Understanding STDs in Pregnancy -- Treatment

What Are the Treatments?


HIV, the virus that causes AIDS, is spread through sexual fluids, or through sharing needles with, or exposure to blood from, an infected person. A baby can contract it from the mother before or during birth, or through breast milk.


It's recommended that all pregnant women — not just those at risk — be screened for HIV. If you are HIV-positive, you can significantly reduce the potential for transmission to the baby by taking the right medicines. But to get treatment and prevent infection, you need to know that you are infected. If your doctor or midwife hasn't offered you HIV testing, ask for it.



Chlamydia is caused by bacteria spread through sexual contact with an infected partner. In pregnant women, it's routinely tested for by checking the vaginal and cervical secretions and is easily treated with antibiotics such as amoxicillinazithromycin, or erythromycin. Even if you have been treated, you should be retested within three months to ensure the infection is truly gone, even if your partner has been treated. During pregnancy you should not use the antibiotic doxycycline because it can discolor your baby's teeth. Ointment is now routinely put in the eyes of newborns to prevent conjunctivitis due to a mother’s chlamydia infection, which can lead to blindness if not treated.


Genital Herpes

Genital herpes is caused by the herpes virus. It is transmitted through sexual contact with someone in whom the virus is active. There is no cure for genital herpes, but it can be managed. If tests show the virus to be active or you have a herpes genital lesion close to your delivery date, your doctor may recommend having a cesarean section instead of a vaginal birth. This will cut down the chance of the baby contracting the virus by contact with lesions in the birth canal. Acyclovirfamciclovir, and valacyclovir are all considered safe to take in pregnancy and there are no studies that show an increase in birth defects among women that have taken these drugs. It appears that they are safe and may be prescribed if medically indicated by your doctor. Daily suppressive treatment after 36 weeks may be prescribed by your doctor to reduce shedding of the virus prior to delivery  and hopefully prevent the need for a C-section delivery from a herpes outbreak.



Genital Warts

The human papillomavirus that causes genital warts is spread during sexual contact with an infected partner. Many women discover that they have been infected by HPV when they have an abnormal Pap test. Other women may notice the warts. Although the virus never leaves the body, the warts can be treated with surgery or medications.


Several other, extremely rare, problems related to HPV and pregnancy:


  • During pregnancy, warts may occasionally get larger. This is probably due to increasing levels of pregnancy estrogens. But they can be surgically removed — even in pregnancy — and preferably before labor to ensure a normal labor and delivery.
  • If warts on the external female genitalia, such as the labia, grow very large, this may sometimes prevent the baby from passing through the birth canal. Occasionally, cesarean section is required.
  • Warts located inside the vagina may make the vagina less elastic. This wart-infected tissue can tear and hemorrhage during a vaginal delivery.


Small warts require no treatment, while larger, more bothersome, ones may be treated by chemical burning with acids or by cutting them away. During pregnancy, medications such as podophyllin or podofilox should be avoided since they are absorbed by your skin and can cause birth defects in your baby. Imiquimod should be used only if potential benefits outweigh the risks. Babies rarely contract warts from their mothers, so the CDC generally does not recommend cesarean delivery for women with HPV. However, your doctor will suggest a cesarean if warts block the birth canal or if there is a danger of warts tearing and bleeding during delivery. Some women find that their warts go away after childbirth.


Because HPV may increase the risk of cervical cancer, be sure to get regular Pap smears if you have been infected — even if you've had the visible warts removed.



Bacteria spread through sexual contact with an infected partner cause gonorrhea. Oral antibiotics or an antibiotic injection can get rid of the bacteria. Both you and your sexual partners must be tested and treated, or the infection can recur. Routine pregnancy testing includes screening for gonorrhea in the vaginal and cervical secretions because it is such a common STD. Because gonorrhea can be present without symptoms, most doctors automatically treat the eyes of all newborns to prevent infection.



Hepatitis B

The transmission of hepatitis B virus occurs most commonly through sexual contact. However, it can be passed through all bodily fluids. This means you can catch it from kissing or sharing the toothbrush or IV drug needles of an infected person. A mother may carry the virus to their fetus during pregnancy or childbirth. A simple blood test done routinely in pregnancy can detect whether you are carrying the virus.


If a baby is born to a mother with the virus, the baby is given an injection of gamma globulin after birth, a vaccine within 12 hours of birth, and follow-up vaccines during the first six months of life. In many areas, newborns are routinely vaccinated against hepatitis B along with other immunizations given during infancy and childhood.


Anyone who works in a high-risk setting and is exposed to blood should get a vaccine against hepatitis B to prevent infection.



Syphilis is caused by bacteria spread through intercourse and other forms of sexual contact with an infected partner, such as oral sex and kissing. All pregnant women have routine blood screening for syphilis at the first prenatal visit. If you test positive, you can protect your baby from infection by taking a course of penicillin, which your doctor will prescribe for you. Women allergic to penicillin usually can be treated after a series of steps to make their bodies and immune system accustomed to the antibiotic. In order to avoid reinfection during your pregnancy and afterward, abstain from sexual relations with infected partners.



Trichomoniasis is an infection that can cause yellow-green vaginal discharge and pain with sex or when emptying the bladder. It can increase the risk of having a preterm baby. Rarely, the new baby can get the infection during delivery and have a vaginal discharge after birth. Usually an oral antibiotic called metronidazole (Flagyl) is given to treat trichomoniasis. It is the only drug that should be used to treat trichomoniasis if you are pregnant. Your partner should also be treated at the same time to prevent reinfection and further spread of the disease. You should get retested after three months to be certain the infection is gone, even if your partner has been treated.

WebMD Medical Reference Reviewed by Traci C. Johnson, MD on May 28, 2020


SOURCES: American Academy of Family Physicians. National Institutes of Health. National Institutes of Allergy and Infectious Diseases.

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