Perinatal Infection: Treatment

Pregnant women can be treated during the third trimester with oral erythromycin, for seven to 14 days depending on the dose used. Newborn infants can be treated with erythromycin liquid for 10–14 days at a dosage determined by their body weight.

No drugs or vaccines are currently available for prevention or treatment of CMV.

The antiviral drugs acyclovir or famciclovir can be administered to the mother during pregnancy. Little is known about the risks of these drugs to the fetus, however, the risk of birth defects does not seem to be any higher than for women who do not take these medications. Infants with suspected HSV-2 can be treated with acyclovir. Delivery of the infant by cesarean section is recommended if the mother has an active case of genital herpes.

Infants born to mothers who test positive to the HBsAg test should be treated with hepatitis B immune globulin at birth to give them immediate protection against developing hepatitis B. These infants, as well as all infants, should also receive a series of three hepatitis B vaccine injections as part of their routine immunizations.

Pregnant women with HIV should be treated as early in the pregnancy as possible with zidovudine (AZT). Other newer drugs designed to treat HIV/AIDS may also be used during pregnancy with the knowledge that these drugs may have unknown effects on the infant. The risks and benefits of such treatments need to be discussed. Infants born with HIV should receive aggressive drug treatment to prevent development of AIDS.

Genital warts are very difficult to treat and frequently reoccur even after treatment. They can be removed by cryotherapy (freezing), laser or electrocauterization (burning), or surgical excision (cutting) of the warts. Some medications (imiquimod 5% cream, podophyllin, trichloroacetic acid or topical 5-fluorouracil) can be applied to help dissolve genital warts. Cesarean delivery rather than vaginal delivery seems to reduce the risk of transmission of HPV from mothers to infants.

No treatment is available. Some health care providers may recommend giving the mother an injection of immune globulin (to boost the immune system to fight off the virus) if she is exposed to rubella early in the pregnancy. However, no evidence to support the use of these injections exists. Exposure to rubella early in pregnancy poses a high risk that the infant will have serious birth defects. Termination of the pregnancy may be considered. Women who have not been previously exposed to rubella will usually be vaccinated immediately after the first pregnancy to protect infants of future pregnancies.

Pregnant women diagnosed with GBS late in the pregnancy should be treated with antibiotics injected intravenously to prevent premature labor. If transmission of GBS to the newborn infant is suspected or if the baby develops symptoms of infection, infants can be treated with antibiotics.

Antibiotic therapy, usually penicillin, given early in the pregnancy can be used to treat the infection and may prevent transmission to the infant.

— Altha Roberts Edgren