Gonorrhea in Pregnancy: CDC Statistics, Risks, and Prevention

CDC estimates ~700,000 pregnant women in the US are infected with gonorrhea annually (based on 2018 surveillance data; actual may be higher due to asymptomatic cases).

Transmission & Pathogen

• Neisseria gonorrhoeae – gram-negative diplococcus.
• Sexual contact (vaginal, anal, oral); vertical transmission during delivery.

Maternal Risks

• Pelvic inflammatory disease (PID) – rare in pregnancy due to cervical mucus plug.
• Chorioamnionitis, preterm premature rupture of membranes (PPROM), preterm labor.
• Postpartum endometritis.
• Disseminated gonococcal infection (DGI) – arthritis, dermatitis, tenosynovitis.

Neonatal Risks

• Ophthalmia neonatorum: Conjunctivitis → corneal scarring, blindness if untreated. Prevented by erythromycin 0.5% ointment at birth (mandatory in most states).
• Scalp abscesses, sepsis, arthritis, meningitis.

Screening & Treatment

• Universal screening at first prenatal visit (NAAT – urine, endocervical, vaginal swab).
• Repeat in 3rd trimester if high risk (age <25, new/multiple partners, prior STI, high-prevalence area).
• Treatment: Ceftriaxone 500 mg IM single dose (1 g if ≥150 kg) + Doxycycline 100 mg BID × 7 days (if chlamydia co-infection suspected) – doxycycline contraindicated in pregnancy; use azithromycin 1 g PO single dose instead.
• Test-of-cure 2 weeks post-treatment (NAAT).
• Partner treatment essential (expedited partner therapy where legal).

Prevention

• Condoms, mutual monogamy, regular screening.
• Expedited partner therapy reduces reinfection.

Untreated gonorrhea in pregnancy has serious maternal-fetal consequences; screening and prompt treatment are standard of care.