This section looks at the Human Immunodeficiency Virus (HIV) and sexually transmitted infections (STIs), and how they can affect you in pregnancy and childbirth.
At the end of the section, there is information on other vaginal infections, which can affect you during pregnancy, and also some information on how to reduce your risks of getting HIV or an STI.
HIV is a virus, which affects the body’s immune system so that it cannot fight off infection. HIV can be passed on from one person to another through close/intimate sexual contact. There are approximately 100,000 people in the UK who are HIV positive, 30,000 of which do not know they are infected. As most people with HIV look and feel well, you cannot tell if you or your partner has it without being tested.
It is important to test pregnant women for HIV antibodies as treatment of HIV can reduce the chance of passing the virus onto the baby during pregnancy, during the birth or when breastfeeding. It is now routine to test pregnant women for HIV antibodies when they attend antenatal clinic for their ‘booking’ appointment (this is usually when you are between 11-14 weeks pregnant). The test is included in the routine ‘booking bloods’, so involves having a sample of blood taken. HIV testing in pregnancy now accounts for approximately 750,000 tests per year, and 99% of the results are negative.
If the test shows that you are HIV positive, you will be given information about the benefits of antiretroviral drug therapy to you and your baby, how the baby is born (whether a caesarean section is recommended) and if breastfeeding should be avoided.
It is important to remember that HIV treatment is so good now that people with HIV can live long and happy lives, which includes becoming a parent.
Chlamydia is the most common curable STI in the UK. If you are under 25 years of age, you have a 1 in 10 chance of having this infection. Most women (70%) with Chlamydia do not know that they are infected, as they will have no signs or symptoms.
Untreated Chlamydia can cause complications in pregnancy; it can infect the lining of the womb and be passed onto the baby during childbirth, which can lead to infection of the baby’s eyes and lungs. These complications can easily be prevented by taking antibiotics if you are found to have Chlamydia whilst pregnant.
If you under 25 years of age, you will routinely be offered a Chlamydia test in the antenatal clinic. The test simply involves providing a urine sample, which is then sent to the labs to be tested.
If the test is positive, you will be referred to the Genitourinary Medicine (GUM) clinic. You will be given some antibiotic tablets (this treatment may be given to you by your midwife). It is really important that your partner is tested and treated (if appropriate) so that you do not become re-infected.
Gonorrhoea is a common bacterial infection that can cause an unusual discharge from the vagina, and it can also cause pain when passing urine, bleeding following sex and itching in the genital area. It is transmitted by intimate sexual contact, including oral and anal sex.
If you are pregnant and think you may be infected with gonorrhoea, it is really important that you get tested as it can cause ectopic pregnancy, miscarriage, preterm labour, premature rupturing of the membranes, infections of the amniotic sac and fluid and many other problems. During childbirth it can be transmitted to the baby as it passes through the birth canal, which can cause eye problems (conjunctivitis) if left untreated.
Gonorrhoea is easily diagnosed by having a simple swab test and it is effectively treated with antibiotics. Your partner will also need to be screened and, if appropriate, treated with antibiotics. You will also be referred to the GUM clinic. If it is left untreated, it can cause long term problems including infertility.
Genital herpes is caused by the Herpes Simplex Virus (HSV) and is a long-term condition, which affects approximately 15 million people in the UK. It is similar to the virus that causes ‘cold sores’. Once a person is infected, the virus can lay dormant (inactive) for long periods of time. If you do get symptoms, you may develop sores in the vaginal, anal, upper thigh areas. It is transmitted by having intimate sexual contact, including oral and anal sex.
You may not know you have been infected as there are often few or no initial symptoms. Some people notice a tingling or burning sensation around their genitals or rectum followed by the appearance of small, painful red sores / blisters. These blisters typically heal within four weeks. You may also experience additional symptoms, including fever, swollen lymph glands, muscle aches, and pain when passing urine. The virus can be dormant or active (known as outbreaks) a number of times each year, although this is thought to lessen over time.
Certain triggers can activate the virus causing outbreaks of painful blisters in the genital region. Pregnancy can trigger an outbreak of herpes, and this may in some circumstances be transmitted to the baby during childbirth. If you contract herpes during pregnancy, your baby is at risk of contracting the virus and becoming ill. This can cause brain damage, eye problems, and rashes in newborns. It can also increase the risk of preterm labour or stillbirth. If you have an active herpes outbreak during labour, you may need to have a caesarean section to reduce the baby’s chances of contracting the disease.
