Ep 48: How Sexually Transmitted Infections (STIs) Can Affect Pregnancy and Babies

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Sexually Transmitted Infections (STIs) are a common part of life, though many of us are afraid or ashamed to talk about them. In reality, 50% of adults will have an STI at some point in our lives. This includes pregnant women, and there shouldn't be any stigma associated with having an STI.

Having or contracting an STI during pregnancy happens to many people and it's important to know how STIs can affect your pregnancy and your baby. Today I'm running through five common STIs - chlamydia, gonorrhea, syphilis, herpes, and human papillomavirus (HPV) - to talk about the treatment for each.

Treatment for STIs during pregnancy can  be a little different than normal treatments, but it's important to catch infections early so that they don't spread to your baby. Many STIs can only reach baby during the actual birth process, but some can cross over the placenta - so it's best to know what your options are early on.

Remember that STIs don't mean anything about your worth - they should just be treated as a health issue that can treated for the benefit of both mom and baby.

In this Episode, You’ll Learn About:

  • Why we have switched over to the term STI instead of STD 
  • What STI tests you can expect in your first trimester and why we run them
  • How each of these STIs can affect you during pregnancy 
  • Which of these STIs can affect your baby during pregnancy and which can only be transmitted during birth
  • How each of these STIs can be treated during pregnancy
  • Why it's important to get an accurate diagnosis of the phase of Syphilis, herpes, or HPV you are in

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Speaker 1: Warning, this episode contains a more adult subject matter. I'm talking about how sexually transmitted infections affect pregnancy.

Speaker 2: Welcome to the All About Pregnancy & Birth podcast. I'm your host, Dr. Nicole Calloway Rankins, a board certified Ob Gyn physician, certified integrative health coach and creator of The Birth Preparation Course, an online childbirth education class that will leave you feeling knowledgeable, prepared, confident and empowered going into your birth. Quick note, this podcast is for educational purposes only and it's not a substitute for medical advice. You see the full disclaimer at www.ncrcoaching.com/disclaimer.

Speaker 1: Well hello there everyone. Welcome to another episode of the podcast. This is episode number 48 and as always I'm glad you're here today. I hope you are having a wonderful, wonderful day. All right. In today's episode I'm talking about something that can be a bit tough to discuss and that is how sexually transmitted infections affect pregnancy. We've gotten away from saying disease because that has sort of a stigma associated to it. So sexually transmitted infections, STI's and how they affect pregnancy. And this is hard to talk about because unfortunately there is still a lot of stigma surrounding STI's in our society. They've historically been associated with promiscuity. However, I just want to say right up front that nothing could be further from the truth. It only takes one encounter to get infected with an STI. And oftentimes people are asymptomatic. So STI's are actually fairly common.

Speaker 1: It's estimated that 50% of sexually active people will have at least one STI by age 25, the most common being HPV. So to be clear, getting a sexually transmitted infection does not mean you're damaged goods. It does not mean there's something wrong with you or that you somehow have low moral values or anything like that. It just means you have an infection that was acquired from sex. And that is it. So what I'm going to do today in this episode is talk about how five common STI's affect pregnancy and babies. I'm going to talk about chlamydia, gonorrhea, syphilis, herpes and HPV or the human papillomavirus. Now I could have also potentially talked about HIV and hepatitis. They are also sexually transmitted, but they're also transmitted by blood, so I felt like they were a little bit more complex and probably could deserve episodes each on their own. So I'm just going to focus on those five, chlamydia, gonorrhea, syphilis, herpes, and HPV.

: All right, now before we get into the episode, let me take a moment and remind you that if you have not already started making your birth plan or birth wishes you need to start doing so, it's not too early to start making your birth wishes and I have a wonderful resource to help you. It's a free online class called how to make a birth plan that works. It's an amazing class, women love it, there's lots of great information. See, making your birth plan is about so much more than a template or form that you fill out. It's really about asking your doctor some questions and getting information about the hospital so that you have the best chances of having the birth that you want. So I'll cover all of this information in the free class. You can sign up for it at www.ncrcoaching.com/register.

Speaker 1: The other great thing about the class is that if you go through the class, you get access to an amazing discount on my signature online childbirth education class, The Birth Preparation Course. The Birth Preparation Course leaves women knowledgeable, prepared, confident and empowered to have the birth that they want. So you can check out the class at www.ncrcoaching.com/enroll. But again to get that nice discount, check out the free online class first and that's www.ncrcoaching.com/register.

