Gonorrhea and Pregnancy

If COVID-19 has taught us nothing else, we’ve learned that new diseases are cropping up all the time. And although COVID-19, regardless of the role close contact plays in its transmission, is not technically a sexually transmitted infection (STI), we’ve certainly had “newer” STIs such as HIV and hepatitis C front and center in recent decades.

Unfortunately, there are STIs we’ve known about since antiquity that are still with us. In recent blogs we’ve talked about many of the ones we’ve known about for a while—syphilis and chlamydia, for example. In this blog, we’ll discuss another one, gonorrhea: what’s old, what’s new, and what we still need to worry about.

Gonorrhea Basics

Gonorrhea comes from a type of bacteria that only affects humans. Outside the newborn period, it is almost exclusively sexually transmitted and can cause infection through the vagina, penis, rectum, or mouth. Of those four areas, the penis is most likely to show symptoms: a discharge and pain on urination. Vaginal symptoms may be similar but can be more subtle or even absent. It’s common for rectal and oral gonorrhea to cause no symptoms, although rectal gonorrhea may cause itching, pain, bleeding, or discharge.

Late complications in adults outside the reproductive tract aren’t seen that often these days, but it’s still worth knowing about them. They include damage to the heart and joints.

Gonorrhea and Pregnancy

Although no one should have to suffer a complication from gonorrhea, a major concern is what it might do to women who are trying to become pregnant or are pregnant. We also get concerned about how it can affect a newborn. Let’s explore these in more detail.

Untreated gonorrhea can lead to pelvic inflammatory disease. This affects a woman’s ability to become pregnant and may lead to infertility. It can also lead to ectopic pregnancy, which can put a woman’s health in jeopardy. For this reason, all women are tested earlier in pregnancy—and also later, if thought to be high risk.

Newborn can become infected during birth, and the big danger here is blindness from an eye infection. This is preventable to a great degree by putting medication in the eyes right after birth. Rarely, the germ can cause joint or blood infections in a young infant.

Gonorrhea Through the Ages: Recognizing, Preventing and Treating

The disease has been recognized for millennia and is even alluded to in several places in the Bible. This has led to many different treatments of varying effectiveness. Many, in the pre-antibiotic era, involved metals such as zinc, mercury, lead and silver. (Even I have been around long enough to put silver nitrate in a newborn’s eyes, according to the standard procedure of the hospital at the time!)

The arrival of antibiotics made gonorrhea much more treatable. However, the germ is a pretty smart one; early on, it began to develop resistance to antibiotics. This is still a challenge today, particularly since new antibiotics are not being developed at a rapid rate. Usually to avoid this, two medicines are used at the same time to treat the disease. And although affected individuals aren’t automatically retested, testing is very important for anyone who continues to have symptoms after treatment.

Your Gonorrhea “To Do” List

Anyone who is sexually active—particularly those under 25—should get periodic screening for STIs. It’s especially important if there are symptoms or if there is a change in partner. And you should absolutely have the test done if you are pregnant! Genital gonorrhea is tested either by taking a swab of the area or by obtaining a urine sample (rectal and oral gonorrhea require a swab).

Be honest with your provider about your risk for STIs. You may benefit from additional testing during your pregnancy. And during delivery, say yes to the preventive antibiotic for your little one’s eyes! No matter what your or your baby’s risk for gonorrhea, these measures are non-hazardous and the consequences of skipping them are too great. Finally, don’t hesitate to talk with your provider about your risk and, if applicable, ways to reduce it.

If you do have a positive test for gonorrhea, it’s important to notify any sexual partners. Most states have a notification system that can help with that if necessary.

Like it or not, the threat posed by gonorrhea I sn’t going away anytime soon. It’s still estimated that there are over 1 million cases per year in the United States. As we deal with everything else that is going on, let’s do what we can to keep STIs like gonorrhea off the back burner—and in doing so, help prevent its spread and its risks.

Stan Sack
Dr. Stan Sack has 29 years’ experience as a primary care pediatrician in Massachusetts and Florida. A medical writer since 2015, he enjoys blogging on topics that are on parents’ minds but are covered less often in books and on websites. He lives in the Florida Keys with his family and enjoys healthy cooking, fitness activities and singing in his spare time.

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