Infectious Disease Types
STDs pose a great risk to women in parts of Asia, Africa, and Eastern Europe, where rape and prostitution and arranged marriages between older men and girls and young women are common. Children spread infections directly to their mothers and other women in traditional roles as teachers, nurses, and caregivers. These factors make women at high risk for STDs and diseases that spread among the general population. Several diseases also can be carried by pregnant women and transmitted to her fetus during pregnancy and to her child at birth.
Pelvic infections in women lead to the following diseases:
Vaginitis. Vaginitis is usually diagnosed initially by the presence of inflammation,
itching, or discharge in the area of the vagina or cervix. There are several types
of vaginitis caused by infections, including yeast infections, cervicitis,
lichen simplex chronicus, bacterial vaginosis, trichomoniasis, chlamydia, gonorrhea,
and genital
herpes. Organisms can be transmitted from person to person,
leading to gynecological and other diseases because of the proximity of the vagina
to the gastrointestinal tract. Once any type of viral, bacterial, or fungal
pathogen enters the female gastrointestinal tract, pelvic infection is possible,
including pelvic blastomycosis, schistosomiasis, actinomycosis, shigellosis,
amebiasis, and listeriosis.
Listeriosis. Almost two-thirds of the cases of listeriosis occur when a woman is pregnant and, therefore, has decreased
immunity to the Listeria monocytogenes bacterium. Men can carry
this bacterium without symptoms and can transmit it to women during sexual
intercourse. The bacteria can lead to infection, especially when the female’s
immune system is compromised during, for example, pregnancy. Symptoms include
fever, abdominal pain, and other flulike symptoms. Listeriosis transmitted to a
fetus through the placenta can develop into granulomatosis infantiseptica, which
results in death for the infant. Treatment of listeriosis includes a minimum of
two weeks of penicillin, ampicillin, tetracycline, erythromycin, or other
antibiotic.
Schistosomiasis. Schistosomiasis is a type of infection caused by the presence in the blood of
flatworms of the class Trematoda. This type of infection
continues to increase worldwide, with more than 200 million persons infected at
any given time. The most common initial symptom is a skin rash, often called
swimmer’s itch, which is visible within twenty-four hours of entering the human
body. About one month after infection, symptoms will include fever, sweating,
chills, headache, and cough. Treatment with the drugs niridazole or stibocaptate
is recommended. If not treated, cervical ulcers, cervical
cancer, infertility, and death may result. A fetus may become
infected by the pregnant woman. Typical diagnosis includes analysis of the urine
or a rectal biopsy.
Amebiasis and shigellosis. Amebiasis and shigellosis can be caused by members of the Enterobacteriaceae family, which are
gram-negative organisms in contaminated water. These organisms can cause
dysentery, diarrhea, abdominal pain, fever, and chills. Limiting exposure to
unhealthy water is the best way to prevent the development of these infections.
The most effective treatments are the tetracycline or ampicillin antibiotics. If,
however, the bacteria strain proves to be resistant to these antibiotics, then
trimethoprim and sulfamethoxazole can be effective.
Intrauterine-device-related infections. The gram-positive bacterium Actinomyces israelii
is often associated with the usage of intrauterine devices (IUDs), which are used as contraception. A. israelii can establish a colony within the pelvis of a female, leading to gynecological infections such as actinomycosis. Initial symptoms include fever and severe abdominal pain. Diagnosis is accomplished by either examination of the IUD after it has been removed from the female, or by a Pap test. If treated with antibiotics such aspenicillin, erythromycin, tetracycline, or chloramphenicol within one week of infection, the prognosis is good. Otherwise, the required treatments can involve blood transfusion. Death may result if the infection is severe.
Blastomycosis and coccidioidomycosis. Blastomycosis
and coccidioidomycosis are fungal infections that gain entry to the female body either
through inhalation or through a skin abrasion. These infections are especially
dangerous to pregnant women because they can quickly spread to many organs
throughout the body. Symptoms of the two infections are similar and include
coughing, chest pain, and wartlike skin lesions that continue to spread.
