Диагностика и лечение ЗППП во время беременности

[Dr. Nika]

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последние рекомендации.

основные выдержки:

Azithromycin is an effective treatment of chlamydia during pregnancy (level of evidence, B). To date, there have been no long-term safety studies.


For treatment of gonorrhea during pregnancy, intramuscular ceftriaxone and oral cefixime are similarly effective (level of evidence, B). Although spectinomycin is also effective, it is painful to use and is not available in the United States.


In women known to have HSV infections, beginning treatment with acyclovir or valacyclovir at 36 weeks' gestation decreases recurrence of genital HSV lesions as well as the number of cesarean deliveries needed because of genital HSV infections (level of evidence, A). Serologic screening for HSV infection is not recommended.


To prevent congenital syphilis, penicillin treatment is effective provided infection in the mother is diagnosed and treated early (level of evidence, A). Therefore, screening should be performed at the first visit.




Recommended treatment regimens for STIs during pregnancy are as follows:

Bacterial vaginosis: metronidazole, 500 mg orally twice daily for 7 days.
Bacterial vaginosis is more common in sexually active women but is not STI
Screening and treatment in asymptomatic women does not decrease pregnancy complications.


Chlamydia: azithromycin, 1 g orally in a single dose, or amoxicillin, 500 mg orally 3 times daily for 7 days.


Gonorrhea: ceftriaxone, 125 mg intramuscularly in a single dose, or cefixime, 400 mg orally in a single dose.
Tests include culture on Thayer-Martin media and nucleic acid amplification test on cervical or urine specimen.


HIV: Highly active antiretroviral therapy in an individualized, patient-specific regimen.


First episode of HSV type 2: acyclovir, 400 mg orally 3 times daily or 200 mg orally 5 times daily for 7 to 10 days, or valacyclovir, 1 g orally twice daily for 7 to 10 days.


Recurrent HSV: acyclovir, 400 mg orally 3 times daily for 5 days, or valacyclovir, 1 g orally once daily for 5 days.


Suppressive therapy for HSV: acyclovir, 400 mg orally twice daily, or valacyclovir, 500 mg orally once daily.
HSV vertical transmission risk is higher if acquired by women near delivery time
Screening occurs by patient history or observed lesions.
Tests include culture or polymerase chain reaction assay of lesion.
Treatment with acyclovir or valacyclovir starting at 36 weeks' gestation reduces recurrence of lesions and viral shedding at delivery.


Primary syphilis: benzathine penicillin G, 2.4 million units intramuscularly as a single dose.


Positive syphilis serology in asymptomatic women: 3 doses 1 week apart (for women allergic to penicillin, desensitization is recommended).
Screening tests are rapid plasma reagin or Venereal Disease Research Laboratories test.
Treatment failure is more likely if fetal ultrasound shows syphilis findings.


Trichomoniasis: single dose of metronidazole, 2 g orally.
Because treating trichomoniasis infection had not been shown to decrease the incidence of preterm birth, screening for trichomoniasis is not recommended in asymptomatic women (level of evidence, A).testing of symptomatic women includes saline wet mount or culture.
Metronidazole as single 2-g oral dose or twice-daily 500 mg for 1 week after the first trimester, does not decrease preterm delivery.

HPV
Biopsy can be done if visual diagnosis unclear, treatment ineffective, or lesions pigmented, ulcerated, fixed, or bleeding.
Treatment is weekly topical trichloroacetic acid, 80% to 90%.

[Dr. Nika]

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