During pregnancy many things can affect the fetus and the pregnant person; each and every one of them has a different effect on both of them. Some of the most important things a pregnant person has to phase during that time are the TORCH infections. "TORCH" is an acronym for Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus and Herpes and these infections, if they happen during pregnancy and are left untreated and without proper care, they can have very negative results on the outcome of that pregnancy. For example, perinatal infections account for 2% to 3% of all congenital anomalies.
In this article, we will include information about what those infections are, how someone gets infected and how to deal with them during pregnancy.
Disclaimer: Midwifery is a very inclusive and safe space for everyone, where your identity and your needs are valid and important to us. Thus, the terms used in this article aim towards making everyone feel comfortable and included.
Uterus owner (person with a uterus, uterus-having person) <--> person with female genitalia
Pregnant person (female, male or non-binary) <--> the person who carries the baby in their womb
[if you feel that you are not included at any point, please contact us and help us change that]
© NIKOLETA CHATZIPANAGIOTIDOU, SOME RIGHTS RESERVED 10/10/2022
Toxoplasmosis
Toxoplasmosis is a disease that results from infection with the Toxoplasma gondii parasite, one of the world's most common parasites. Infection usually occurs by eating undercooked contaminated meat, exposure to infected cat feces, or transmission during pregnancy.
While pregnant there are some ways to try and avoid getting infected. As CDC recommends:
Avoid changing cat litter if possible. If no one else can perform the task, wear disposable gloves and wash your hands with soap and water afterwards.
Ensure that the cat litter box is changed daily. The Toxoplasma parasite does not become infectious until 1 to 5 days after it is shed in a cat’s feces.
Feed your cat commercial dry or canned food, not raw or undercooked meats.
Keep cats indoors.
Avoid stray cats, especially kittens. Do not get a new cat while you are pregnant.
Keep outdoor sandboxes covered.
Wear gloves when gardening and during contact with soil or sand because it might be contaminated with cat feces that contain Toxoplasma. Wash hands with soap and water after gardening or contact with soil or sand.
Cook food to safe temperatures. A food thermometer should be used to measure the internal temperature of cooked meat. Color is not a reliable indicator that meat has been cooked to a temperature high enough to kill harmful pathogens like Toxoplasma. Do not sample meat until it is cooked.
Your doctor will give you some blood tests at the beginning of the pregnancy journey in order to determine if an infection is ongoing. Those tests include IgG and IgM antibodies for Toxoplasma gondii. If IgG antibodies are positive, then an infection had occurred in that person's past, at some point in their life. If the IgM antibodies are positive, then that person is currently infected.
If you are newly infected with Toxoplasma while you are pregnant, or just before pregnancy, then you can pass the infection on to your baby. You may not have any symptoms from the infection. Most infected infants do not have symptoms at birth but can develop serious symptoms later in life, such as blindness or mental disability. Occasionally, infected newborns have serious eye or brain damage at birth. (CDC, 2020)
Luckily, after the diagnosis of Toxoplasmosis, the pregnant person can take medication and treat the infection. However, both the parent and the baby should be closely monitored during pregnancy and after the baby is born.
Other (syphilis, varicella-zoster, parvovirus B19)
- SYPHILIS
Syphilis is a bacterial infection usually spread by sexual contact. The disease starts as a painless sore — typically on the genitals, rectum or mouth. Syphilis spreads from person to person via skin or mucous membrane contact with these sores. This can cause a lot of harm to the baby if infected during pregnancy, which can happen through the placenta or during birth.
Congenital syphilis can have a major health impact on a baby, but how it affects the baby’s health depends on when syphilis was acquired in pregnancy and if — or when — the pregnant person received treatment for the infection. Syphilis in pregnant people can cause miscarriage, stillbirth, or the baby’s death shortly after birth. Approximately 40% of babies born to people with untreated syphilis can be stillborn or die from the infection as a newborn. Babies born with congenital syphilis can have bone damage, severe anemia, enlarged liver and spleen, jaundice, nerve problems causing blindness or deafness, meningitis, or skin rashes. (CDC, 2020)
Sadly there is no vaccine for syphilis, so to help prevent the spread of syphilis, follow these suggestions (CDC, 2021):
Abstain or be monogamous. The only certain way to avoid syphilis is to avoid (abstain from) having sex. The next-best option is to have mutually monogamous sex in which both partners have sex only with each other and neither partner is infected.
