The impact of STIs on pregnancy

Nothing in this article is or should be construed as medical advice; for any medical questions, consult your healthcare professional.

If you’re thinking about pregnancy, trying to conceive or you’re pregnant, you may have questions and concerns about sexually transmitted infections (STIs), which affect millions of people in the U.S.¹ Here we explore the impact STIs have on pregnancy and why a preconception appointment, even if you don’t think you’re at risk, is important.

STIs and pregnancy — why testing is important

According to the Centers for Disease Control and Prevention (CDC) 2022 STI Surveillance Report, “In 2022, more than 2.5 million cases of syphilis, gonorrhea, and chlamydia were reported in the United States.”¹ You may not think you have an STI (and millions of people don’t!), but consider these facts:

• Many people don’t know they have an STI.²
• Some people have signs and symptoms of STIs, but many do not.²
• Sex isn’t the only way STIs are shared. For example, some STIs (such as syphilis, herpes and HIV) can be shared if you touch an infected person’s genitals or kiss someone who has an infected sore.²
• Some people believe pregnancy protects you from STIs — this is a myth.²
• STIs can cause many serious complications for babies, which is why testing and treatment are key.²

Talk to your healthcare professional about STIs and pregnancy before you start trying to get pregnant. If you get pregnant unexpectedly, you should speak to your healthcare professional to discuss testing. Testing can protect you and your baby. Let’s dive a little deeper.

Syphilis and pregnancy

Syphilis is on the rise.³ According to the CDC, “There were more than 3,700 babies born with syphilis in 2022, over 10 times the number reported in 2012.”³ If you have unprotected sex with someone who has syphilis or you kiss — or touch — a syphilis sore on someone who is infected, you are at risk.^2,4 You may have syphilis and not know it. Syphilis may not cause signs or symptoms immediately after exposure, which can create a false sense of security.⁵ But here’s the good news: Regular testing and early treatment can combat early pregnancy loss, stillbirth, newborn death, and many (sometimes severe) health complications that can affect your baby very early on and throughout their life.^2,4 Additionally, if left untreated, syphilis can enter the secondary stage, with signs and symptoms that may include warts in the vulva area, a rash (commonly on the hands and feet) and feeling like you have the flu.⁴ The American College of Obstetricians and Gynecologists (ACOG) recommends syphilis screening during your prenatal appointment — some states are now even requiring it at delivery.⁴ If a blood test shows you have syphilis, your healthcare professional will prescribe antibiotics (and yes, it’s OK to be treated throughout your pregnancy).^2,4

HPV and pregnancy

Human papillomavirus (HPV), which can be transmitted during sex via direct skin-to-skin contact, is very common, often shows no signs or symptoms, and can clear up without treatment.⁶ But sometimes, if untreated, HPV can cause genital warts and some kinds of cancer, including cervical cancer.⁶ HPV genital warts can worsen during pregnancy, so much so that they can sometimes obstruct the vagina, requiring a cesarean (C-section).² You can also pass HPV to your baby.² Thankfully, there’s an HPV vaccine! The CDC recommends getting vaccinated for HPV at age 11 or 12.⁶ If you haven’t had the HPV vaccine, some notes:

• If you are 26 years old or younger, not pregnant, and you didn’t get the vaccine or you didn’t get both doses of the vaccine when you were 11 or 12, the CDC recommends you get vaccinated or complete your vaccination series.⁶
• If you are 26 years old or younger and pregnant, the CDC recommends waiting to get the HPV vaccine until after the pregnancy is complete.⁶
• If you are older than 26, the CDC recommends regular screening, including Pap and HPV tests.⁶
• Your healthcare professional may recommend a Pap test, which screens for cervical cancer.⁶

Genital herpes and pregnancy

You can get genital herpes if you have sex with an infected person, come in contact with infected genital fluids or touch an infected person’s genitals.⁷ If pregnant, genital herpes can lead to infections in the baby’s brain, lungs, liver, kidneys, eyes, skin and mouth, and may be fatal.² Your healthcare professional may order a blood test or check you for sores.⁷ Take precautions to reduce your risk of genital herpes while pregnant.⁷ Having an open conversation about genital herpes with your healthcare professional is important. If you do have genital herpes and you are pregnant, your healthcare professional may recommend medication near the end of your pregnancy and/or a C-section.⁷ Regular prenatal appointments are key.⁷

Chlamydia and pregnancy

You can get chlamydia, caused by a kind of bacteria, if you have sex with someone who is infected.⁴ Even though chlamydia doesn’t always cause signs or symptoms, an untreated infection can cause pelvic inflammatory disease (PID), affecting fertility and thereby making pregnancy difficult or impossible.⁸ ACOG recommends yearly screening for chlamydia if you’re younger than 25 or at risk.⁴ Ask your healthcare professional about testing for chlamydia during the first prenatal appointment.⁸ Chlamydia can cause an ectopic pregnancy or preterm delivery; there’s also a chance you may pass it to your baby during delivery, which could lead to pneumonia or an eye infection.⁸ If you have chlamydia, your healthcare professional will prescribe an antibiotic.⁴ Sometimes newborns are prescribed an antibiotic eye ointment.⁵ According to the CDC, “Testing and treatment are the best ways to prevent health problems” while pregnant.⁸

Gonorrhea and pregnancy

Gonorrhea is similar to chlamydia in that it’s also caused by a bacteria you can be exposed to if you have sex with someone who is infected.⁴ Gonorrhea left untreated can lead to pelvic inflammatory disease (PID), which can cause fertility problems.⁹ ACOG recommends annual screening for gonorrhea if you’re younger than 25 or at risk.⁴ In pregnancy, gonorrhea can cause early pregnancy loss, preterm delivery, a birth weight that’s too low, and joint, eye, or blood infections, and the baby may experience blindness.⁵ Treatment is an antibiotic, whether you’re pregnant or not, and an antibiotic eye ointment for your newborn if you had gonorrhea while pregnant.⁵

Trichomoniasis and pregnancy

Trichomoniasis, which is caused by a parasite, is spread by unprotected sex with an infected individual.¹⁰ Like many other STIs, you may or may not have signs or symptoms.¹⁰ Trichomoniasis matters during pregnancy because having an infection, with or without symptoms, can lead to preterm delivery and/or a low birth weight.¹⁰ If there is a suspicion of trichomoniasis, your healthcare professional may order a lab test.¹⁰ Luckily, trichomoniasis is easily treated with prescribed medication that can also be taken during pregancy.¹⁰

HIV and pregnancy

If you have HIV, your partner has HIV, or either of you is at risk for HIV, it’s important to have a conversation with your healthcare professional before getting pregnant. Testing for HIV is important too.¹¹ Treating HIV with antiretroviral therapy (ART) can help protect you and your baby.¹¹ According to HIV.gov, “If you have HIV and take HIV medicine as prescribed throughout your pregnancy and childbirth and give HIV medicine to your baby for 2-6 weeks after giving birth, your risk of transmitting HIV to your baby can be less than 1%.”¹¹ If you want to get pregnant but your partner has HIV, talk to your healthcare professional about the possibility of taking pre-exposure prophylaxis (PrEP), which can keep you safe from contracting HIV while having sex.¹¹

Many people don’t have an STI, and even if you do, a healthy pregnancy is possible. The most important takeaway in all of this? Talk to your healthcare professional about STIs sooner rather than later when planning a pregnancy. Consider syphilis: According to the CDC, “Timely testing and treatment during pregnancy can help keep people healthy and might have prevented 9 out of 10 newborn syphilis cases in 2022.”³ Your healthcare professional can recommend appropriate testing and treatment for your situation.

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