The prevalence of sexually transmitted diseases (STDs) among expectant women is a significant concern not only to their health but also to the well being of the fetus. Chlamydia, genital herpes, and gonorrhea are examples of STDs that pose a high risk during pregnancy because they can quickly be passed from mother to infant during child delivery as they pass through an infected birth canal (Teasdale et al., 2018) . Research studies also point out that other STDs such as syphilis, HIV can affect a fetus before birth. Therefore, pregnant women need to know that being pregnant does not prevent them from the risk of becoming infected with the same STDs as those infecting non-pregnant women. Getting tested for STDs is the only sure way pregnant women can ascertain whether they are infected or not. It is also crucial for pregnant women to gain awareness about the harmful effects of STDs and learn how to protect themselves and their unborn babies against infection. Analysis of relevant literature on the topic, incidence, prevalence, and burden of STDs on pregnant women, therapeutic approach to promote patient’s health, and the role of APRN in therapeutic interventions will be discussed in detail.
Review of Literature
A study conducted across five states in the United States showed that there is a direct association between the prevalence of STDs and socioeconomic factors such as ethnicity and education (Williams et al., 2018) . The researchers analyzed data of expectant women from the Pregnancy Risk Assessment Monitoring System (PRAMS). Logistic regression was then conducted by the researchers to ascertain various socioeconomic characteristics that are associated with sexually transmitted diseases.
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The study findings established that the prevalence of curable STDs was higher among younger women compared to those with older age ( Williams et al., 2018) . Also, pregnant women who are of the black race, unmarried, lack college education, lack pre-pregnancy health insurance, and those with less than $25,000 annual income had a higher prevalence of STDs ( Williams et al., 2018) . Chlamydia is the most common STD that affects not only pregnant women by also other individuals in the nation. However, most data relating to STDs among pregnant women is limited because most of them are not subjected to STD sentimental surveillance system during screening. Also, about 80-90 percent of chlamydial infections cause minimal or no symptoms hence often go undiagnosed and untreated. STDs such as gonorrhea also present a lot of problems for women because they are asymptomatic (Williams et al., 2018) . The researchers assert that about 50 to 80 percent of gonococcal infections among women are asymptomatic.
The researchers argue that monitoring the prevalence of STDs among the infected women is vital to help manage ad treat the conditions before they result in adverse outcomes to both the women and their unborn babies. According to Williams et al. (2018), significant adverse effects brought by STDs during pregnancy include the low birth weight of infants. Such effects are the primary causes of infant morbidity and increased mortality rate across the United States. Pregnant women need to undergo frequent screening to diagnose the STDs early and help reduce the burden associated with them.
Incidence, Prevalence, and Burden
Incidence
Various research studies and data from routine screening from antenatal care settings show that younger pregnant women have a higher rate of STDs. For instance, almost half of women in sub-Saharan Africa under the age of 30 years are infected with Herpes ( Teasdale et al., 2018) . Another study conducted in Portugal shows that 11 percent of expectant teenagers are infected with trichomoniasis, while 5 percent have gonorrhea (Teasdale et al., 2018) . The difference in the incidence rate of STD among pregnant women is highly determined by socioeconomic factors and also individual-level determinants, including high-risk behaviors. Women that have sexual relationships with more than one sexual partner are at a higher risk of getting infected with STD. The risk increases, especially when they engage in a sexual encounter with an infected person. STD incidence in pregnant women is also high because most pregnant women report less condom use compared to non-pregnant women. Other sexual risk behaviors such as douching, cleaning, wiping, and inserting materials into the vagina also increase the risk for STD acquisition (Teasdale et al., 2018) .
Prevalence
The most prevalent forms of STDs among pregnant women are gonorrhea and chlamydia. The two curable STDs are prevalent because they are asymptomatic and thus often undiagnosed. The prevalence of STDs, however, varies among different groups of people and also among regions. Studies show that STDs are common in the developing world because such regions lack affordable and straightforward diagnostic tests (Wynn et al., 2020 ). Poverty and lack of accessibility to STD services, unstable housing, and homelessness also significantly influences the sexual risk of women in developing countries. Syphilis is also another type of STD that is prevalent in developing countries. Studies reveal that the prevalence of syphilis infection among pregnant women in sub-Saharan Africa is 2.7% (Wynn et al., 2020) .
