Pregnancy is one of the most closely monitored periods in a person’s life — and for good reason. Dozens of routine tests are performed at prenatal visits to protect both mother and baby. Yet despite Florida’s persistently elevated STI rates, STI-related complications in pregnancy remain an underappreciated risk for many expectant mothers in Southwest Florida.
Several sexually transmitted infections — including HIV, syphilis, gonorrhea, chlamydia, and herpes — can be transmitted from mother to baby during pregnancy, delivery, or breastfeeding. These congenital infections can cause serious harm, including stillbirth, preterm birth, blindness, deafness, neurological damage, and death. The critical fact is that most of these outcomes are completely preventable with early screening and appropriate treatment. At Florida Infectious Disease Care in Fort Myers, we provide expert evaluation and management for STI testing and care during pregnancy when obstetricians need specialist support.
Why STI Rates During Pregnancy Matter in Florida
Florida’s STI rates have been rising for several consecutive years. Congenital syphilis — the transmission of this bacterial infection from a pregnant mother to her baby — has reached its highest national levels in decades, with Florida among the hardest-hit states. According to the CDC, congenital syphilis cases in the United States increased by more than 700 percent between 2012 and 2022. Florida has contributed disproportionately to this alarming trend.CDC
Many of these cases occur in women who had prenatal care but were not rescreened for syphilis later in pregnancy, or who were not treated promptly after a positive result. This is not a failure of medicine — it is a failure of system-level follow-through that additional specialist involvement and patient education can address.
HIV and Pregnancy: Prevention of Mother-to-Child Transmission
Without intervention, the risk of an HIV-positive mother transmitting the virus to her baby during pregnancy, delivery, or breastfeeding is approximately 15 to 45 percent, according to the WHO. With appropriate antiretroviral therapy and medical management, that risk drops to less than one percent.
All pregnant women in Florida should receive HIV testing at their first prenatal visit. Women at higher risk should be retested in the third trimester. Women who test HIV-positive during pregnancy receive antiretroviral therapy that both treats their own infection and reduces the viral load to levels at which transmission to the baby is negligible. This is one of the most significant success stories in modern infectious disease medicine.
If you are pregnant and HIV-positive — or if you test positive during pregnancy — our infectious disease team works closely with your obstetrician to coordinate antiretroviral management throughout your pregnancy and to plan appropriate delivery and neonatal care.
Syphilis in Pregnancy: An Urgent Public Health Emergency
Syphilis during pregnancy is a medical emergency. The Treponema pallidum bacterium crosses the placenta readily and can infect the baby at any stage of pregnancy. Congenital syphilis causes miscarriage, stillbirth, prematurity, and in liveborn babies, multi-organ damage including bone abnormalities, skin lesions, liver and spleen enlargement, neurological involvement, and hearing loss.
The only proven treatment for syphilis in pregnancy is benzathine penicillin G, administered by injection. No oral antibiotic is an acceptable substitute for penicillin in this context. Women with documented penicillin allergy require desensitization before treatment — a process managed by infectious disease specialists. If you have been diagnosed with syphilis during pregnancy and have a penicillin allergy, contact our clinic immediately for specialist coordination.
Gonorrhea and Chlamydia During Pregnancy
Both gonorrhea and chlamydia can cause serious complications in pregnancy and for the newborn. In the mother, untreated gonorrhea and chlamydia increase the risk of preterm labor, premature rupture of membranes, and postpartum infection. In the newborn, gonorrheal conjunctivitis (ophthalmia neonatorum) can cause corneal scarring and blindness without prompt treatment.
The CDC recommends screening all pregnant women for gonorrhea and chlamydia at the first prenatal visit, with repeat testing in the third trimester for women at continued risk. Antibiotic treatment during pregnancy is safe and effective, with regimens selected based on culture sensitivity and pregnancy safety profiles.
