Prevalence of Curable Sexually Transmitted Infections in Pregnant Women in Low- and Middle-Income Countries From 2010 to 2015

Davey, Dvora Joseph; Shull, HI; Billings, JD; Wang, D; Adachi, Kristina; Klausner, JD

doi:10.1097/olq.0000000000000460

Cited by 94 publications

(104 citation statements)

References 92 publications

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“…We found that the associations between chlamydia and spontaneous abortion, infertility and ectopic pregnancy were stronger in low-middle-income countries compared with high-income countries. This finding is consistent with previous work showing a higher prevalence and morbidity of chlamydia in low-middle-income countries compared with high-income countries 11 18. Although research from low-middle-income countries was limited, this difference may suggest disparities in the detection and treatment of chlamydia.…”

Section: Discussionsupporting

confidence: 92%

“…To better inform modelling studies and policy, more evidence is needed examining the associations between chlamydia infection and adverse pregnancy outcomes. Previous studies estimating the global burden of chlamydia infection18 19 suggested the cost-effectiveness of chlamydia screening among women20 and identified morbidity associated with chlamydia infection in pregnancy as a significant global health problem, especially in low-income and middle-income countries 11 21. In addition, a few studies have confirmed the association between chlamydia infection and pregnancy and fertility-related adverse outcomes 22 23.…”

Section: Introductionmentioning

confidence: 99%

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Pregnancy and fertility-related adverse outcomes associated withChlamydia trachomatisinfection: a global systematic review and meta-analysis

Tang

Mao

et al. 2019

Sex Transm Infect

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BackgroundGenital chlamydia infection in women is often asymptomatic, but may result in adverse outcomes before and during pregnancy. The purpose of this study was to examine the strength of the relationships between chlamydia infection and different reproductive health outcomes and to assess the certainty of the evidence.MethodsThis review was registered and followed the Cochrane guidelines. We searched three databases to quantitatively examine adverse outcomes associated with chlamydia infection. We included pregnancy and fertility-related outcomes. We performed meta-analyses on different study designs for various adverse outcomes using unadjusted and adjusted analyses.ResultsWe identified 4730 unique citations and included 107 studies reporting 12 pregnancy and fertility-related outcomes. Sixty-eight studies were conducted in high-income countries, 37 studies were conducted in low-income or middle-income countries, and 2 studies were conducted in both high-income and low-income countries. Chlamydia infection was positively associated with almost all of the 12 included pregnancy and fertility-related adverse outcomes in unadjusted analyses, including stillbirth (OR=5.05, 95% CI 2.95 to 8.65 for case–control studies and risk ratio=1.28, 95% CI 1.09 to 1.51 for cohort studies) and spontaneous abortion (OR=1.30, 95% CI 1.14 to 1.49 for case–control studies and risk ratio=1.47, 95% CI 1.16 to 1.85 for cohort studies). However, there were biases in the design and conduct of individual studies, affecting the certainty of the overall body of evidence. The risk of adverse outcomes associated with chlamydia is higher in low-income and middle-income countries compared with high-income countries.ConclusionChlamydia is associated with an increased risk of several pregnancy and fertility-related adverse outcomes in unadjusted analyses, especially in low-income and middle-income countries. Further research on how to prevent the sequelae of chlamydia in pregnant women is needed.Trial registration numberCRD42017056818.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Pregnancy and fertility-related adverse outcomes associated withChlamydia trachomatisinfection: a global systematic review and meta-analysis

Tang

Mao

et al. 2019

Sex Transm Infect

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“…Given the high incidence of STIs risk among African adolescent girls [ 49 , 50 ], it is encouraging that both parents and teachers were supportive of school-centered STI screening for adolescent girls. Addressing the issue of disclosure versus non-disclosure of STI screening results to parents is likely to be a cross-cutting issue for research and programs addressing STIs in adolescents throughout Africa.…”

