What general principles apply to managing STIs in pregnancy?

1. Screen antenatally (syphilis VDRL, HIV, hepatitis B; treat/screen others as indicated)
2. Use pregnancy-safe antibiotics (e.g. azithromycin not doxycycline; penicillin for syphilis)
3. Treat the partner(s) and advise on safe sex / barrier protection
4. Plan delivery to reduce vertical transmission (e.g. caesarean for primary herpes; neonatal eye prophylaxis; hepatitis B immunoprophylaxis)

Clinical relevance. A screen-treat-partner-plan delivery framework manages STIs in pregnancy and protects the neonate.

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Principles of managing STIs in pregnancy

STI management in pregnancy protects both mother and baby.

Screening

• Routine antenatal screening for syphilis (VDRL), HIV and hepatitis B; screen for others (chlamydia/gonorrhoea) where indicated.

Treatment

• Use pregnancy-safe antibiotics - e.g. azithromycin (not doxycycline) for chlamydia, ceftriaxone for gonorrhoea, penicillin for syphilis, topical clotrimazole for candida, metronidazole for trichomonas/BV.
• Aciclovir for herpes.

Partner and prevention

• Treat the partner(s) and advise barrier protection / safe sex to prevent reinfection.

Reduce vertical transmission

• Plan delivery - caesarean for primary genital herpes in the third trimester; neonatal eye prophylaxis where relevant; hepatitis B vaccine + immunoglobulin for the neonate; antiretrovirals for HIV.