: All right, so let's go ahead and hop into today's episode. So most women, as I mentioned a couple episodes back on prenatal tests that are done during pregnancy, I should say all women actually are routinely screened at the initial prenatal visit for sexually transmitted infections, specifically HIV, syphilis and hepatitis B. And if you're younger than 25 or have other risk factors, then you will also be screened for chlamydia and gonorrhea, although some providers routinely screen for those as well. And the reason that we screen for sexually transmitted infections is that they can have bad effects on your pregnancy. They can have effects on your partner if your partner contracts them. Although I'm not going to talk about the effects on partners today, and they can also have an effect on your baby. So that's why we check these conditions and treat these conditions as appropriate because they can really have some serious effects.

: So first up, I want to talk about chlamydia and chlamydia trachomatis, that's the long name for it. So chlamydia is the most common bacterial sexually transmitted infection in the United States and it's estimated that up to about 20% of pregnant women will be infected with chlamydia. It tends to be more common in young adult women and also adolescents. Now the thing about chlamydia is that it is most often asymptomatic meaning that you have no idea that you have the disease. It's very common, not just common, but like almost standard that women who are infected with chlamydia don't have any symptoms. That's very, very common. All right. Now as far as what chlamydia will do to a pregnancy, one of the biggest things that it does is increase the risk of ectopic pregnancy. So if you get chlamydia when you're not pregnant and that chlamydia progresses to a more severe form of disease called pelvic inflammatory disease, that increases the risk of having an ectopic pregnancy in the future. And an ectopic pregnancy is a pregnancy that implants outside of the uterus and it can be potentially life threatening.

: Now chlamydia infection during pregnancy can increase the risk of your water breaking early, can increase the risk of preterm delivery and can also increase the risk of your baby being born at a low birth weight. Now as far as the risk for babies, a baby born to a mom that has chlamydia, that baby is at risk for developing conjunctivitis and most often affects the eye. Chlamydia can affect a baby's eye or it will also affect pneumonia or also cause pneumonia, I should say. Now, chlamydia is primarily transmitted to babies by the baby being exposed to the mother's genital area and what's called the flora, which is all the bacteria that live in the vagina. So if there's chlamydia within that flora, the baby gets exposed to it and the baby can get infected. The risk of a baby acquiring chlamydia is actually quite high. If mom has chlamydia, then the risk is at least 50% that baby will get chlamydia. And again, this is at the time of delivery, not during pregnancy, but at the time of delivery. If mom has active chlamydia, 50% of the time, that baby will get chlamydia. And in some studies it's been shown to be as high as 60 or 70% of the time. Now, vaginal birth carries the highest risk of transmission, which makes sense. You know, when the baby gets exposed to the actual bacteria, then that risk is going to be highest.

Speaker 1: But there is also a small risk of it happening by cesarean birth, both if the water is broken and if the water has not broken. So what do we do if you are diagnosed with chlamydia during pregnancy? Well, thankfully it can be treated very easily. It's a medicine called azithromycin. It's a one time dose, one gram of azithromycin and that's it. It's very, very effective at treating chlamydia. Now if for some reason you have an adverse reaction to that medicine or an allergy, there are some other regimens that are available, but they are going to be for 7 to 14 days. Azithromycin is just a one time dose and you're good to go. Now after you get treated then we need to do a test of cure. So what that means is test to make sure that the infection has actually gone away. Cure rates are a bit lower during pregnancy compared to non pregnant women. So we really do need to be sure that the infection has gone. So we do a test of cure no sooner than three weeks after you take the medicine and it's important to wait for that three weeks to give it time for the bacteria to completely clear from your system. And then it's also recommended that whether you have chlamydia outside of pregnancy or not, that you get a followup test three months later to make sure that things are still okay.

