Pregnancy with Sexually

Transmitted Diseases

Li Lin
Sun Yat-sen Memorial Hospital

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 Sexually Transmitted Diseases
(STDs)

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 General Considerations

• A group of transmitted diseases mainly

transmitted by sexual behaviors
– sexual intercourse
– close body contact, kissing,
mouth-breast contact, anal intercourse
cunnilingus, anilingus, fellatio
– transplacental spread, passage through the birth
canal, lactation

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Pathogen

• Bacteria • Chlamydia
• Virus • Fungus
• Spirochete • Protozoon
• Mycoplasma • Parasite

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 Route of Transmission

• Sexual contact
• Direct or Indirect contact
• Hematogenous spread
• Mother-infant transmission
– Vertical transmission
– Intrapartum
– Postpartum

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• Syphilis
• Gonorrhea
• Condylomata Acuminata
• Acquired Immunodeficiency Syndrome
(AIDS)

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 Syphilis
(梅 毒)

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 Etiology

• Treponema Pallidum

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 Route of Transmission (1)

• Sexual contact (95%)

– strongest infectivity in 1st year for
untreated patients
– little infectivity after 4-yr infection
• Direct or indirect contact
• Hematogenous spread

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Route of Transmission (2)

• Vertical transmission
– Congenital syphilis
– 30% of fetal death
– Usually after 4-month gestation in
early syphilis
• Transmission of birth canal

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 Type & Stage of syphilis

• Acquired syphilis
–Early syphilis <2 yr
» Primary syphilis
» Secondary syphilis
–Late (tertiary) syphilis >2 yr
• Congenital syphilis
• Latent syphilis

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 Clinical Manifestations (1)

• Primary syphilis
– Painless genital sore (Chancre) on labia, vulva,
vagina, cervix, anus, lips, nipples
– Painless, rubbery, regional lymphadenopathy
followed by generalized lymphadnopathy in 3-6
weeks
– Darkfield microscopic findings
– Positive serologic test in 70% of cases

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Chancre
 Clinical Manifestations (1)

• Primary syphilis
– Chancre: painless genital sore on labia, vulva,
vagina, cervix, anus, lips, nipples
– Painless, rubbery, regional lymphadenopathy
followed by generalized lymphadnopathy in 3-6
weeks
– Darkfield microscopic findings
– Positive serologic test in 70% of cases

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 Clinical Manifestations (2)

• Secondary syphilis
– Syphilid: bilateral symmetric extragenital
papulosquamous eruption
– Condyloma latum, mucous patches
– Darkfield findings positive in moist lesions
– Positive serologic test for syphilis

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Syphilid
Syphilid
Syphilid
 Clinical Manifestations (2)

• Secondary syphilis
– Syphilid: bilateral symmetric extragenital
papulosquamous eruption
– Condyloma latum, mucous patches
– Darkfield findings positive in moist lesions
– Positive serologic test for syphilis

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 Clinical Manifestations (3)

• Tertiary syphilis (Late syphilis)

– Skin, bone lesion (gumma)
– Cardiovascular syphilis (aortic aneurysm or
insuffciency)
– Neurosyphilis (meningitis, tabes dorsalis, paresis)
– Ophthalmic, auditory lesions

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Gumma
 Clinical Manifestations (3)

• Tertiary syphilis (Late syphilis)

– Skin, bone lesion (gumma)
– Cardiovascular syphilis (aortic aneurysm or
insuffciency)
– Neurosyphilis (meningitis, tabes dorsalis, paresis)
– Ophthalmic, auditory lesions

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Aortic aneurysm

主
动
脉
瘤
 Clinical Manifestations (3)

• Tertiary syphilis (Late syphilis)

– Skin or bone lesion (gumma)
– Cardiovascular syphilis (aortic aneurysm or
insuffciency)
– Neurosyphilis (meningitis, tabes dorsalis, paresis)
– Ophthalmic, auditory lesions

