Prevalence and correlates of sexually transmitted infections in pregnancy in HIV-infected and- uninfected women in Cape Town, South Africa

Abstract

Objectives Sexually transmitted infections (STIs) are associated with adverse outcomes in pregnancy, including mother-to-child HIV transmission. Yet there are limited data on the prevalence and correlates of STI in pregnant women by HIV status in low- and middle-income countries, where syndromic STI management is routine. Methods Between November 2017 and July 2018, we conducted a cross-sectional study of consecutive pregnant women making their first visit to a public sector antenatal clinic (ANC) in Cape Town. We interviewed women ≥18 years and tested them for Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG) and Trichomonas vaginalis (TV) using Xpert assays (Cepheid, USA); results of syphilis serology came from routine testing records. We used multivariable logistic regression to identify correlates of STI in pregnancy. Results In 242 women (median age 29 years [IQR = 24–34], median gestation 19 weeks [IQR = 14–24]) 44% were HIV-infected. Almost all reported vaginal sex during pregnancy (93%). Prevalence of any STI was 32%: 39% in HIV-infected women vs. 28% in HIV-uninfected women (p = 0.036). The most common infection was CT (20%) followed by TV (15%), then NG (5.8%). Of the 78 women diagnosed with a STI, 7 (9%) were identified and treated syndromically in ANC. Adjusting for age and gestational age, HIV-infection (aOR = 1.89; 95% CI = 1.02–3.67), being unmarried or not cohabiting with the fetus’ father (aOR = 2.19; 95% CI = 1.16–4.12), and having STI symptoms in the past three days (aOR = 6.60; 95% CI = 2.08–20.95) were associated with STI diagnosis. Conclusion We found a high prevalence of treatable STIs in pregnancy among pregnant women, especially in HIV-infected women. Few women were identified and treated in pregnancy.

Prevalence, risk factors and association with delivery outcome of curable sexually transmitted infections among pregnant women in Southern Ethiopia

“…The rate of T. vaginalis in this study was lower than findings from previous studies; 4.98% in Jimma, Ethiopia [25] using culture system, 5.3% in central Ethiopia [20] using rapid test kits, 7.4% in Kenya [22] using GeneXpert, 9.1% in Nigeria [26] using microscopic method, 15% in South Africa [23] and 16.7% among HIV positive pregnant women in South Africa [24]. This might be due difference in laboratory assays used besides socio-demographic variation in of study population.…”

Detection of sexually transmitted pathogens and co-infection with human papillomavirus in women residing in rural Eastern Cape, South Africa

“…STIs have an impact on women's health, associated with cervicitis, urethritis, pelvic inflammation, complications of reproductive health, and poor pregnancy outcomes (Mermelstein & Plax, 2016). South African women have a high prevalence of STIs, ranging from 12.7% to 47.8%, which differs by age, region, and population (Joseph Davey et al, 2019;Moodley et al, 2015;Mudau et al, 2018;Naidoo et al, 2014). The burden of STIs is more common among women of reproductive age (15-49 years) (WHO, 2018).…”

Southern African guidelines on the safe, easy and effective use of pre-exposure prophylaxis: 2020

“…The frequency of screening should be individualised and guided by the sexual history. We recommend that STI screening should occur at least annually and more frequently (6 monthly) in key populations such as MSM, 36 , 37 pregnant women 38 , 39 , 40 and sex workers. High rates of asymptomatic Chlamydia trachomatis (CT) are occurring amongst young women and MSM in the region.…”