STDs present a substantial public health burden. Statistics show that STDs have dire consequences on the reproductive health of women. STDs lead to the loss of healthy years by younger women in low and middle-level income countries. Data from the World Bank show that STDs contribute to 17 percent of the burden of disease in developing countries in Africa (Ali et al., 2017) . When left untreated, chlamydia and gonorrhea can result in pelvic inflammatory diseases (PID), which causes damage to the fallopian tubes. STDs, therefore, elevates the risk of infertility and ectopic pregnancies among women. Study findings indicate that tubal factors account for 30 percent of female infertility in the United States (Wynn et al., 2020) . Curable STDs are also the primary cause of maternal morbidity, stillbirth, and preterm birth. According to the World Health Organization (WHO), preterm birth leads to global cases of under-five mortality, accounting for 1 million deaths. Besides, the number of annual stillbirths associated with STDs is estimated to be 2.6 million ( Ali et al., 2017) . Untreated maternal Chlamydia trachomatis, which can be transmitted to an infant during birth, cause eye infections, which may result in corneal damage and blindness. STDs also increase the risk of mother-to-child transmission of HIV.
Therapeutic Approach to Promote Health Wellness
The use of case management, together with the patient-delivered partner therapy (PDPT) approach, will help control STDs, thereby promoting health and wellness. STDs case management involves the process of caring for pregnant women who present related syndromes or have positive tests for any form of sexually transmitted diseases. Case management should b supplemented with universal serological testing and screening. Screening is vital as it will make it possible to detect asymptomatic STDs, such as gonorrhea and chlamydia, which presents a higher risk to pregnant women. In the case of management, reproductive health practitioners need to pay close attention to patient confidentiality, counseling, and treatment.
PDPT involves the treatment of sexual partners infected by STDs by bypassing the medical evaluation of all partners. In PDPT, a reproductive health practitioner dispenses medication to infected pregnant women to give to their sex partners. PDPT is effective because it improves partner notification outcomes. By dispensing STD medications to their partners, pregnant women are less likely to have STDs diagnosed again ( Golden et al., 2015) . PDPT will, therefore, help in the treatment of recurrent STDs like gonorrhea. However, patients should be counseled to be educated on the importance of observing healthy sexual behaviors. Counseling should help to modify sexual behaviors by encouraging sexual abstinence, maintaining mutually faithful sexual relationships, and promoting 'safe sex' through the correct use of condoms. Counselors also need to develop peer-assisted education programs to enable patients to share information and educate one another. Peer-assisted education is especially vital in helping adolescents change their risky sexual behaviors. The power to make any necessary behavioral changes is heavily dependent on an individual; hence it is crucial to involve infected individuals in the change process.
The Role of APRN to Perpetuate and Implement PDPT
The role of advanced practice registered nurses (APRN) in ensuring the effectiveness of case management and PDPT relies on their ability to make a correct diagnosis of STDs. Through proper diagnosis, APRN will be in a position to provide effective treatment methods that will enable sexual partners to treat and mitigate the effects of recurrent STDs. APRN to act as the lead counselor to their patients in matters relating to sexual education and advice on sexual behavior. The focus of APRNs should not only be on antimicrobial treatment but also on enhancing comprehensive care of the patient’s needs for reproductive health.
The best possible way of implementing PDPT is by improving ‘partner notification’ programs for STDs. Partner notification involves informing the sex partners of the sex partners of pregnant women with an STD of their risk of exposure to ensure treatment ( Golden et al., 2015) . APRNs need to advise their patients to talk to their partners on the STD treatment options available. Through counseling, patients will be empowered to engage in ‘partner notification,' thereby encouraging their sexual partners to accept the medication given by the doctor, thus getting treated.
References
Ali Abdulai, M., Baiden, F., Afari-Asiedu, S., Gyabaa-Febir, L., Adjei, K. K., Mahama, E., ... & Owusu-Agyei, S. (2017). The risk of sexually transmitted infection and its influence on condom use among pregnant women in the Kintampo North Municipality of Ghana. Journal of sexually transmitted diseases , 2017 .
Golden, M. R., Kerani, R. P., Stenger, M., Hughes, J. P., Aubin, M., Malinski, C., & Holmes, K. K. (2015). Uptake and population-level impact of expedited partner therapy (EPT) on Chlamydia trachomatis and Neisseria gonorrhoeae: the Washington State community-level randomized trial of EPT. PLOS Medicine , 12 (1).
Teasdale, C. A., Abrams, E. J., Chiasson, M. A., Justman, J., Blanchard, K., & Jones, H. E. (2018). Incidence of sexually transmitted infections during pregnancy. PloS one , 13 (5).
Williams, C. L., Harrison, L. L., Llata, E., Smith, R. A., & Meites, E. (2018). Sexually transmitted diseases among pregnant women: 5 states, United States, 2009–2011. Maternal and child health journal , 22 (4), 538-545.
Wynn, A., Bristow, C. C., Cristallo, A. D., Murphy, S. M., van den Broek, N., Muzny, C., ... & Litch, J. A. (2020). Sexually transmitted infections in pregnancy and reproductive health: Proceedings of the STAR sexually transmitted infection clinical trial group programmatic meeting. Sexually Transmitted Diseases , 47 (1), 5-11.
