screened for HPV puts you at risk for cervical cancer.
Read carefully: Approximately half of all cervical cancers occur in women who have never been screened (2). That is an amazing statistic! Do half of the people who have never been tested for HIV actually acquire HIV? No. At one time cervical cancer was responsible for more deaths in women than any other form of cancer! The advent of Pap screening has been the single most important factor in the dramatic decrease of mortality in women due to cervical cancer.
When should you get tested? Recommendations on scheduled screening from the US Preventive Service Task Force, the American College of Obstetricians and Gynecologists, and the American Cancer Society range from annually, to every 2-3 years. Several factors such as age of initial sexual activity (all recommend that girls get tested within 3 years of the onset of sexual activity), your current age, and results of prior tests all play a part in when it is recommended that a woman be screened for HPV. It is best to consult with your doctor as to when your next test should be and how frequently you should be tested; the important thing is to ask. If you have never been tested you should be tested as soon as possible.
A recent U.S. survey indicated that only 23% of women knew that HPV was a primary cause for cervical cancer, less than half of U.S. women were aware that HPV existed (3). Just as most people would probably prefer the protection of a seatbelt during an accident. Pap tests are a figurative seatbelt, they provide the opportunity of early identification and medical intervention for women facing the menace of HPV, and cervical cancer. If you have not been tested, or if it has been several years since you were last tested for HPV, pick up the phone, call your doctor or health clinic and make an appointment to do so! And remember to wear your seatbelt!

1. Cates W, Jr. Estimates of the incidence and prevalence of sexually transmitted diseases in the United States. American Social Health Association Panel. 1999

2. Hildesheim A, Herrero R, Castle P, et al. HPV co-factors related to the development of cervical cancer: results from a population-based study in Costa Rica. Br J Cancer. 2001

3. Association of Reproductive Health Professionals. HPV Survey Executive Summary. Available at www.ahrp.org/HPVsurvey/executivesummary.cfm

Dynamics of a Herpes Outbreak.

How many of the 45 million people in the U.S. infected with Herpes understand how Herpes lesions manifest in outbreaks? Unfortunately, I believe that very few people who have Herpes understand the viral disease process that is Herpes. Many are unaware that there are two primary Herpes viruses, Herpes Simplex Virus 1 (HSV1) and Herpes Simplex Virus 2 (HSV2). These two viral strains of Herpes are typically classified as Oral Herpes (HSV1) and Genital Herpes (HSV2). The list of myth, misinformation and urban legend ascribed to Herpes is so long that I would need to creat a seperate blog to discuss it. In this blog entry I will attempted to represent my understanding of the dynamics of a herpes outbreak in a manner that the average Joe or Joe Ann might comprehend . I do this not to insult your intelligence but to break through much of the confusing medical terminology that healthcare professionals so often utilize. To do this we must first look into how Herpes is contracted.




(I will concentrate on HSV2 for the sake of brevity, as I discuss Herpes throughout the remainder of this entry I simply will use HSV as the discriptor for HSV2.)




We contract (or get) HSV through "intimate" (sexual) skin to skin contact with another person who has HSV. It is important to note that the virus does not have to be located on the penis or vagina to be transmitted. As you well know there is alot of skin to skin contact going on when we have sex and the virus may be located anywhere in the gential region, it could be on the inner thighs, in the groin region, the pubic region (the area directly above and around the penis or vagina), it may even be located on the lower abdomen or buttocks.




When Herpes from one partner is transmitted to another partner the virus migrates through the skin of the person being infected, it attaches to a nerve found in the inner layer of skin. It then travels up that nerve until it reaches the spinal ganglia which are nerves that branch off of the spine. It is here (spinal ganglia) where the virus basically sets up shop.




So your probably thinking, if the virus lives in nerves that branch off of the spine how does it cause outbreaks of lesions in the genital region. I mean really come on it sounds alittle far fetched doesn't it, how does some little virus hanging out in nerves located near the spine cause these annoying outbreaks. Well periodically this little virus rears its ugly head and travels right back down that same nerve system it took on its way up to the area near the spine. As it moves along this nerve it can irritate the nerve, and an irriated nerve sends signals like itching, burning, tingeling sensations in the genital region where the outbreak will soon occur. Medical professionals who use complicated medical terminology that we don't normally understand call this the "Prodromal Syndrome". Now to me that just sounds scarry. What, now not only do you have to worry about this annoying virus but now theres a "syndrome" you have to deal with. Yikes! Well fortunately it's not as scarry as it sounds, I call this Prodromal Syndrome the "Outbreak Signal", ahh there that sound alot less scarry.


Usually about 12-24 hours after the "Outbreak Signal" signals begin the virus will manifest in the genital region as small fluid filled blisters (scarry medical term "Vesicular Lesions"), normally in or near the exact same area where it was initally "contracted". Not everyone with HSV will have this "Outbreak Signal". Some individuals who have HSV may never manifest lesions or may not notice that they have lesions representative of HSV. Others may have outbreaks about 4-5 times per year, some may have outbreaks more frequently, while still others may never manifest any signs or symptoms of HSV. These individuals who never manifest any symptoms yet still have HSV are said to by patients who "asymptomatically sheed" the virus.



Here we find another in the long line of medical terms that can be confusing. "Asymptomatic" sounds like a condition or state where someone has symptoms, or maybe only "A" or 1 symptom related to a disease process. To "asymptomomatically" sheed anything sounds like something I would really prefer not to have any part of. However, this confusing term means simply to be without symptoms (a=without). When one is considered Aphasic or to have Aphasia they are said to be unable to use or understand language or speech. A (without) + Phasia (speech) = Aphasia (without speech). Thus asymptomatic would mean without symptoms. So the person who is asymptomatic would sheed the virus through there skin yet show no symptoms.



Whats that you say, wait stop right here, hold up a minute, run that last part back again. OK, yes there are individuals who have HSV AND have no signs, symptoms, bruises, bumps, sores, lesions..... NOTHING. Ahhh, now your beginning to understand. Its a dangerous world we live in, isn't it. Yeah I see you nodding your head.



For those with HSV who do manifest lesions, the inital HSV outbreak usually takes about 2-4 weeks to occur after they are initially infected. The inital outbreak will typically last for 2-4 weeks after it first begins or after they first show symptoms. Subsequent outbreaks usually last for about 2-5 days. However, we are all differant, each of us have different immune systems so it is possible for each of us to have outbreaks that last for varying lengths of time and each of us can have outbreaks at differant intervals. There is no set timeframe for outbreaks to occur or for what each outbreak duration will be.



As you can see HSV can be a difficult disease process to understand, diagnose and treat effectively. I hope this short overview on the how a outbreak mechanically occurs has stripped away atleast a small bit of the medical mystery we have to overcome to understand how this virus operates in our bodies. There is much more information regarding HSV that I plan to discuss in the near future. The one sure thing about this blogs major topic sexual health is that it is an ever changing, evolving topic.



All my best and remember.... Don't Look Back >>>> Keep Moving Forward!