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 Clinical Manifestations (4)

• Syphilis during pregnancy

– Highest infectivity in secondary syphilis
– Vertical transmission
– Congenital syphilis
– Abortion, premature delivery, fetal death, stillbirth

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 Clinical Manifestations (5)

• Congenital syphilis
– History of maternal syphilis
– Stigmata of congenital syphilis
• x-ray changes of bone, hepatosplenomegaly,
jaundice, anemia
– Often stillborn or premature
– Positive serologic test

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• Features
– premature
– dehydrated
– dystrophy
– anemia
Hepatosplenomegaly
Skin lesions
 Late congenital syphilis

• Active damages
– Gumma in the skin and mucosa
– Acute interstitial keratitis
– Periostitis, osteochondritis
• Marker damages
– Hutchinson triad signs
– Saber-shin

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 Hutchinson triad signs

• Hutchinson tooth

• Interstitial keratitis

• Nerve deafness
X-ray changes of bone
 Clinical Manifestations (5)

• Congenital syphilis
– History of maternal syphilis
– Stigmata of congenital syphilis
• x-ray changes of bone, hepatosplenomegaly,
jaundice, anemia
– Often stillborn or premature
– Positive serologic test

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 Laboratory Examinations (1)

• Identification of the pathogen

– Darkfield examination
– Silver staining

梅毒螺旋体镀
银染色
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 Laboratory Examinations (2)

• Serologic tests
– Nontreponemal tests
• Highly sensitive, nonspecific
• Screening, follow-up
– Treponemal antibody tests
• More sensitive and specific
• Remain positive after therapy

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 Treatment (1)

• Primary, secondary, early latent syphilis

– Procaine penicillin 0.8 million U/d im, qd× 10-15d
– Benzathine penicillin 2.4 million U im, qw× 3
– Doxycycline 0.5 qid×15d, orally
• nonpregnant penicillin-allergic patients
– Erythromycin 0.5 qid×15d, orally
• pregnant patients

Jarish-Herxhermer Reaction

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 Treatment (2)

• Late syphilis
– Procaine penicillin 0.8 million U/d im, qd× 20d
– Benzathine penicillin 2.4 million U im, qw× 3
– Doxycycline 0.5g qid×30d, orally
• nonpregnant penicillin-allergic patients
– Erythromycin 0.5g qid×30d, orally
• pregnant patients

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 Treatment (3)

• Congenital syphilis
– Procaine penicillin 50 hundred U/kg·d im, qd× 10-15d
– Benzathine penicillin 50 hundred U/kg·d, im ×1
– Erythromycin 7.5-12.5 mg/kg·d qid×30d, orally
• penicillin-allergic patients

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 Summarization

• Chronic STD caused by Treponema

• Sexual contact, vertical transmission
• Acquired and Congenital syphiils
• Early and Late syphilis
• Involvement of multiple systems
• Treatment of Penicillin

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 Gonorrhea
(淋病)

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 Etiology

• Neisseria gonorrheae
– Epithelium of the genitourinary tract

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 Clinical Manefestations (1)

• Adult patients
– Most affected women are asymtomatic carriers
– Purulent vaginal discharge, urinary frequency,
dysuria
– complicated gonococcal infections

– disseminated gonococcal infection

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Purulent discharge
 Clinical Manefestations (1)

• Adult patients
– Most affected women are asymtomatic carriers
– Purulent vaginal discharge, urinary frequency,
dysuria
– complicated gonococcal infections

– disseminated gonococcal infection

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 Clinical Manifestations (2)

• Neonates or children
– Gonorrheal conjunctivitis
• Delivery through an infected birth canal
– Vulvovaginitis
• Purulent vaginal discharge, dysuria,
urinary frequecy