Use a latex condom. Condoms can reduce your risk of contracting syphilis, but only if the condom covers the syphilis sores.
Avoid recreational drugs. Misuse of alcohol or other drugs can inhibit your judgment and lead to unsafe sexual practices.
The same blood tests are done for syphilis (IgG & IgM antibodies). If the IgM antibodies are positive, then the pregnant person should get treated immediately. Syphilis can be treated effectively with penicillin. Their sex partner(s) should also receive treatment to prevent the person from becoming re-infected and to improve the health of their partner. Surviving infants exposed to syphilis should be evaluated at birth to assess the need for additional treatment, and closely followed post-delivery whether or not treatment was provided. (CDC, 2020)
-VARICELLA ZOSTER VIRUS
Varicella-zoster virus (VZV) causes chickenpox and herpes zoster (shingles). Varicella is characterized by a pruritic, maculopapular, vesicular rash that evolves into noninfectious dried crusts over a 3- to 7-day period. Reactivation of the dormant virus results in the characteristic painful dermatomal rash of herpes zoster, which is often followed by pain in the distribution of the rash (postherpetic neuralgia).
The virus is highly contagious and it spreads through infected respiratory droplets. Many pregnant people have already been exposed to the virus and are therefore immune. However, those who have never had the infection or been immunized can get infected by this virus and it can potentially cause birth defects or illness in the baby. Approximately 10 to 20 percent of those people infected with varicella develop pneumonia, a severe lung infection. Encephalitis, or an inflammation of the brain tissue, may also occur in a very small number of pregnant people with varicella. A baby with congenital varicella syndrome might have underdeveloped arms and legs, eye inflammation, and incomplete brain development. The baby may also contract congenital varicella if delivery occurs while the pregnant person is still infected and hasn’t yet developed antibodies to the virus. If varicella develops within five days or within one to two weeks after delivery, the baby might be born with a potentially life-threatening infection called congenital varicella. (Healthline, 2016)
The same blood tests are done. If the virus is detected, treatment can help prevent or weaken the severity of the illness.
Thankfully there is a vaccine and people who are vaccinated cannot get infected with VZV. However, during pregnancy people should avoid those with chickenpox, including daycare centers and school settings, where children may not be vaccinated, and often exposed.
-PARVOVIRUS B19
Parvovirus B19 spreads through respiratory secretions, such as saliva, sputum, or nasal mucus, when an infected person coughs or sneezes. Parvovirus B19 can also spread through blood or blood products. A pregnant person who is infected with parvovirus B19 can pass the virus to their baby. Otherwise known as the " fifth disease", the infection with Parvovirus B19 can cause a mild rash illness and this disease is usually not a problem for pregnant women and their babies.
According to CDC, about half of pregnant women are immune to parvovirus B19, so they and their babies are usually protected from getting the virus and fifth disease. Pregnant women who are not immune usually have only mild illness if they are exposed to the fifth disease. Also, their babies usually do not have any problems.
Testing for Parvovirus B19 during pregnancy is done with a simple blood test. That test is able to show pregnant people if:
- they are immune and have no recent serologic evidence of infection.
- they are not immune, but they have never been infected.
- they have been infected recently.
If a pregnant person gets infected or thinks that they may have been infected, they should inform their healthcare provider and follow their instructions, as there is no specific way to monitor pregnant people with parvovirus B19 infection.
Rubella
Rubella on the other side, is a very dangerous virus for both the pregnant person and the embryo. Although rubella was declared eliminated from the U.S. in 2004, cases can occur when unvaccinated people are exposed to infected people, mostly through international travel according to CDC.