: Now, as I mentioned, the way that chlamydia shows up in babies is conjunctivitis and pneumonia for the conjunctivitis. The good news is that if it's treated, it usually results in healing without any complications. However, if it's not treated, then the infection can actually linger on for months and can even cause corneal scarring or scarring of the conjunctiva and the eye. So it's really important to recognize it and treat it. As far as the pneumonia, the pneumonia tends to be treated easily as well. So as far as preventing chlamydia infection for babies, really the best thing that we have is routinely screening pregnant women at the initial visit. And I don't think I said earlier, but women should also be rescreened not just for chlamydia, but for all sexually transmitted infections. They should be rescreened in the third trimester if they're considered to be at higher risk. So had it before, new partner, concerned that a partner's having multiple sexual partners. There a few things that would prompt us to retest again in the third trimester. Now, unlike the next bacteria that I'm going to talk about, gonorrhea, there is no way to do prophylaxis against the eye infection for gonorrhea. There's an ointment we put in the eye and I'll talk about that in a second, but that ointment does not work for chlamydia infection. Okay, so that is it for chlamydia.

: Let's talk about gonorrhea. So gonorrhea is actually not very common among pregnant women in resource rich countries like the United States, it's estimated that it occurs in less than 1% of pregnant women. It's a bit higher in resource limited settings. The thing about gonorrhea is that very often women who have gonorrhea will also have co-infection with chlamydia and gonorrhea increases the risk of getting infected with HIV. So you have to look out for those two things as well whenever a woman has a positive test for gonorrhea. Now as far as what gonorrhea does during pregnancy, untreated maternal gonococcal infection does seem to increase the risk of preterm delivery not associated with other things, just particularly preterm delivery. The biggest thing about gonorrhea, is that it can have very severe consequences for a newborn, particularly for the eye, so something called ophthalmia neonatorum or newborn conjunctivitis that is caused by gonorrhea.

Speaker 1: It can actually lead to blindness and for a long time or at one time in the United States, this was actually the most common cause of blindness among babies. So in babies the eye is the most frequent site of gonorrhea infection and the way that they acquire it is similarly during delivery. When baby passes through that vaginal floor and I'll look all of the vaginal bacteria that are there and they get exposed to the gonorrhea. Thankfully that most severe form of gonorrhea infection in the eye is rare. And a lot of that is due to the fact that we do the antibiotic eye ointment that I'm going to talk about and we treat it is look for it during pregnancy. But that most severe form is rare. It can however, be treated. If it's recognized early, it has to be treated with IV antibiotics or antibiotics that are put in through a muscle.

Speaker 1: Babies that have that gonococcal eye disease, they have to be hospitalized, they have to be observed, so it is a very serious issue. Now for pregnant women, they get gonorrhea during pregnancy. You just get treated with a single dose of a medicine that's injected in your muscle as well as treated for chlamydia at the same time and then the same sort of retesting three weeks later to make sure the, or I'm sorry, no sooner than three weeks later to make sure the infection is cleared and then tested again three months later or in the third trimester if you're considered at a higher risk for getting re-infection. So for preventing gonorrhea, the most effective measure that we have is to test pregnant moms. That's the same for gonorrhea and chlamydia. So making sure that we test for it and giving antibiotics and treating as needed.

Speaker 1: However, for gonorrhea, we can also reduce the risk of an infection by giving prophylactic antibiotic eye ointment to babies at birth. This is routinely done in almost all hospitals in the United States is when you see that goopy sort of stuff in the baby's eyes that's put in shortly after birth. It can be deferred for up to an hour after birth, but it typically gets put in pretty quickly after birth. There is some controversy about whether or not this is truly necessary if you've had a negative test. It's something that I dive into further in my online childbirth education class, The Birth Preparation Course, about some of the controversy surrounding this. And also I want to say Rebecca Dekker at Evidence Based Birth has an article about this as well. We'll link to them in the show notes.

: Okay, so next up, let's talk about syphilis. So syphilis is an infection that's caused by a spirochete that's a specific type of bacteria that has a specific shape. The spirochete, treponema palladium or pallidum. And this is a particular concern during pregnancy because unlike gonorrhea, unlike chlamydia, syphilis will cross the placenta during pregnancy and it can actually have some very, very devastating effects on babies including death. So whereas gonorrhea and chlamydia during pregnancy are not that much of an issue for mom, they don't become an issue until delivery and the baby gets it, syphilis on the other hand can cross the placenta and affect a growing baby. Now, oddly enough, we don't have a lot of information or data on how frequently pregnant women are infected with syphilis. However, we do know that outside of pregnancy the rates of syphilis among women in general has been increasing in recent years having doubled from 2014 to 2018 and along with that rise in women, we've also seen a rise in babies being infected with syphilis as well.