Blastomycosis is caused by the Blastomyces
(Ajellomyces) dermatitidis fungus, which can
be found in the Ohio, Mississippi, and St. Lawrence River systems. If not treated,
blastomycosis will be fatal.
Coccidioidomycosis, however, is not fatal, is usually self-limiting, and is without a progressive nature. The fungus Coccidiodes immitis causes this infection. This fungus is found in the soil of the southwestern United States and in some areas of South America and Central America.
Both infections can be diagnosed by testing body fluids or antigen-based skin tests and can be treated with the medication amphotericin B. Because blastomycosis can be fatal if not treated, the drug 1-hydroxystilbamidine can also be used if necessary.
Pelvic inflammatory disease. Pelvic inflammatory disease
(PID) is caused by the Chlamydia trachomatis
bacterium and transmitted through sexual intercourse. Colonies of
these bacteria can gain strength and grow in size when a pregnant woman has a
cesarean
section, leading to severe PID. Antibiotics that include tetracycline,
doxycycline, and erythromycin are effective treatments after definitive diagnosis.
Diagnosis has become much more efficient since the development of the tissue
culture technique in 1965. The C. trachomatis bacterium also can
cause several other diseases, including urethritis, salpingitis, neonatal
pneumonia, and endemic trachoma. Also, pregnant women are susceptible to
stillbirth and abortion because of these bacteria.
Cytomagalic inclusion disease. Cytomagalic inclusion disease (CID) occurs in the fetus of a pregnant woman who is infected by a
cytomegalovirus. The results can be pneumonia, hepatitis, seizure disorders,
deafness, retardation, and anemia. The woman may have very few symptoms other than
fever or malaise. Therefore, diagnosis of a pregnant woman is made after seeing
the results of blood tests, urinalysis, or immunofluorescent tests
on the blood of an infant’s umbilical cord.
Chancroid. Hemophilus ducreyi is a bacterium
that causes the sexually transmitted disease chancroid. The first symptoms include fever and malaise, followed by pain in
the lymph nodes. Tissue cultures and Gram staining are definitive methods of
diagnosis. Although this type of bacteria is resistant to penicillin, other
antibiotics, such as tetracycline, erythromycin, and streptomycin, are effective.
Washing with soaps and disinfectants does not help to prevent infection, but
condom usage does.
Group B Streptococcus infection. Group B
Streptococcus (GBS) infections are those infections caused by
the Streptococcus agalactiae bacterium. Infection by this
bacterium can lead to a variety of diseases, including skin infections,
peritonitis, arthritis, meningitis, urinary tract infection, gangrene, and
pneumonia. Colonies of these bacteria can cause death in pregnant women following
a cesarean section. Infected women pass the bacterium during childbirth in
approximately 33 percent of cases, and more than 50 percent of infected newborns
die within the first five days of birth. To detect the presence of GBS, a doctor
will order urine, blood, or cerebral-spinal fluid tests, followed by a bacterial
culture. Ampicillin and penicillin G are effective antibiotics, but the
tetracycline
antibiotics are not effective.
Maternal infections. Maternal infections include puerperal and intraamniotic infections, both of which cause more than 13 percent of the deaths in the United States each year, making them the fourth leading cause of death among pregnant women. Several terms are used to describe intra-amniotic infection, including “amnionitis,” “clinical choricamnionitis,” and “amniotic fluid infection.” Regardless of the name used, the primary risk factors for acquiring these types of infections are a complicated pregnancy involving prelabor rupture of membranes, excessive internal fetal monitoring, prolonged labor lasting more than twelve hours, and abortions. These complications make a pregnant woman more susceptible to group B Streptococcus growth and colonization. Additional risk factors include the presence of bacterial vaginosis and the occurrence of preterm births. Bacterial vaginosis, which is present in a minimum of 20 percent of all pregnant women, can be caused by exposure to Mycoplasma hominis and Gardnerella vaginalis during sexual intercourse.
