In sum, treatment for symptomatic women is reasonable and outlined above. For most asymptomatic women during pregnancy, screening is not recommended. However, for pregnant women with HIV infection, screening at the first prenatal visit and prompt treatment are encouraged. his is because T vaginalis infection in pregnant women with HIV may be a risk factor for vertical HIVtransmission (Gumbo, 2010; Workowski, 2015).
Candida albicans or other candidal species can be identified by culture from the vagina during pregnancy in approximately 20 percent of women. A link between candidiasis and preterm birth is not robust (Cotch, 1998; Kiss, 2004; Roberts, 2015). hus, asymptomatic colonization requires no treatment. he organism, however, can create an extremely profuse, irritating discharge.
For symptoms, efective treatment is a 100-mg miconazole vaginal suppository or a 2-percent butoconazole, I-percent clotrimazole, 2-percent miconazole, or 0.4-percent terconazole cream, any of which is used daily for 7 days. A shorter, 3-day regimen is daily 2-percent clotrimazole, 4-percent miconazole, or 0.8-percent tioconazole cream, or daily 200-mg miconazole or 80-mg terconazole suppository (Workowski, 2015). In some women, infection is likely to recur and require repeated treatment during pregnancy. In these cases, symptomatic infection usually subsides after pregnancy (Sobel, 2007). For treatment, the American College of Obstetricians and Gynecologists (2017 c) and the CDC recommend topical rather than oral azoles for symptoms. As discussed urther in Chapter 12 (p. 241), oral fluconazole is generally not considered teratogenic, but in 2016, the FDA released a safety alert regarding a possible link with miscarriage (M0Igaard-Nielsen, 2016).
Causative agents of acquired immunodeficiency syndrome (AIDS) are RNA retroviruses termed human immunodiciency viruses, HIV-J and HIV-2. Most cases worldwide are caused by HIV-l infection. Sexual intercourse is the major mode of transmission. he virus also is passed by blood, and infected by breast milk. he primary determinant of transmission is the plasma HIV-l viral load.
For sexual transmission, the viral HIV envelope binds to mucosal dendritic cells. These cells then present the viral par ticle to specific T lymphocytes. These lymphocytes are defined phenotypically by their cluster of dierentiation 4 (CD4) glyco protein surface antigens. The CD4 site serves as a receptor for the virus. Once infected, CD4 T lymphocytes may die, and the common denominator of clinical illness with AIDS is pro found immunodeficiency that gives rise to various opportunis tic infections and neoplasms.
In the United States, the CDC (2016c) estimated that more than 1.2 million individuals were infected in 2013, and new cases numbered more than 39,000. Approximately 8500 women with HIV give birth annually in the United States. However, the estimated number of perinatally acquired HIV cases has decreased dramatically, and the perinatal transmission rate in 2013 was 1.8 percent (Centers for Disease Control and Prevention, 2016b, 2017). his is predominantly due to the implementation of prenatal HIV testing and antiretroviral therapy (ART) for the woman and then her neonate.