Speaker 1: Now for a pregnant woman to get infected or I should say anyone to get infected with syphilis, it requires exposure to an open lesion where there are organisms present and the spirochetes go from that open lesion and then the person who gets the disease has to have some type of abraded skin or a place for the spirochetes to enter that new host. So it's actually not very efficient at transmission. For folks who are exposed to syphilis, about 30% will end up getting infected so it's not a terribly contagious disease. And then it does have a long incubation period, meaning that the time from when you get infected, so when you have symptoms can be anywhere from ten days to up to three months. On average it's about three weeks.

: Now, just to circle back to those adverse pregnancy outcomes that can result from the fact that syphilis crosses the placenta, it can lead to miscarriage, preterm birth, stillbirth, it can severely impact a baby's growth. Babies can be born with an infection which can cause problems afterwards and then as a result, death within that first month of life. Now because these outcomes are so severe and we know that with the appropriate treatment, these things can be prevented, that's why we test for syphilis. Again, that's why we test for all of these things because we know that there are things that can be done to help reduce the chances of bad things happening. It wouldn't make much sense for us to test for something if we didn't have a treatment or option to help with it. So that's why we test for these things because we know that there are things that can be done in order to improve or reduce the risk of bad things happening. So as far as who's screened, same thing, screened at the first prenatal visit and then screened again for women who are at higher risk in the third trimester or closer to birth.

Speaker 1: Now when you are diagnosed with syphilis, it's important to categorize the stage of the disease because the stage of the disease impacts the type of treatment you receive. And it also impacts the risk of vertical transmission. And what vertical transmission is, it's the risk of the infection going from mom to baby. So there's primary syphilis, secondary syphilis, latent syphilis and late or tertiary syphilis. So primary syphilis is when you see that skin lesion that's there. So that is when it's considered primary syphilis. Secondary syphilis occurs in about 25% of untreated patients and it usually happens between six weeks and six months after the appearance of that first lesion from the primary syphilis. Sometimes folks have fever, they have a sore throat, they have weight loss. But not everyone. They can also have a rash as well. Now latent syphilis is when folks have a positive blood test for syphilis, but they are completely asymptomatic and this is the case that we often see in pregnancy is that, or I shouldn't say often that if it's diagnosed in pregnancy, this is what we see is that it is latent syphilis, so asymptomatic but a positive blood test.

Speaker 1: And then finally late syphilis. That is very infrequent. It doesn't happen until five to twenty years after the initial infection. And if it's untreated then it can progress to some severe symptoms, but that's not very common. All right, so when you have primary or secondary syphilis, so again, primary is that first lesion that's noted. Secondary is within the first six weeks to six months afterwards. A single dose of penicillin through your muscle is sufficient to treat primary or secondary syphilis. However, as I said, most folks will be diagnosed with latent disease and in that case it requires three doses of penicillin through your muscle at weekly intervals. So three doses of penicillin. So if you get it on Monday, then the following Monday, then the following Monday, so not terribly burdensome or complicated in terms of treatment thankfully, but really, really important. And then after you get your treatment and then we have to monitor blood tests and make sure the levels of the spirochete go down.

Speaker 1: Now there is one particular snafu or difficulty I should say, so to speak in treating women who have syphilis and that is if you have an allergy to penicillin. Penicillin is the most effective really. I'm sorry, the only medicine they can be used during pregnancy to treat syphilis. So if you are pregnant and you are diagnosed with syphillis and you have a penicillin allergy, then you have to get desensitization therapy to desensitize you to penicillin and then get the penicillin treatment. That's a bit of an involved procedure for sure, but just know that if you have that penicillin allergy, it's going to be more complicated if you're diagnosed with syphilis.

: So as I said, syphilis is different in that it will affect the placenta and it can cross the placenta as early as nine or ten weeks of pregnancy. It tends have worse effects the later you are in pregnancy. So the most pronounced effects of syphilis happen after 20 weeks of pregnancy. And again that can cause liver dysfunction, liver infection, amniotic fluid infection, it can cause baby's blood count to be low, baby's platelets to be affected. Ascites which is fluid that develops around the baby. So syphilis has some very significant consequences for babies. Now the good news is that treating mom with penicillin is typically curative for both her and fixes the infection in baby as well. So really that treatment with penicillin is really, really important.

