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Chlamydia & Gonorrhea
in Pregnancy
Diagnosis · Treatment · Pregnancy Implications
A Patient-Centered Discussion
Based on CDC STI Guidelines 2021 & ACOG Recommendations
What Are These Infections?

🦠 Chlamydia

  • Caused by Chlamydia trachomatis
  • Most common bacterial STI
  • Often completely silent
  • Easily treated with antibiotics

🦠 Gonorrhea

  • Caused by Neisseria gonorrhoeae
  • Second most common bacterial STI
  • Often completely silent
  • Treatable with a single injection
Most pregnant patients with these infections have no symptoms at all — which is why routine screening is essential.
Who Should Be Screened?
Screening is a standard part of prenatal care
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All Patients < 25 yrs
Screen at first prenatal visit
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Patients ≥ 25 yrs
Screen if risk factors are present
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Repeat Screening
Third trimester for high-risk patients
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Co-Screening
HIV, syphilis & hepatitis B if positive
ACOG / CDC Screening Recommendations
How Do We Test?
We use a highly accurate test called NAAT
(Nucleic Acid Amplification Test)
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Specimen Type
Vaginal swab (preferred) or first-catch urine
✅
Accuracy
Highest sensitivity & specificity available
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Self-Collection
Patient-collected swabs are acceptable
⚡
Results
Typically available within 24–48 hours
Risks to the Pregnancy
Untreated infections can cause ascending inflammation

🔵 Chlamydia Risks

  • Preterm labor
  • Early water breaking (PPROM)
  • Chorioamnionitis (womb infection)
  • Postpartum uterine infection

🔴 Gonorrhea Risks

  • Preterm labor
  • Early water breaking (PPROM)
  • Chorioamnionitis
  • Spontaneous pregnancy loss
Treatment eliminates these risks. Early detection and therapy protect both mother and baby.
Risks to the Baby
Transmission occurs during vaginal delivery
Condition Cause Onset After Birth
Gonococcal Eye Infection (Ophthalmia Neonatorum) Gonorrhea 2–5 days
Chlamydial Eye Infection Chlamydia 5–14 days
Neonatal Pneumonia Chlamydia 1–3 months
Disseminated Gonococcal Infection (Sepsis) Gonorrhea First weeks of life
Treating the infection before delivery prevents vertical transmission to the newborn.
Safe Treatment in Pregnancy
Pregnancy-specific regimens — effective and well-tolerated
Infection First-Line Treatment Alternative
Chlamydia Azithromycin 1 g — single oral dose Amoxicillin 500 mg three times daily × 7 days
Gonorrhea Ceftriaxone 500 mg — single IM injection Cefixime 400 mg oral (if injection unavailable)
⚠️ Doxycycline, tetracyclines, and fluoroquinolones are strictly contraindicated in all trimesters of pregnancy.
Partner Treatment Matters
Treating your partner prevents reinfection — the most common cause of treatment failure.
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Partner Therapy
Partner should be treated at the same time
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Abstain
Avoid intercourse for 7 days after treatment
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Expedited Partner Therapy
We can provide a prescription for your partner
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Confidentiality
Your privacy is fully protected
Confirming the Infection Is Gone
Test-of-Cure (TOC) — Required in Pregnancy
Day 0 — Treatment Completed Take all prescribed medication as directed
3–4 Weeks Later — Test-of-Cure (NAAT) Confirms the bacteria are fully eliminated. Do not test earlier — false positives can occur.
3 Months Later — Reinfection Screen Checks for any new exposure
Third Trimester — Routine Rescreen Captures late-pregnancy reinfections before delivery
CDC STI Treatment Guidelines 2021
What Can You Do?
Complete all medication Ensure partner is treated Abstain for 7 days after treatment Return for Test-of-Cure at 3–4 weeks Attend all scheduled prenatal visits Ask your care team any questions
These infections are common, treatable, and curable.
With proper care, your pregnancy can be completely healthy.
Summary
Topic Key Point
Presentation Usually asymptomatic — universal screening is essential
Diagnosis NAAT (vaginal swab or urine) — highly accurate
Treatment Azithromycin (CT) · Ceftriaxone (GC) — safe in pregnancy
Maternal Risks Preterm labor, PPROM, chorioamnionitis if untreated
Neonatal Risks Eye infections, pneumonia, sepsis — prevented by treatment
Follow-Up Test-of-Cure at 3–4 weeks · Rescreen at 3 months
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You Are Not Alone
Your care team is here to guide you
every step of the way.
Treatable Curable Preventable Neonatal Harm
Maternal-Fetal Medicine · Patient Education
CDC STI Treatment Guidelines 2021 · ACOG Practice Bulletin · DoctorsWhoCode.blog
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