Infection with rubella virus causes the most severe damage when the mother is infected early in pregnancy, especially in the first 12 weeks (first trimester). During 2005-2018, 15 babies with Congenital Rubella Syndrome (CRS) have been reported in the United States. (CDC, 2020).
Pregnant women who contract rubella are at risk for miscarriage or stillbirth, and their developing babies are at risk for severe birth defects with devastating, lifelong consequences. CRS can affect almost everything in the developing baby’s body and the most common birth defects include:
Deafness
Cataracts
Heart defects
Intellectual disabilities
Liver and spleen damage
Low birth weight
Skin rash at birth
Although specific symptoms can be treated, there is no cure for CRS. Since there is no cure, it is important for women to get vaccinated before they get pregnant. (CDC) That is because the rubella vaccine can help prevent a pregnant woman from catching the virus, but once the virus is found in her bloodstream, it is too late to be vaccinated.
Cytomegalovirus
Cytomegalovirus (CMV) is a common virus that is usually harmless. Sometimes it causes problems in babies if you get it during pregnancy (congenital CMV).
It is mainly spread through close contact with someone who already has CMV.
It can be passed on through sexual contact and contact with other body fluids including saliva, blood, breast milk, tears, pee and poo. CMV can only be passed on when it's "active".
If CMV is not causing symptoms (a high temperature, aching muscles, tiredness, skin rash, sore throat, swollen glands, etc.), the mother or the baby may not need any treatment.
There's currently no treatment for CMV in pregnancy, but in most cases, the virus does not cause any problems for the baby.
Babies born with congenital CMV may have tests to check their kidneys, liver, brain, eyes and hearing, and regular follow-up appointments until they're around age 5.
As the NHS advises, the best way to reduce the chance of getting CMV during pregnancy is to:
wash your hands using soap and water – especially after changing nappies, feeding young children or wiping their nose
regularly wash toys or other items that may have young children's saliva or urine on them
avoid sharing food, cutlery and drinking glasses or putting a child's dummy in your mouth
avoid kissing young children on their mouth
There's currently no vaccine for CMV.
Herpes
Genital herpes is a common sexually transmitted infection caused by the herpes simplex virus (HSV). There are two types, HSV-1 and HSV-2, both of which can cause infection in the genital and anal area (genital herpes). Herpes simplex can also occur around the mouth and nose (cold sores) and fingers and hand (herpetic whitlows). In women, genital herpes can occur on the skin in and around the vagina, the vulva (lips around the opening of the vagina), the urethra (tube through which urine empties out of the bladder) and the anus (back passage). (RCOG)
The timing of the infection of the mother is of big importance, as it plays a crucial part in whether the baby gets infected or not.
If the mother has genital herpes before pregnancy or if they are first infected early in pregnancy --> less than 1% possibility of the baby getting infected.
If the mother is recently infected later on in her pregnancy --> high risk of infection for the baby ( 30-50%).
In order to prevent getting infected and not knowing about it, it is recommended that all pregnant people should be tested for herpes when they get pregnant, especially if their sex partners have herpes. Women who don't have genital herpes should be careful about sex during the third trimester. Unless they know for sure that their partner is checked for herpes, they should avoid sex (and oral) altogether during the third trimester, because the infection for the baby can be fatal.
The treatment for Herpes during pregnancy is something that should be discussed with the patient's doctors as it is personalised to each case. Women already taking antiviral drugs for herpes should consult their doctor about whether to take the drugs during pregnancy or not.
Last but not least, newborns can be infected and it can be very serious so parents should be very careful with who kisses and touches the baby in general, especially if it is someone with a cold sore!
Conclusion
All in all, TORCH diseases are a big risk for pregnant people, their embryos and later on their babies, as they grow older. There are many ways to protect yourself and prevent an infection from happening, however, you have to be informed in order to do that.
Last but not least, you should always get vaccinated for all the diseases and viruses that a vaccine is available. Vaccination saves lives!
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