Gonorrhoea and pregnancy: time for action
Gonorrhoea and pregnancy: time for action |
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Key words: pregnancy, gonorrhoea, screening, and neonates
Case history
A two-day-old baby boy was diagnosed with gonococcal conjunctivitis in the Ophthalmology department, at North Riding Infirmary, Middlebrough and was appropriately treated in the Paediatric department. His mother was referred to the Genitourinary Medicine department for sexually transmitted infections (STIs) screening. The results showed that she was positive for gonorrhoea, chlamydia, bacterial vaginosis and candida vaginitis. She was treated with ciprofloxacin, deteclo (triple tetracycline), metronidazole and clotrimazole pessary. Her only male partner in the previous one-year attended the clinic and was screened for STIs. All the tests performed were negative. He was however treated epidemiologically for gonorrhoea and chlamydia. Mother and baby responded well to treatment.
Comments and discussion
The incidence of genital gonorrhoea infection is rising both at national and local levels. In age, most of the patients are in their second and third decades of life. Gonorrhoea infection is a good surrogate marker for risky sexual behaviour, and pregnancy is evidence of heterosexual activities. In England between 1997 and 2001
[1], there was 84% increase in the number of cases in men from 8418 to 15475, and a rise of 67% in females from 3981 to 6641, with an overall increase for both sexes of 78% (fig 1). In Middlesbrough, there was 162 % increase in the number of cases between 1995 and 2002, in males 129 % and females 340% (fig2). In Hartlepool between 1998 and 2002 the figures were 331%, 300% and 370% respectively (fig 3). The dramatic rise in the number of gonococcal infection especially in the females is of concern. The consequences in pregnancy are serious for the baby, and there is the possibility of tubal damage, which in future may result in infertility for the mother.
Pregnancy does not provide women or their babies any protection against STIs. Chlamydia trachomatis infection of the cervix can also be vertically transmitted to the newborn during delivery (2). The consequences of STIs can be serious to both mother and baby if the woman becomes infected while she is pregnant. Unfavourable consequences of STIs on the baby are many and they include still birth, low birth weight, conjunctivitis, pneumonia, neonatal sepsis, neurologic damage, congenital abnormalities, acute hepatitis, meningitis, chronic liver disease and cirrhosis.
Gonorrhoea can cause blindness, joint infection or a life threatening blood infection (septicaemia) in the baby. Prevention of neonatal infection should be principal goal of medical care in the newborn. The optimal method of prevention is the diagnosis and treatment of disease in the mother, so that exposure of the newborn does not occur. In this regard taking endocervical cultures of gonorrhoea in the first and third trimester need to be considered, especially in areas of high prevalence. New non-invasive nucleic acid and amplifications tests such as ligase chain reaction (LCR) for gonorrhoae and chlamydia screening urine tests are less intrusive and may be more acceptable. [3]
Those infected with N. gonorrhoeae should be treated with ceftriaxone 250 mg intramuscularly in a single dose. Pregnant women should not be treated with quinolones or tetracyclines as these have adverse effects on the unborn baby. The baby born to a gonococcal-infected mother should be treated with ceftriaxone 25-50mg/kg IV or IM, and this should not exceed 125 mg, in a single dose.
STIs affect women of every socio-economic and educational level, age, race, ethinicity, and religion. In the United Kingdom, HIV, syphilis and hepatitis B tests are offered to all pregnant women. Extending this to gonorrhoea and chlamydia should be strongly considered and encouraged.
All healthcare professionals – General practitioners, Obstetricians, Midwives and Paediatricians involved in the care of pregnant women need to aware of the rising incidence of STIs. Health education on matters of STIs should become part of standard antenatal care. General practitioner can help by providing the necessary information, midwives and obstetricians by offering the test and referring to GUM department for advice and counselling if found to be positive for STIs. Paediatricians if aware of the STIs in the mother can screen and treat the baby epidemiologically even if the tests are negative. This approach will prevent STI related complications in the mother and baby. The National Sexual Health Strategy (4) encourages Primary Care Trusts to take local initiatives to combat the rising trend of sexually transmitted infections. Now is the time for action. Further delay may be dangerous.
References:
©2002 Sexual Health Matters. Published Quarterly by Express Print Works, Middlesbrough,
UK
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