: And then in addition to crossing the placenta, just like the other bacterias, babies can get infected with syphilis at the time of delivery just from coming in contact with those maternal secretions or blood that has the syphilis spirochetes. Now some factors that influence whether or not baby will get infected with syphilis. As you may imagine, if it's in the earlier stages of the disease or early stage syphilis, then the risk of a baby getting infected is pretty high, particularly in the first four years after mom gets infected. It's very common that the spirochetes will hang around in the blood. If mom is not treated, the risk starts to go down when it's secondary syphilis or latent syphilis. But again the risk is still there and then also as I said, if you get the infection later in pregnancy rather than earlier in pregnancy, it tends to have worse effects on baby.

: All right. Next up I want to talk about herpes. Herpes simplex virus type one and type two are very common infections and actually both types of the virus can cause genital herpes. Although HSV one is more typically associated with cold sores, whereas HSV two is more typically associated with genital herpes, but really both of them can cause genital infection. Genital HSV is often very under-recognized because the infection may not cause a whole lot of symptoms. It's estimated that most cases of herpes are transmitted by people who are not aware that they have an infection or they don't have symptoms when the transmission occurs.

Speaker 1: Now having been exposed to one of the types of HSV viruses is very common among pregnant women. One study suggested that 59% of pregnant women have been exposed to HSV one and 20% of pregnant women have been exposed to HSV two so very, very common. For some reason I feel like herpes is the disease that really makes people the most uncomfortable, you know, that has the worst like stigma associated with it for whatever reason. Maybe because it's not curable or just, I don't know, it just has a really bad stigma associated with it and telling women about sexually transmitted infections, this is the one that I often find causes the most angst. So when we talk about herpes and pregnancy, then it's really important to classify it a certain way because depending on the classification, that affects how things are managed and the impact that it will have on baby.

Speaker 1: So there's primary herpes, which means that you have the first occurrence of a lesion during pregnancy. And then when we check your blood work, there's no evidence that you've had a prior infection before. So this is truly, truly your first episode. A non-primary first episode is when you have your first occurrence of a genital lesion, but you have preexisting antibodies from a different type of HSV. So for example, if you have a new lesion and we determined that that new lesion is HSV two and then we check your blood and you've been exposed to HSV one, this is what's called a non primary first episode. So you've been exposed to a different type of before. But the other type is what's causing the genital lesion. And then the third type is recurrent. So we check the type of ages from a lesion that happens during pregnancy and check your blood and you've been exposed to that type before.

Speaker 1: Now, the initial presentation of a primary herpes infection can often be severe. It can be quite painful, it can cause ulcers, it can cause itching, fever, headache. But a lot of patients, even most I would say, have mild symptoms or are asymptomatic. In one study only about a third of folks who got herpes during pregnancy actually had symptoms. Now recurrent infections tend to be milder. They may be proceeded by what's called prodromal symptoms like itching or burning, sometimes pain before that lesion is visible. And that's the case with genital and cold sores as well. I occasionally get cold sores and I can tell when they're coming before because it's like burning itching on my lip. But the thing with recurrent infection is that the lesions tend to be there for a less, a shorter period of time. And there's not as much what we call viral shedding or virus present.

Speaker 1: So when we talk about how herpes can affect babies, babies get infected with herpes usually during labor and delivery, and that is a result of direct contact with the virus that's being shed from infected sites. So whether it's the cervix, the vagina, the vulva area, near the anal area, if a baby comes in contact with an active lesion, then that's how they get infected. Now the highest risk of infection occurs in women with a primary genital infection that is acquired near the time of delivery. So highest risk again is if you have that first infection and it's near the time of delivery, that's when the virus is going to be at its highest levels. You can also transmit the virus to the baby if you have an active lesion that's a recurrent episode near the time of delivery. But the frequency of the baby getting it is much lower.

