Gonorrheal infections, including those that are asymptomatic, should be treated during pregnancy with cefixime or ceftriaxone to reduce the risk of preterm labor and neonatal infection (Table 47-8).30 Spectinomycin is an alternative for penicillin- or cephalosporin-allergic women.30 Tetracycline should be avoided during pregnancy owing to tooth and bone malformations, and quinolones should be avoided because of the theoretical risk of bone or cartilage malformations (Table 47-8).28

All CDC recommended first-line therapies for gonorrhea are deemed compatible with breast-feeding by the AAP.19 Since the number of quinolone-resistant species is increasing, the CDC recommendations should be consulted before prescribing a quinolone.3 Perform an endocervical swab culture for gonorrhea 3 weeks after completion of therapy.

Herpes Simplex

Herpes simplex virus may be transmitted to the neonate at birth. The risk of transmission is more likely if the mother acquired genital herpes near the time of delivery (30-50%). Prevention of neonatal herpes includes preventing acquisition of herpes infection during late pregnancy and avoiding fetal exposure to active herpetic lesions during delivery.

The majority of obstetricians recommend cesarean section for women with active genital herpetic lesions at the onset of labor, even though caesarean section does not completely eliminate the risk of neonate transmission. Oral acyclovir is recommended for treatment of herpes episodes. Acyclovir or valacyclovir is recommended to de-

32 33

crease the risk of a recurrence at term (Table 47-8). ' IV therapy may be indicated for severe episodes. Surveillance data do not suggest an increased risk of teratogen-

28 32

ic effects with acyclovir. ' Acyclovir is preferred over valacyclovir or famciclovir because experience with the latter agents during organogenesis is limited.

Acyclovir and valacyclovir are deemed compatible with breast-feeding, but no recommendation can be made regarding the safety of famciclovir during lactation.19 Infants born to mothers with active disease at birth should be monitored for signs and symptoms of disease.


Treponema pallidum can cross the placenta and cause fetal infection with severe consequences. All women should be screened serologically for syphilis at the beginning of pregnancy. Serologic testing should be repeated at 28 to 32 weeks of pregnancy and at delivery in populations in which the prevalence of syphilis is high or in women at high risk, such as those who were previously untested or had a positive serology in the first trimester.30

Benzathine penicillin G administered to the mother is effective to prevent transmission and to cure the disease in the fetus (Table 47-8).30 Penicillin-allergic women must undergo desensitization to the drug since alternative therapies used in nonpreg-

nant patients are either teratogenic (e.g., tetracycline and doxycycline) or will not cure

disease in the fetus (e.g., erythromycin). The intensity of the treatment should be adjusted to the stage of syphilis.

Syphilis in lactating women should be treated with benzathine penicillin G or any of the CDC-recommended alternatives for penicillin-allergic patients (Table 47-8).13,30


Vaginal trichomoniasis is associated with maternal symptoms, premature rupture of the membranes, preterm delivery, low birth weight, and respiratory or genital infection of the neonate. However, treatment does not reduce perinatal morbidity.19 Thus, treatment is reserved to alleviate maternal symptoms, and asymptomatic disease should not be treated.19 Recommended treatment is oral metronidazole (Table 47-8).19

Women requiring single-dose metronidazole during lactation should discontinue breast-feeding for 12 hours in order to minimize the infant's exposure to the drug.19,30

During this time, women should pump and discard breast milk in order to avoid engorgement.

Women taking metronidazole should avoid drinking alcohol or using alcohol-containing substances to avoid having a disulfiram-like reaction.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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