Module Five: Sexually Transmitted Infections in Pregnancy

Question 1

syphillis

Answer 1

screen all pregnancy

Question 2

syphillis mode of transmission

Answer 2

direct contact with syphyllis sore, sexual contact

Question 3

syphillis incubation period

Answer 3

primary 3-6weeks: chancre sore or sores (round firm raised painless
secondary: skin rash mucous membrane lesion palm and sore of feet.

Question 4

syphillis preventive measures

Answer 4

screen all women on first visit

RPR to confirmed with treponemal specific test

Question 5

syphillis sign & symptoms

Answer 5

may indistinguisable and unrecognized for many years.

Question 6

syphillis dx criteria

Answer 6

RPR reactive, confirmation w/ Treponemal-specific test

Question 7

syphillis - maternal effects

Answer 7

PTL
IUFD
neonatal infection
neonatal death

Question 8

syphillis treatment

Answer 8

single dose of PNC IM injection will cure infection <1 year

Question 9

Gonorrhea

Answer 9

screen ONLY for high risk people

** repeat test in 3rd trimester if dx in first **

Question 10

Gonorrhea risk factors

Answer 10

live in Southern U.S.A. 
young women between 15 to 24 y.o. 
Black
new partner
multiple sexual partner 
hx inconsistent condom use

Question 11

gonorrhea mode of transmission

Answer 11

oral
anal
vaginal
**contact with secretions from urogenital tract
vertical transmission–>ocular infection in neonate

Question 12

Gonorrhea signs & symptoms

Answer 12

dysuria
abnormal vaginal discharge or bleeding (if infected from the vagina)
sore throat
anal itching soreness & bleeding (painful BM)

Question 13

Gonorrhea dx criteria

Answer 13

NAAT
lymph node enlarge
mucopurulent
adnexal tenderness or CMT–> PID

Question 14

gonorrhea maternal effect:

Answer 14

PID
fallopian tube damage = infertility, ectopic pregnancy, & chronic pelvic pain
**disseminated Gonorrhea: join pain & rash

Question 15

gonorrhea fetal effect

Answer 15

preterm birth
OPHTHALMIA NEONATORIUM
pharygnitis
rectal infections
rare: pneumonia

Question 16

chlamydia

Answer 16

most reportable

PRENATAL SCREEN at first visit

Question 17

chlamydia mode of transmission

Answer 17

urogenital also orophragnx & rectum.

Question 18

chlamydia signs & symptoms

Answer 18

mostly mild or absent
abnormal vaginal discharge or dysuria most common
33% have urethral syndrome urethritis or Bartholin’s gland infection

Question 19

chlamydia dx criteria

Answer 19

NAAT (urine, cervical,vaginal or liquid cytology specimen)

Question 20

chlamydia maternal effects

Answer 20

PID, ectopic pregnancy & infertility

Question 21

chlamydia fetal effects

Answer 21

conjuntivitis

Question 22

chlamydia management

Answer 22

single dose of azithromycin
treat all sexual partner from last 60 days
abstain from intercourse until partner is treat for 7 days after single dose treatment or until she complete multidose treatment
should be test for other STI as co-infect frequently
pregnant women should be retest no sooner than 3 weeks after tx then rescreen again 3 month later or in the 3rd trimester

Question 23

Herpes

Answer 23

NO ROUTINE needed

>300,000 cases/year

Question 24

Herpes risk factors

Answer 24

young women & college students

Question 25

herpes s/sx

Answer 25

sore/lesion
vulvar pain
burning
itching

Question 26

herpes dx criteria

Answer 26

PRC - more sensitive 1-2 days result differentiate from type 1 or type 2
Glycoprotein G-based: blood draw can detect absence of lesion but more time recommended by CDC

Question 27

herpes treatments

Answer 27

acyclovir or valacyclovir for primary

secondary or suppressive therapy during last 4 weeks of pregnancy

Question 28

herpes vaginal births/c-section births

Answer 28

C/C for women with HSV perineal lesion in labor.

Question 29

human papillomavirus (HPV)

Answer 29

most common
no treatment for asymptomatic case
treatment is focus on warts & precancerous lesion

Question 30

human papillomavirus. incubation period

Answer 30

week to month & years.

Question 31

preventive measure HPV

Answer 31

Gardasil 
Cervarix (contraindicated for pregnancy)

Question 32

HPV maternal effect

Answer 32

no link to pregnancy complications

Question 33

HPV fetal effect

Answer 33

transmission is rare

spontaneous clear if infected –>respiratory papillomavirus.

Question 34

HPV midwifery care/counseling

Answer 34

no tx for virus. just for genital warts.
may grow larger
may bleed
if too large occlude birth vaginally need laser or surgical treatment
C/S is not needed to prevent transmission

Question 35

Bacterial Vaginosis

Answer 35

common in 10-30% during pregnancy

Question 36

Bacterial Vaginosis risk factors.

Answer 36

new partner/multiple partner 
smoker 
chronic stress
frequent or recent douching 
ethnic different

Question 37

BV signs & symptoms

Answer 37

odor, pain pruritist or burning

Question 38

BV dx criteria

Answer 38

odor (after sex) –> positive whiff test
wet prep clue cells
pH >4.5

Question 39

BV maternal effect

Answer 39

SAB
PTL 
LBW 
PPROM 
choriominitis 
Amniotic fluid infection 
Chronic BV may lead to PID

Question 40

BV treatment

Answer 40

metronidazole/clindamycin PO or Vaginal gel

Question 41

HIV

Answer 41

those infected with another STD are 2-5 x more become infected with HIV
women fastest grow in infection
SCREEN ALL PREGNANT women on 1st prenatal

Question 42

HIV mode of transmission

Answer 42

perinatal (most common route)

Question 43

HIV incubation period

Answer 43

days to week

acute HIV usually <10 days

Question 44

HIV signs & symptoms

Answer 44

fever night sweat fatigue rash HA lymphadenopathy

Question 45

HIV diagnostic criteria

Answer 45

ELISA (99.5% sensitive)
confirmed with Western Blot
Immunflorescene assay (IFA) –rapid available for unknown status & is in labor.

Question 46

midwifery management for HIV

Answer 46

complex & alterations in medical regimens outside of CNM scope
bottle feed instead breastfeed :o(