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Public Health ImpactWomen and infants disproportionately bear the long term consequences of STDs. Women infected with Neisseria gonorrhoeae or Chlamydia trachomatis can develop pelvic inflammatory disease (PID), which, in turn, may lead to reproductive system morbidity such as ectopic pregnancy and tubal factor infertility. If not adequately treated, 20% to 40% of women infected with chlamydia1 and 10% to 40% of women infected with gonorrhea2 may develop PID. Among women with PID, tubal scarring will cause involuntary infertility in 20%, ectopic pregnancy in 9%, and chronic pelvic pain in 18%.3 Approximately 70% of chlamydia infections and 50% of gonococcal 4-6 infections in women are asymptomatic. These infections are detected primarily through screening programs. The vague symptoms associated with chlamydial and gonococcal PID cause 85% of women to delay seeking medical care, thereby increasing the risk of infertility and ectopic pregnancy.7 Data from a randomized controlled trial of chlamydia screening in a managed care setting suggest that such screening programs can reduce the incidence of PID by as much as 60%.8 Gonorrhea and Chlamydia can also result in adverse outcomes of pregnancy, including neonatal ophthalmia and, in the case of chlamydia, neonatal pneumonia. Although topical prophylaxis of infants at delivery is effective for prevention of ophthalmia neonatorum, prevention of neonatal pneumonia requires prenatal detection and treatment. Human papillomavirus (HPV) infections are highly prevalent, especially among young sexually active women. While the great majority of HPV infections in women resolve within one year, they are a major concern because persistent infection with specific types (e.g., types 16, 18, 31, 33, 35, and 45), are causally related to cervical cancer; these types also cause Pap smear abnormalities. Other types (e.g., types 6 and 11) cause genital warts, low grade Pap smear abnormalities and, rarely, recurrent respiratory papillomatosis in infants born to infected mothers.9 Genital infections with herpes simplex virus are extremely common, may cause painful outbreaks, and may have serious consequences for pregnant women including potentially fatal neonatal infections.10 When a woman has a syphilis infection during pregnancy, she may transmit the infection to the fetus in utero. This may result in fetal death or an infant born with physical and mental developmental disabilities. Most cases of congenital syphilis are easily preventable if women are screened for syphilis and treated early during prenatal care.11 ObservationsChlamydia and Gonorrhea
Primary and Secondary Syphilis
Congenital Syphilis
Pelvic Inflammatory Disease
Ectopic Pregnancy
1 Stamm WE, Guinan ME, Johnson C. Effect of treatment regimens for Neisseria gonorrhoeae on simultaneous infections with Chlamydia trachomatis. N Engl J Med 1984;310:545-9. 2 Platt R, Rice PA, McCormack WM. Risk of acquiring gonorrhea and prevalence of abnormal adnexal findings among women recently exposed to gonorrhea. JAMA 1983;250:3205-9. 3 Westrom L, Joesoef R, Reynolds G, et al. Pelvic inflammatory disease and fertility: a cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopy. Sexually Transmitted Diseases 1992;9:185-92. 4 Hook EW III, Handsfield HH. Gonococcal infections in the adult. In: Holmes KK, Mardh PA, Sparling PF, et al, eds. Sexually Transmitted Diseases, 2nd edition. New York City: McGraw-Hill, Inc, 1990:149-65. 5 Stamm WE, Holmes KK. Chlamydia trachomatis infections in the adult. In: Holmes KK, Mardh PA, Sparling PF, et al, eds. Sexually Transmitted Diseases, 2nd edition. New York City: McGraw-Hill, Inc, 1990:181-93. 6 Zimmerman HL, Potterat JJ, Dukes RL, et al. Epidemiologic differences between chlamydia and gonorrhea. Am J Public Health 1990;80:1338-42. 7 Hillis SD, Joesoef R, Marchbanks PA, et al. Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility. Am J Obstet Gynecol 1993;168:1503-9. 8 Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, Stamm WE. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med 1996;34(21):1362-6. 9 Division of STD Prevention. Prevention of Genital HPV Infection and Sequelae: Report of an External Consultants' Meeting. National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, December 1999. 10 Handsfield HH, Stone KM, Wasserheit JN. Prevention agenda for genital herpes. Sexually Transmitted Diseases 1999;26:228-231. 11 Centers for Disease Control. Guidelines for prevention and control of congenital syphilis. MMWR 1988;37(No.S-1). 12 U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office, November 2000. 13 Centers for Disease Control and Prevention. Congenital syphilis - United States, 2002. MMWR 2004;53:716-9. 14 Rolfs RT, Galaid EI, Zaidi AA. Pelvic inflammatory disease: trends in hospitalization and office visits, 1979 through 1988. Am J Obstet Gynecol 1992;166:983-90. 15 Centers for Disease Control and Prevention. Ectopic pregnancy in the United States, 1990-1992. MMWR 1995;44:46-8.
Page last modified: November 8, 2005 Page last reviewed: November 8, 2005 Historical Document Content Source: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention |
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