Herpes in Pregnancy: Managing a Lifelong Virus
Genital herpes (HSV-2 and increasingly HSV-1) poses a specific risk in pregnancy, primarily during delivery rather than in the womb. Neonatal herpes — acquired during passage through an infected birth canal — is rare but can be devastating, causing encephalitis, disseminated infection, and death if not treated promptly.
Women with a known history of genital herpes are offered suppressive antiviral therapy with acyclovir or valacyclovir in the last four weeks of pregnancy to reduce the risk of an active outbreak at delivery. Women who acquire herpes for the first time late in pregnancy face the highest risk of neonatal transmission and require specialist guidance on delivery planning.
Hepatitis B in Pregnancy
Hepatitis B can be transmitted from mother to baby at delivery, and without intervention, approximately 90 percent of babies born to hepatitis B surface antigen-positive mothers will develop chronic Hepatitis B infection. All pregnant women are screened for Hepatitis B at their first prenatal visit. Babies born to infected mothers receive Hepatitis B immune globulin and the first dose of hepatitis B vaccine within 12 hours of birth — a protocol that is highly effective at preventing transmission.
When Should an Infectious Disease Specialist Be Involved?
Most STI management during pregnancy is appropriately led by obstetricians. However, infectious disease specialist involvement is warranted when:
- A pregnant patient is HIV-positive and requires antiretroviral management or has a complex HIV history
- Syphilis is diagnosed and penicillin allergy is documented — requiring desensitization
- A pregnant patient has a drug-resistant STI requiring alternative antibiotic selection
- Multiple concurrent infections are present requiring coordinated management
- STI treatment is not producing the expected serological response in a pregnant patient
Frequently Asked Questions
Q: Will treating an STI during pregnancy harm my baby?
No. The antibiotics used to treat bacterial STIs — including penicillin, azithromycin, and cephalosporins — are pregnancy-safe when prescribed in appropriate doses. Antiretroviral medications for HIV have extensive safety data in pregnancy. Untreated STIs pose far greater risk to the baby than their treatment. Your obstetrician and infectious disease specialist will always select treatments with the best available pregnancy safety profile.
Q: Can I breastfeed if I have an STI?
It depends on the specific infection. Women with HIV who are on effective antiretroviral therapy can breastfeed with very low transmission risk in high-resource settings, though formula feeding is still recommended in the United States where safe alternatives are readily available. Women with active herpes lesions on the breast should not breastfeed from the affected side. Bacterial STIs that have been fully treated do not contraindicate breastfeeding. Your provider will give specific guidance based on your diagnosis.
Q: I was tested for STIs at my first prenatal visit — do I need to be tested again?
For many STIs, yes — particularly if you have ongoing risk factors. The CDC recommends repeat syphilis testing in the third trimester and at delivery for women in high-prevalence areas, which includes much of Florida. Repeat gonorrhea and chlamydia testing in the third trimester is recommended for women at continued risk. Discuss your personal risk profile with your obstetrician at each prenatal visit.
Q: What if I am diagnosed with an STI but my partner refuses testing or treatment?
This is a difficult but important situation. Your own treatment should proceed regardless of your partner’s decisions. For STIs such as syphilis, gonorrhea, and chlamydia, partner notification is important because reinfection after treatment can occur with an untreated partner. The Florida Department of Health offers partner notification assistance services. Our team can also help you navigate this conversation and connect you with appropriate support resources.
Ready to Get the Expert Care You Deserve?
At Florida Infectious Disease Care, our board-certified specialists bring decades of combined expertise to every patient encounter — with compassion, precision, and complete confidentiality. Whether you are navigating a new diagnosis, a recurring infection, or a prevention decision, we are the right team for you. Call us today at 239-245-8223 or visit us at 14192 Metropolis Ave, Fort Myers, FL 33912.
Book your appointment at floridaidcare.com/make-an-appointment or find us on Google Maps. Expert infectious disease care is closer than you think — and your health cannot wait.