
(STD) Sexually Transmitted Disease
Q. Can a pregnant woman who just recently found out she has genital warts still perform oral sex on her partner, who shows no signs of HPV, without harming the unborn child?
-Anonymous, Mississippi
A. Human Papillomavirus (HPV), or genital warts, are contagious and can be spread during oral, genital or anal sex with an infected partner. Although it is possible to transmit HPV through oral sex, it is less likely than through vaginal or anal sex. HPV seems to prefer genital or anal skin. So, there is a small chance that a pregnant woman with genital warts may pass on the virus orally to her partner, but the fetus will be unaffected regardless. Other than the warts possibly bleeding and/or enlarging, having HPV during pregnancy usually presents no problems.
Q. My friend is 2.5 months pregnant and found out she has Chlamydia. Is it okay for her to have an abortion even though she has this virus?
-Anonymous, Connecticut
A. Women with Chlamydia who have an abortion at the time have a higher chance of developing Pelvic Inflammatory Disease (PID). Your friend should tell her OB/GYN that she has Chlamydia. The doctor will most likely treat the infection with antibiotics before attempting an abortion procedure.
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Q. I'm three months pregnant. I recently found out I have Chlamydia. I am now being treated. Will this cause me to have a C-section birth or will I still be able to deliver vaginally?
-Anonymous, South Carolina
A. Chlamydia is an infection that can be treated with antibiotics and will most likely clear up in a week or two. This should have no effect on your chances for a vaginal vs. C-section delivery.
Q. My husband and I are planning to have a family. I have herpes and I would like to know what my options are for getting pregnant without infecting him?
-Anonymous, Washington, DC
A. Most people who have been living with herpes for a year or more are familiar with the virus' outbreak cycle. Some people only experience an outbreak when their immune system is depressed from illness, while others get an outbreak every month at the onset of menstruation. If your outbreaks are very random or if you get them frequently, the window of opportunity for pregnancy may be smaller for you.
I recommend tracking your ovulation carefully by checking your cervical mucous and basal body temperature or by using a home ovulation test kit (this is the easiest, fail-safe method, in my opinion). To avoid giving your husband the virus, try to have unprotected intercourse only during your days of ovulation and be sure you are not displaying any of the precursory signs of an outbreak, such as feeling a tingly or sore spot, having a sore or enlarged lymph node in the groin, having the presence of a sore, etc.
If you find you are almost experiencing an outbreak or are on the verge of an outbreak during ovulation, artificial insemination may be your only safe option to avoid spreading the virus. You can try this at home with the assistance of a turkey baster or you can ask your OB/GYN for a professional deposit.
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Q. This is my first pregnancy and the opening of my vagina is swollen, purple and red, and I am having a lot of vaginal discharge. It doesn't smell, but it does hurt (burn/soreness) when touched. I have a friend who has genital herpes and we went swimming together a little while ago. Is my swelling normal or is it a sign that I caught genital herpes from my friend?
-Anonymous, Texas
A. I highly doubt you have contracted genital herpes from your friend. Herpes is transmitted through mouth to mouth, mouth to genital or genital to genital contact. Swimming with your friend should not put you at risk. The swelling and discharge you mention are perfectly normal symptoms of pregnancy. The pain and burning could be from a yeast or bacterial infection, which can occur more often during pregnancy. You should contact your OB/GYN about treatment to get some relief.
Q. I have genital herpes and I am seven months pregnant. Do you know how safe suppressive therapy is in the last month of pregnancy?
-Emily, Maryland
A. As with many drugs, the oral antiviral tablets used for suppressive therapy are not generally recommended for use during pregnancy. They are considered one of those "maybe" risks, because it is not known for certain that they will not cause harm to the baby. Recurrent episodes of genital herpes during pregnancy are not harmful to the fetus. Therefore, most OB/GYNs will not prescribe antiviral tablets for pregnant women. Exceptions to this general rule may include women who have a continuous outbreak problem or pregnant women who are having their first-ever episode of genital herpes.
I imagine you are considering suppressive therapy for your last month to prevent an outbreak at the time of delivery, which may transmit the virus to the baby. If you do have an active infection at the time, the baby can be delivered safely via Cesarean section.
If you feel very strongly about having a vaginal delivery and/or you have frequent outbreaks, you should discuss this with your OB/GYN. During the last month of pregnancy, all of the baby's vital organs and parts are already fully developed and much less prone to any possibly harmful effects of drugs. Some doctors will permit certain medications in the last trimester that were not previously allowed, such as antacids, painkillers and antibiotics. Antiviral medication may also be an option at this point. It is up to you and your doctor to determine the risks versus the benefits of using an antiviral medication.
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Q. I suffer from herpes outbreaks, however they aren't vaginal. They actually break out on my lower back, about four inches above my anus. Will I still need the anti-viral medicine to keep my unborn child safe?
-Anonymous, California
A. Unless your doctor recommends it, you should not take your anti-viral medication during pregnancy. (See the other suppressive therapy question for more details.)
If you do have an outbreak near the time of delivery, your doctor may decide to do a Cesarean delivery to avoid infection. Or, your doctor may feel there is no risk of transferring the virus to the baby since the outbreak is not in the vagina, and deliver vaginally. I recommend discussing the possibility of an outbreak with your doctor well before delivery to go over your options.
Q. I am currently 29 weeks and for the last month or so I have noticed some serious itching at the top of my vagina. About a month ago I noticed what felt like a skin tag on my inner vulvar lips. Now I am noticing more of these "tags" along the area with continued vaginal itching. I don't think it's a yeast infection. When I scratch I feel as though the skin is getting broken and rashed. I've had multiple pap smears to test for possible sexually transmitted diseases (STDs) and I've never had a positive test for any STD. My husband has also been tested for all STDs and his tests came back negative. WHAT IS THIS?!
-Robin, Arizona
A. Although I'm no medical expert, I'd guess that you've either got genital warts (HPV) or a crop of skin tags accompanied by a bacterial infection. STDs such as HPV may be transmitted without initially showing any symptoms and may not even show up on a STD test. It may even be years before your immune system will trigger an outbreak, causing the warts to appear. These triggers can happen when your immune system is depressed from illness or during pregnancy. I think you should consult your OB/GYN about your concerns to determine just what is going on.
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Q. Are pregnant women tested for sexually transmitted diseases (STDs) early on in pregnancy? I am ready to deliver any day and have an itchy vaginal rash. I'm trying to rule out everything.
-H, Pennsylvania
A. During an initial pregnancy exam most OB/GYNs and clinics will test for STDs because some, such as syphilis, can be harmful to a fetus during pregnancy. You were most likely tested in your first trimester. The rash you have could be a yeast or bacterial infection, which can be quite common during pregnancy, especially in the last trimester. (See "Yeast & Bacterial Infections" for more information.)
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