Section: Discussionmentioning

confidence: 99%

Parents’ and teachers’ views on sexual health education and screening for sexually transmitted infections among in-school adolescent girls in Kenya: a qualitative study

et al. 2017

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BackgroundTo successfully develop and implement school-based sexual health interventions for adolescent girls, such as screening for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis, it is important to understand parents’ and teachers’ attitudes towards sexual health education and acceptability of sexually transmitted infection (STI) screening interventions.MethodsIn this qualitative study, we approached parents and teachers from three high schools to participate in in-depth interviews (IDIs) and focus-group discussions (FGDs). Parents and teachers were asked about their general knowledge of STIs and sexual health education. In addition, they were asked whether they would support utilizing outreach to schools to facilitate provision of sexual health education and screening for STIs in adolescent girls. Data were audio-recorded, transcribed, and translated into English. An initial coding matrix was developed and refined throughout the coding process. Transcripts were coded by two researchers and analyzed using the content analysis approach.ResultsWe conducted 10 IDIs (5 parents and 5 teachers) and 4 FGDs (2 with parents, 2 with teachers, total of 26 participants). Most parents reported few or no discussions regarding STIs with their adolescent girls. Parents were more comfortable discussing consequences of sexual activity including loss of virginity and the potential for pregnancy. Parents tended to place responsibility for sexual health education with teachers. The teachers, in turn, provided basic sexual and reproductive health education including puberty, abstinence, and overview of STIs. Both parents and teachers found the idea of screening for STIs in adolescent girls to be acceptable, and were comfortable with research staff contacting girls through informational meetings at schools. Parents felt that adolescents’ STI screening results should be shared with their parents.ConclusionIn this African setting, parents and teachers provide limited sexual health education, with a focus on negative consequences including loss of virginity, pregnancy, and risk for STIs. Nonetheless, both parents and teachers were supportive of STI screening for adolescent girls, beginning with school-based informational meetings for the girls. Research and programs that aim to provide STI screening in this setting must offer treatment and address the issue of whether results will be disclosed to parents.

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“…Studies in Latin America show that the prevalence of trichomoniasis is approximately 3.9%, which is higher than the prevalence of Neisseria gonorrhoeae (1.2%) and syphilis (1.1%) [4]. Among pregnant women in Brazil, studies have recorded a prevalence of 7.7% [5].…”

Section: Introductionmentioning

confidence: 99%

The prevalence of trichomoniasis and associated factors among women treated at a university hospital in southern Brazil

et al. 2017

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BackgroundTrichomoniasis is the most prevalent non-viral sexually transmitted disease (STD) in the world; however, it remains a neglected parasitic disease. This study aimed to determine the prevalence of trichomoniasis and its associated epidemiological factors among women treated at a hospital in southern Brazil.Methodology/Principal findingsA cross-sectional study was performed to determine the prevalence of this infection in women treated at Hospital Universitário (HU) in Rio Grande, Rio Grande do Sul, Brazil, between January 2012 and January 2015. This study consisted a self-administered questionnaire regarding demographic, clinical, and behavioural data and a molecular diagnosis with polymerase chain reaction (PCR) using the TVK3/7 primer set, which was confirmed with sequence analysis. Of the 345 women surveyed, the overall prevalence of Trichomonas vaginalis (T. vaginalis) was 4.1% (14/345). The prevalence rates were 5.9% among pregnant women, 8.5% among HIV-positive women, and 10.1% among HIV-positive pregnant women. The rates for groups with other significant demographic and clinical features were as follows: 6.6% among women with white skin, 12.3% among women with an income below the minimum monthly wage, 7.4% among women with a vaginal pH greater than or equal to 4.6, and 7.9% among women with a comorbid STD. The multivariate analysis confirmed that pregnant women who were HIV-positive (p = 0.001) and had low incomes (p = 0.026) were the most likely to have this infection.ConclusionsA multivariate analysis confirmed that HIV-positive pregnant women with low incomes were the participants most likely to have trichomoniasis. These results are important because this Brazilian region presents a high prevalence of HIV-1 subtype C, which is associated with greater transmissibility. Additionally, low family income reveals a socioeconomic fragility that might favour the transmission of this STD.

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Prevalence of Curable Sexually Transmitted Infections in Pregnant Women in Low- and Middle-Income Countries From 2010 to 2015

Cited by 94 publications

References 92 publications

Pregnancy and fertility-related adverse outcomes associated withChlamydia trachomatisinfection: a global systematic review and meta-analysis

Pregnancy and fertility-related adverse outcomes associated withChlamydia trachomatisinfection: a global systematic review and meta-analysis

Parents’ and teachers’ views on sexual health education and screening for sexually transmitted infections among in-school adolescent girls in Kenya: a qualitative study

The prevalence of trichomoniasis and associated factors among women treated at a university hospital in southern Brazil

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