Majeroni Barbara A, Ukkadam Sreelatha
School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA.
Am Fam Physician. 2007 Jul 15;76(2):265-70.
Many sexually transmitted infections are associated with adverse pregnancy outcomes. The Centers for Disease Control and Prevention recommends screening all pregnant women for human immunodeficiency virus infection as early as possible. Treatment with highly active antiretroviral therapy can reduce transmission to the fetus. Chlamydia screening is recommended for all women at the onset of prenatal care, and again in the third trimester for women who are younger than 25 years or at increased risk. Azithromycin has been shown to be safe in pregnant women and is recommended as the treatment of choice for chlamydia during pregnancy. Screening for gonorrhea is recommended in early pregnancy for those who are at risk or who live in a high-prevalence area, and again in the third trimester for patients who continue to be at risk. The recommended treatment for gonorrhea is ceftriaxone 125 mg intramuscularly or cefixime 400 mg orally. Hepatitis B surface antigen and serology for syphilis should be checked at the first prenatal visit. Benzathine penicillin G remains the treatment for syphilis. Screening for genital herpes simplex virus infection is by history and examination for lesions, with diagnosis of new cases by culture or polymerase chain reaction assay from active lesions. Routine serology is not recommended for screening. The oral antivirals acyclovir and valacyclovir can be used in pregnancy. Suppressive therapy from 36 weeks' gestation reduces viral shedding at the time of delivery in patients at risk of active lesions. Screening for trichomoniasis or bacterial vaginosis is not recommended for asymptomatic women because current evidence indicates that treatment does not improve pregnancy outcomes.
许多性传播感染与不良妊娠结局相关。疾病控制与预防中心建议尽早对所有孕妇进行人类免疫缺陷病毒感染筛查。采用高效抗逆转录病毒疗法进行治疗可减少病毒传播给胎儿。建议在产前检查开始时对所有女性进行衣原体筛查，对于年龄小于25岁或风险增加的女性，在孕晚期再次进行筛查。阿奇霉素已被证明对孕妇安全，被推荐为孕期衣原体感染的首选治疗药物。对于有风险或居住在高流行地区的人群，建议在孕早期进行淋病筛查，对于仍有风险的患者，在孕晚期再次进行筛查。淋病的推荐治疗药物是头孢曲松125mg肌内注射或头孢克肟400mg口服。首次产前检查时应检查乙肝表面抗原和梅毒血清学。苄星青霉素G仍然是梅毒的治疗药物。通过病史和病变检查筛查单纯疱疹病毒感染，通过对活动性病变进行培养或聚合酶链反应检测诊断新病例。不建议进行常规血清学筛查。口服抗病毒药物阿昔洛韦和伐昔洛韦可在孕期使用。对于有活动性病变风险的患者，从妊娠36周开始进行抑制性治疗可减少分娩时的病毒脱落。不建议对无症状女性进行滴虫病或细菌性阴道病筛查，因为目前的证据表明治疗并不能改善妊娠结局。
