Gonorrhea in Pregnancy: Risks to Mother and Baby, Testing, and Treatment

Gonorrhea Does Not Cause Infertility Directly, But Complicates Pregnancy

Neisseria gonorrhoeae infection during pregnancy poses serious risks:

Maternal Risks

• Ascending infection → endometritis, salpingitis, PID (if undiagnosed pre-pregnancy).
• Premature rupture of membranes (PROM).
• Preterm labor and delivery.
• Chorioamnionitis.
• Postpartum endometritis.

Neonatal Risks

• Ophthalmia neonatorum: Conjunctivitis at 2–5 days; can cause corneal perforation, blindness. Prevented by mandatory erythromycin 0.5% eye ointment at birth.
• Disseminated gonococcal infection: Sepsis, arthritis, meningitis, scalp abscesses (from fetal monitoring).
• Low birth weight, prematurity.

Screening Guidelines (CDC)

• All pregnant women <25 years: Screen at first prenatal visit.
• Age ≥25 with risk factors: New/multiple partners, prior STI, inconsistent condoms, drug use, partner with STI.
• Repeat in 3rd trimester if risk persists.
• Test of cure: NAAT 7–14 days after treatment (culture if available).

Treatment in Pregnancy

• Ceftriaxone 500 mg IM single dose (1 g if ≥150 kg) – only recommended regimen.
• Azithromycin 1 g PO added if chlamydia co-infection not ruled out.
• Avoid fluoroquinolones, tetracyclines.
• Partner treatment essential (expedited partner therapy where legal).

Key Point

Gonorrhea doesn't prevent conception, but untreated infection jeopardizes pregnancy outcomes. Universal prenatal screening and prompt treatment are standard of care.