Herpes is usually diagnosed by having a physical examination, although a swab test of the area may be taken. Whilst herpes is incurable, it is easily treated and can be effectively controlled using antiviral medication.
Genital warts are small fleshy growths/bumps that appear on around the genital and anal area. They are caused by a viral skin infection caused by the Human Papillomavirus (HPV). Genital warts are spread by skin-to-skin contact, so you do not have to have penetrative sex to be infected by them. It is one of the commonest STIs in the UK, with some estimates stating that 50% of the population is infected with the HPV. There are over 100 strains of HPV with approximately 30 of them being transmitted via sexual contact. Some strains can be very serious and cause vulval, cervical or penile cancer. It is really important that women attend for regular cervical smear tests.
The HPV strain that causes genital warts can cause problems in pregnancy as the warts can grow very large, making passing urine difficult. They can also block the birth canal during delivery, making a caesarean delivery the safest option. In rare circumstances, the wart virus can be transmitted to the baby during delivery and the warts can grow in the baby’s throat making breathing difficult.
If you think that you may have genital warts, it is important that you get assessed by a doctor or nurse who specialises in sexual health. If the warts are not visible, a simple swab test (soaked in acetic acid) of your genital region can diagnose if the wart virus is present.
Whilst there is no cure for genital warts, they are easily treated by either using creams or cryotherapy (freezing the warts). If the warts are extensive, this may require specialist treatment.
Bacterial Vaginosis (BV) is a common condition which affects one in three women. It occurs when the amount of good and bad bacteria in the vagina becomes out of balance, and the bad bacteria grow and outnumber the good bacteria. It can cause a fishy smelling greyish discharge from the vagina.
Whilst BV is not sexually transmitted, it can be associated with having sex with a new partner.
If you think that you have BV, you should go and see your Health Care Provider (HCP) and get checked out. This involves having a simple vaginal swab test. Your HCP may also discuss testing you for STIs as there is evidence to suggest that having BV makes women more likely to get an STI, because the reduction in good bacteria reduces your body’s protective defences against getting another infection. If you are diagnosed with BV, it is easily treated with antibiotics, even while you are pregnant.
It is really important in pregnancy to treat BV as if left untreated it can cause:
- Miscarriage – women with BV are 6 times more likely to have a miscarriage at any stage in pregnancy than other women.
- Premature labour – women with BV are twice as likely to have a baby before the 37th week than other women.
- Rupture of the amniotic sac before the baby is ready to be born (this is also called spontaneous rupture of membranes).
- Chorioamnionitis– an infection of the chorion and amnion membranes (the membranes that make up the amniotic sac) and the amniotic fluid (the fluid that surrounds the foetus).
- Post-partum endometritis – irritation or inflammation of the lining of the womb after giving birth.
Candida albicans (also known as thrush, candidosis or candidiasis) is a yeast or fungal infection, which is frequently present in the vagina but does not usually cause any symptoms because its growth is kept under control by normal bacteria.
If your immune system is affected in any way, for example, if you are on antibiotics, under a lot of stress or pregnant, the fungus can grow and cause itching, irritation, redness, and soreness and swelling of the vagina and vulva. You may also get a thick, creamy/lumpy discharge, but it will not smell unpleasant.
During pregnancy your body changes in many ways and makes it more likely that you will develop thrush, especially during the third trimester of pregnancy. Whilst this may cause you some discomfort, there is no evidence that thrush can harm an unborn baby.
Thrush can be treated with cream and a pessary (a tablet inserted in the vagina) that contains clotrimazole or a similar antifungal drug. If you are pregnant, you should speak to your GP or pharmacist before using treatments for thrush. Thrush can also be treated with antifungal tablets called fluconazole. However, if you are pregnant, trying to get pregnant, or breastfeeding, you should not take anti-thrush tablets.
If you have thrush when your baby is born, the baby may catch it during the delivery. This is nothing to worry about, and can easily be treated.
With all STIs and HIV, you can significantly reduce your chances of contracting the infections or viruses by:
- Reducing your number of sexual partners.
- Always using a condom or dental dam during sexual activity.
- Not sharing sex toys.
- Frequent testing for STIs and HIV and encouraging your partner to get tested too.
These are all still relevant if you are pregnant and either you or your partner has been diagnosed with STI or HIV.