Prolonged labor and sexual intercourse are just two of the risk factors that
contribute to the incidence of infectious diseases in women because the vagina
itself has a huge supply of organisms that have the potential to become virulent.
There are millions of these microbial organisms within the vagina of the average
woman. Thus, the rupture of any number of membranes of the placenta, uterus, or
vagina, and also cesarean delivery and multiple cervical examinations, can lead to
these severe infections. The most prevalent of these infections that become severe
after childbirth is endometritis. As with most of these
infections, the best treatment is the use of antibiotics.
Perinatal infections. Perinatal infections can occur in pregnant women with few symptoms, and they can be
transmitted to the fetus, often resulting in severe illness or in death for the
fetus. The most common of these infectious diseases are toxoplasmosis; “other”
diseases, specifically syphilis, hepatitis, and zoster; rubella; cytomegalovirus;
and herpes simplex. They are usually referred to by the acronym TORCH.
The protozoan parasite Toxoplasma gondii, which is transmitted
by rodents and cats, is the cause of toxoplasmosis. Almost 80 percent of
infected humans show only nonspecific, mononucleosis symptoms. Thus, the
relatively high incidence of infection that ranges from one of every five to one
of every two persons is generally overlooked. However, approximately one-half of
infected pregnant women will transmit this disease to their fetuses, with an 85
percent mortality rate; those fetuses who do survive will endure permanent visual
and neurological disabilities after birth. If diagnosed early, treatment with the
drugs sulfadiazine and pyrimethamine is effective. Diagnostic methods include
immunofluorescent antibody tests, enzyme-linked immunoabsorbent assay (ELISA)
tests, and the polymerase chain reaction (PCR) method.
Although the rubella vaccine has been a factor in lowering the incidence rate
of rubella in the general population, pregnant women who
acquire rubella during the first trimester of pregnancy will have a spontaneous abortion in more than one-half of cases. If the fetus does survive
until birth, a minimum of 33 percent of these babies will die. Also, in more than
70 percent of cases, the infant will develop deafness, cataracts, heart disease,
pneumonitis, and additional severe disorders. The most effective diagnostic tool
is hemagglutination inhibition (HI) titer, which is an antibody test.
Of the TORCH infections, cytomegalovirus (CMV) is the most common. The mode of transmission is contact with infected saliva, urine, or blood. Generally, adults have very few symptoms, and the symptoms that do occur are fever, headache, and malaise, which certainly are not diagnostic because they could easily indicate many other conditions. Therefore, although definitive diagnosis is usually made using ELISA, antibody tests, or virus isolation methods, many children are born with this infection. Typical health problems include mental retardation, visual and hearing losses, and seizures; the death rate is 20 to 30 percent. The only drug in usage is ganciclovir, but it is not a completely effective treatment.
Faro, Sebastian, and David Soper, eds. Infectious Diseases in Women. Philadelphia: Saunders, 2001. This book is an excellent source of clinical information on gynecological infections.
Hollier, Lisa D., and George D. Wendel, Jr. Infectious Diseases in Women. Philadelphia: Saunders/Elsevier, 2008. Discusses the latest research into infectious diseases common to women. Also provides useful clinical information.
Martin, Richard J., Avroy A. Fanaroff, and Michele C. Walsh, eds. Fanaroff and Martin’s Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 2 vols. 8th ed. Philadelphia: Mosby/Elsevier, 2006. This classic reference work includes discussions of the practice of neonatal-perinatal medicine.
Murthy, Padmini, and Clyde Lanford Smith. Women’s Global Health and Human Rights. Sudbury, Mass.: Jones and Bartlett, 2010. A comprehensive work that examines the state of women’s health around the world. Includes the chapter “Infectious Diseases and Women’s Human Rights.”
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