Oxford Handbook of Midwifery Read Online Free PDF Page B

cervical screening programme, particularly if the woman is over 25 and not yet had her first screening test.
Genital warts in pregnancy
Genital warts are caused by HPV.
In pregnancy the warts may increase considerably in size and have a cauliflower-like appearance.
Occasionally they are so large and widespread that they may obstruct the vulva and lower vagina and prevent a vaginal birth, therefore requiring a caesarean section.
The normal treatment is drug contraindicated in pregnancy, because of possible teratogenic effects, therefore pharmacological treatment is not given until after the birth.
Cryo-cautery is the only treatment possible during pregnancy, done at a specialist sexual health clinic.
Fetal and neonatal infection
Babies and young children may develop laryngeal papilloma after being infected by maternal genital warts during vaginal birth.
Useful websites
British Association for Sexual Health and HIV. Available at: M www.bashh.org.uk. (accessed 2.5.10)
Further reading
Dapaah S, Dapaah V (2009). Sexually transmissible and reproductive tract infections in pregnancy. In: Fraser D, Cooper M (eds) Myles Textbook for Midwives . 15th edn. London: Churchill Livingstone, pp. 415–32.
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CHAPTER 3 Sexual health
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Gonorrhoea
Gonorrhoea is the second most common STI in the UK.
Prevalence is highest among sexually active adults under 25 years.
It is a bacterial infection, caused by Neisseria gonorrhoeae .
The organism adheres to mucous membranes and is more prevalent on columnar rather than squamous epithelium.
The primary sites of infection are the mucus membranes of the urethra, endocervix, rectum, pharynx, and conjunctiva.
Importantly, gonorrhoea frequently co-exists with other genital mucosal infections, such as those caused by Chlamydia trachomatis , Trichomonas vaginalis , and Candida albicans .
Many areas are now also testing for gonorrhoea on the Chlamydia Screening Programme urine samples, because of the prevalence of co-infection. Be aware of the testing procedures in your own area.
Up to 80% of PID in women under 26 is caused by gonorrhoea or chlamydia or both.
The consequences of untreated gonorrhoea leading to PID include
infertility, ectopic pregnancy, and chronic pelvic pain. Although uncommon, it may also cause disseminated general disease and arthritis—Reiter’s syndrome.
50% of women may be asymptomatic.
The most common symptom is increased or altered vaginal discharge (penile discharge in men).
Other symptoms include lower abdominal pain, dysuria, dyspareunia, intermenstrual uterine bleeding, and menorrhagia.
It is also good practice to screen the male partner(s) and to refer both partners to the local sexual health service for further STI screening, contact tracing, and follow-up.
Gonorrhoea in pregnancy
The incidence of 1–5% is small, but the incidence of gonorrhoea nationally is rising, particularly in big cities. Midwives must, therefore, be vigilant, as there is evidence that it is detrimental in pregnancy.
Gonorrhoea is associated with spontaneous abortion, chorioamnionitis, preterm rupture of the membranes, preterm labour, and very low birthweight. Postnatally, it can cause endometritis and pelvic sepsis, which may be severe.
A Cochrane systematic review of interventions for treating gonorrhoea in pregnancy has concluded that the well-established treatment with penicillin and probenecid is effective. 1 However, antibiotic resistant strains are now becoming apparent and making treatment more difficult.
Fetal and neonatal infection
The most common mode of transmission to the baby is through the infected cervix during vaginal birth.
It may also be transmitted in uterus, following prolonged rupture of the membranes.
The risk of vertical transmission from an infected mother is 30–50%.
GONORRHOEA
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The most usual manifestation of neonatal infection is gonococcal ophthalmia neonatorum.
A profuse, purulent discharge from red and swollen eyes appears usually