From the Guidelines
Gonorrhea during pregnancy poses serious risks to both mother and baby if left untreated, and pregnant women with gonorrhea should be treated immediately with ceftriaxone 250 mg intramuscularly and either azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days, as recommended by the CDC 1. The infection can lead to premature labor, premature rupture of membranes, and chorioamnionitis (infection of the amniotic fluid). For the baby, untreated gonorrhea can cause conjunctivitis (eye infection) that may lead to blindness, as well as serious infections like sepsis if the bacteria is transmitted during delivery. Some key points to consider include:
- Gonorrhea is caused by the bacterium Neisseria gonorrhoeae, which can ascend from the cervix to the upper reproductive tract, increasing risks of complications.
- All pregnant women should be screened for gonorrhea at their first prenatal visit, with additional testing in the third trimester for those at high risk, as recommended by the US Preventive Services Task Force 1.
- Partners should also be treated to prevent reinfection.
- Testing for other sexually transmitted infections is recommended as co-infections are common.
- After treatment, a test-of-cure should be performed 1-2 weeks later to ensure the infection has cleared. It is essential to note that the CDC no longer recommends cefixime at any dose as a first-line regimen for treatment of gonococcal infections due to declining cefixime susceptibility among urethral N. gonorrhoeae isolates 1.
From the Research
Risks of Gonorrhea During Pregnancy
The risks of gonorrhea during pregnancy are numerous and can have severe consequences for both the mother and the baby. Some of the risks include:
- Premature birth: Gonorrhea has been associated with an increased risk of premature birth, which can lead to a range of health problems for the baby 2, 3, 4.
- Low birth weight: Gonorrhea has also been linked to low birth weight, which can increase the risk of health problems for the baby 2, 3.
- Chorioamnionitis: Gonorrhea can cause chorioamnionitis, an infection of the membranes surrounding the baby, which can lead to premature birth and other complications 4.
- Intrauterine growth retardation: Gonorrhea has been associated with intrauterine growth retardation, which can increase the risk of health problems for the baby 4.
- Premature rupture of membranes: Gonorrhea can cause premature rupture of membranes, which can lead to premature birth and other complications 4.
- Disseminated gonococcal infection: Gonorrhea can also cause disseminated gonococcal infection, a serious condition that can affect the mother and the baby 5.
- Neonatal infections: Gonorrhea can be transmitted from the mother to the baby during birth, causing neonatal infections such as gonococcal ophthalmia neonatorum 5.
Maternal Risks
Gonorrhea during pregnancy can also pose risks to the mother, including:
- Endometritis: Gonorrhea can cause endometritis, an infection of the lining of the uterus, which can lead to pelvic pain and other complications 5.
- Pelvic sepsis: Gonorrhea can also cause pelvic sepsis, a serious condition that can affect the mother's health 5.
- Recurrence or persistence of positive cultures: Gonorrhea can recur or persist during pregnancy, requiring repeated treatment and increasing the risk of complications 4.
Importance of Treatment
It is essential to treat gonorrhea during pregnancy to prevent these complications and ensure the best possible outcomes for both the mother and the baby. Antibiotics such as ceftriaxone and spectinomycin have been shown to be effective in treating gonorrhea during pregnancy 5, 6. However, the evidence is inconclusive, and more research is needed to determine the most effective treatment regimens 5.