HIV in the Pregnant Patient

Today we go into part 2 of our HIV series, this time focusing on pregnancy and HIV. Check out ACOG CO 752 (Prenatal and Perinatal HIV Screening) and CO 751 (Labor and Delivery Management of Women with HIV).

However, we have to give a major shout out to the OBG Project — their editors have put out an awesome summary of HIV in pregnancy and preventing vertical transmission: Check it out here.

(c) OBG Project

One of the important CREOG points on HIV in pregnancy includes drug interactions. Methergine is metabolized by CYP3A4 enzymes, which may be inhibited by certain antiretrovirals. Thus, methergine should be avoided if possible if encountering postpartum hemorrhage.

Lastly, we wanted to drive home the point again about patient autonomy, especially regarding risk of cesarean delivery. We put the ACOG CO text below for you to chew on!


Herpes Simplex

Today we get back on track in our STI saga with herpes simplex!

Clinically speaking, the most important thing to remember is the treatment of HSV, which is summed up nicely in the CDC guidelines. That said, we’ve tried to put together a little table for ease of reference here.

In pregnancy, suppressive therapy should be initiated at 36 weeks with one of two regimens: acyclovir 400mg TID or valacyclovir 500mg BID.

We also don’t discuss much about disseminated HSV infection or neonatal HSV infection in today’s podcast. These can be devastating to adults and neonates alike, but we will touch on the neonatal aspect in a future episode on TORCH infections.

Find additional resources at The OBGProject!
- STD Screening in Pregnancy
- Ulcerative Genital Conditions in HIV-positive Patients

Gonorrhea and Chlamydia

Though CREOGs are over, we hope you continue to study with us! On today’s episode we tackle chlamydia and gonorrhea.

The most helpful resource we mention on today’s episode comes from the CDC’s 2015 STD Treatment Guidelines. They even have a free smartphone app, which is very handy for use in your emergency department or clinic/office setting.

Gonorrhea is caused by the gram negative diplococcus Neisseria gonorrhoeae. Chlamydia is an obligate intracellular gram negative pathogen. Below we’ve created our own guides to treatment based on the CDC recommendations. Happy listening!