Speaker 1: And we think that's because your body has already developed some protective antibodies in order to fight the virus when it shows up. So it's just not as severe if it's a second outbreak. So what do we do to manage women who have herpes during pregnancy? Well, the mainstay is what's called suppressive therapy. And we start that at 36 weeks where you take daily medication in order to reduce the amount of virus in your system, and that reduces the risk of your baby getting infected with it at delivery. And then in some cases, we recommend a cesarean delivery to reduce the risk of transmission. And I'll talk about that in just a second. And if you are infected during pregnancy and you're not near delivery, then whether it's a primary episode or recurrent episode, then we often recommend treatment for the primary episode. We do so because it's going to reduce the amount of time that the virus is around, it's also going to help the symptoms go away faster.

Speaker 1: Now for recurrent episodes, you may or may not get treated depending on how bad it is, they're typically short lived, so not all doctors will necessarily treat recurrent infection just because it's not as bad and it may be shorter. Now for everybody, you get suppressive therapy at 36 weeks where you're taking daily medication. And it varies the regimen and the type of medication ordered in order to reduce the risk of your baby getting herpes at delivery. Okay, so when it comes time to delivery for all women that have a history of herpes, we will ask when you present in labor, if you're being induced, you know when it's time for delivery, are you having any prodromal symptoms that suggest that you may be getting an infection? And then also we examine for any lesions to see if there's anything going on that we need to be concerned about.

Speaker 1: So if you have prodromal symptoms like pain or burning, you just feel like a lesion may be coming on or if you have an active genital lesion, then we recommend a cesarean delivery as soon as possible after labor starts or after your water breaks in order to reduce the risk of your baby getting that infection. Now, women for whom HSV was known before they were pregnant, if they had a recurrent lesion during pregnancy, if it's not within a couple of weeks of delivery and there are no lesions and no prodromal symptoms, then the risk of transmission is low and so vaginal delivery is okay and then also if you have lesions that are not in the genital area, then vaginal delivery is okay. So if you have a lesion that's on your buttock or on your thigh or sometimes folks get them on their back, then we don't recommend cesarean delivery in that instance because the risk of the baby getting it is low.

Speaker 1: The one area that is a little bit tricky is women who had a primary, you know, that first episode of genital infection during pregnancy. Then the optimal approach isn't clear. And some folks will say as long as you don't have any prodromal symptoms or no active lesions then vaginal delivery is okay. But others will say that if you have primary HSV during pregnancy because the virus is at higher levels, that offering a cesarean delivery is perfectly reasonable and acceptable. So it's an individual decision. And then finally I want to talk about screening pregnant women who have no history of HSV. So that means screening by blood tests. And I want to talk about this because a lot of doctors do this and then women end up popping up with a test potentially that's positive with either HSV one or HSV two and then it can cause a lot of angst. And where did I get this? How did this happen? So let me talk about that for a second.

: So the reason that some people propose it is that that we may want to identify women who have the virus but don't have symptoms. So we can give them the medicine towards the end of pregnancy in order to prevent transmission to the baby. Well, there are a couple issues with that. One being that there are no studies that show that that has helped improved outcomes, so there's no studies that show that if you pop up with a positive blood test in the absence of having actual physical lesions that it helps to give you that suppressive therapy towards the end of pregnancy. Although a lot of people, a lot of doctors will do that, so in general it's recommended against checking at pregnant women who don't have any symptoms for HSV by blood tests.

Speaker 1: It is not recommended that that has to happen. Now if folks do it or if you say that you want to be screened, then we really should do more than just screen you. So we should actually screen your partner and if you're in a monogamous relationship and you and your partner are both negative, then we do routine care. If you are negative and your partner is positive, then it should be recommended that you use condoms during the first and second trimester and then completely avoid intercourse in the third trimester. And then if you are positive for either one another strategy is treating the male partner to reduce the risk of transmission. That's also an option as well, not one that I've seen used very frequently. And then as I said before, if you test positive for either HSV two or one and you have no history of genital herpes lesions, then offering suppressive therapy is not recommended. It's not been studied in that circumstance.

: Whew. Okay. We are in the home stretch. Last thing I want to talk about is HPV. HPV is human papillomavirus and it is the most common sexually transmitted infection in the world. At least 75% of sexually active adults in the United States have been infected with at least one type of HPV during our lifetime. So yes, ladies, three out of four of us have been infected with HPV. Those rates are going to go down as the HPV vaccine becomes more prevalent. But again, as it stands, roughly three out of four adult people will be infected with HPV. Now HPV causes a couple of things. The HPV vaccine provides protection against the high risk forms of HPV that are associated with cervical cancer. It used to be that the vaccine was only recommended up to a certain age group. Now it's available to everyone. We don't give it during pregnancy. We don't know much about the data of it during pregnancy. So you can talk about it with your healthcare provider outside of pregnancy, but that's where the vaccine is for.