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Vulvovaginitis in Children

Gonorrheal conjunctivitis
in neonates
 Clinical Manifestations (3)
• Gonorrhea during pregnancy
– Pregnant patients
• Abortion, intrauterine infection, premature delivery,
premature rupture of membrane
– fetus
• intrauterine infection, fetal growth restriction, fetal
death, stillbirth
– Neonates and children
• Gonorrheal conjunctivitis
• Vulvovaginitis
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 Laboratory Examinations

• Stained smear
– cervical or urethral
discharge
– Gram-negative diplococci
– Screening, low detection
rate in subacute stage

• Gonococcus culture
– Gold standard

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 Treatment (1)
• Uncomplicated infection
– Ceftriaxone (头孢曲松钠) 250mg，im×1
– Cefotaxime sodium (头孢噻肟钠) 1g，im×1
– Spectinomycin (大观霉素) 4g，单次肌注
• Patients cannot take cephalosporins or quinolones
• Plus
– Azithromycin(阿奇霉素) 1g×1，orally
– Doxycycline(多西环素 ) 100mg bid×7 ，orally

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 Treatment (2)

• Pelvic or disseminated infection

– Ceftriaxone (头孢曲松钠) 1g/d, im×10d
– Spectinomycin (大观霉素) 2g/d, im×10d
• Patients cannot take cephalosporins or quinolones
• Plus
– Metronidazole (甲硝唑) 400mg bid×10, orally
– Doxycycline (多西环素 ) 100mg bid×10, orally

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 Treatment (3)

• Gonorrhea during pregnancy

– Ceftriaxone (头孢曲松钠) 1g, im×1
– Plus Erythromycin (红霉素) 0.5 qid×7-10d, orally

• Neonates and Children

– Ceftriaxone 25-50mg/kg（≮125mg), im×1
– 1% Silver Nitrate (硝酸银液) eye drop

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 Condyloma acuminatum
(尖锐湿疣 )

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 Etiology

• Human papilloma virus (HPV)

– Type 6, 11

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 哈拉尔德·楚尔·豪森 弗朗索瓦丝·巴尔－西诺西 吕克·蒙塔尼
（Harald zur Hausen） （Françoise Barré-Sinoussi） （Luc Montagnier）
Harald zur Hausen
哈拉尔德·楚尔·豪森
Germany
 Human papillomavirus (HPV)

• Low-risk subtypes
– HPV 6, 11, 40, 42-44, 61
– Genital tract infection
• High-risk subtypes
– HPV 16, 18, 31, 33, 35, 39, 45, 56, 58
– Cervical cancer

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 Etiology

• Human papilloma virus (HPV)

– Type 6, 11

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 Clinical Manifestations

• Vulva and vagina,

perianal region
• Exophytic or
papillomatous
condyloma

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 Condyloma during pregnancy

• Mothers
– Massive proliferation, often difficult to treat
– Obstruction of birth canal
• Infants
– Rare intrauterine infection
– Laryngeal papilloma

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 Laboratory Examinations

• Pathology
– Vacuolated cells
• PCR detection
– HPV DNA

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 Treatment

• Before 36 –week gestation

– Local application
– Physical therapy, operation
– Treatments of sexual partners
• Perinatal period
– Vaginal delivery (localized foci)
– Cesarean section (diffuse foci)

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 Acquired immunodificiency
syndrome (AIDS)

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 Etiology

• Human immunodeficiency virus (HIV)

opportunistic

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 哈拉尔德·楚尔·豪森 弗朗索瓦丝·巴尔－西诺西 吕克·蒙塔尼
（Harald zur Hausen） （Françoise Barré-Sinoussi） （Luc Montagnier）
Human immunodeficiency virus (HIV)

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 Transmission Routes

• Sexual contact
• Blood contact
• Mother-infant contact
– Intrauterine infection
– Delivery
– Lactation

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Treatment Prevention

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 Summarization
• Syphilis
• Gonorrhea
• Condyloma acuminate
• AIDS
– Pathogen, transmission route
– Influence on fetus, neonate, chilidren
– Diagnosis, treatment, prevention

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