: But there are low risk strains of HPV and those tend to cause warts, so genital warts, they can be vaginal, peri anal and those are not associated with a cancer risk. They are however kind of, you know, annoying. They can affect the cosmetic appearance of your vaginal area. We know that they're associated with the sexually transmitted disease and again, right or wrong that's associated with, I should say wrong, it's associated with stigma. It's hard to overcome that sometimes. And sometimes they can just be uncomfortable depending on where they are. They can be treated to remove the warts, but they commonly recur. So up to 30% of women will have, or people I should say, will have a recurrence even after gentle towards are removed.

Speaker 1: Now as far as how warts affect pregnancy, we don't have much evidence that they have an impact on baby, which is good. There may be some evidence that it causes a rare condition called juvenile onset respiratory papillomatosis where, kids between the ages of two and five develop these things called papillomas in the layer near or in the conjunctiva. It's very rare that it happens and there's some preliminary studies that show that it may be associated with mom having genital warts, but that association is not very strong. So that's the good news about HPV. But during pregnancy, sometimes the warts can get worse just because a pregnant woman's immune system is weakened a bit, so the warts may proliferate more so they can't be treated during pregnancy just for symptomatic relief if nothing else. We do have to be careful about some of the treatments because a lot of them are not compatible with pregnancy because they're dangerous for babies.

Speaker 1: So a couple of treatments that we tend to use are something called TCA or also freeze them as well. But again, HPV is not so much associated with issues for babies. You can again get the HPV vaccine outside of pregnancy. You can get it while you're breastfeeding. It hasn't been shown to cause any harm. And in the last, I want to say year or so, they expanded the availability of the vaccine outside of a certain age group that it initially was. Oh, you know, I think I forgot to say what the issues are with herpes effecting babies. Herpes can cause babies to get something called temporal lobe encephalitis, which is a really bad infection of the brain and cephalitis. So that is why we worry about herpes and pregnancy.

: Ooh, okay. That is the end of this episode. I know that was a lot of information and it may feel a little bit overwhelming, but I hope it gives you some reassurance that these things are common. They can be treated, we can reduce the risk, do not feel any stigma, do not feel bad, do not feel unworthy or any of those things. If you happen to be one of the people that's infected with these sexually transmitted infections, in fact, at least half of us will be at some point in our lifetimes and for HPV it's going to be even higher, 75%. So you're not alone and it doesn't have to be a stigma. It just doesn't, doesn't, doesn't. Now we're going to talk more about this in the All About Pregnancy and Birth Facebook group, so for sure if you are not in the group, definitely join the group. You can search for it on Facebook or we will link to it in this show notes. Also, be sure to subscribe to the podcast in Apple podcast or Spotify, wherever you listen to your podcasts and I love it when folks leave me a review in Apple podcasts. It just makes my day to see what you think about the show. It helps other women to find the show, helps the show to grow and I give shoutouts on episodes. So for sure leave me a review in Apple podcast.

: Also don't forget about that free class on how to make it birth plan that works. You definitely want to take that class before you write a single word of your birth wishes. Go to www.ncrcoaching.com/register to sign up for the class today. And the next week on the podcast I have my friend back on Dr. Keisha Reddick. She is a maternal fetal medicine specialist and she is going to talk about genetic testing during pregnancy. I think this is going to be a great episode. I know after I did the episode on what tests are done during pregnancy and one of the things that popped up that people have a lot of confusion about is the genetic tests. So next week's episode will help clear that up. All right, so come on back next week and until then I wish you a healthy and happy pregnancy and birth.

Speaker 2: Today's episode is brought to you by Women's Wellness Coaching by Dr. Nicole Calloway Ranking. Head to www.ncrcoaching.com to check out my free one hour mini course on how to make your birth plan, as well as my comprehensive online childbirth education class, The Birth Preparation Course with over eight hours of content and a private course community. The Birth Preparation Course will leave you knowledgeable, prepared, confident, and empowered going into your birth. Head to www.ncrcoaching.com to learn more.