Sexually transmitted infections during pregnancy and subsequent risk of stillbirth and infant mortality in Kenya: a prospective study

Warr, Alex J; Pintye, Jillian; Kinuthia, John; Drake, Alison L.; Unger, Jennifer A.; McClelland, R. Scott; Matemo, Daniel; Osborn, Lusi; John‐Stewart, Grace

doi:10.1136/sextrans-2018-053597

Cited by 49 publications

(54 citation statements)

References 24 publications

(23 reference statements)

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“…[4][5][6][7] STIs during pregnancy have been associated with several adverse pregnancy and birth outcomes, including stillbirth, prematurity, low birth weight and several secondary life-threatening conditions in surviving neonates. [8][9][10][11] STIs can cause chronic abdominal pain, and when left untreated they can cause damage to reproductive organs, resulting in long-term complications such as tubal factor infertility. 10 12 STIs have also been shown to increase the risk of HIV acquisition and transmission.…”

Section: Introductionmentioning

confidence: 99%

Prevalence, incidence and associated risk factors of STIs during pregnancy in South Africa

et al. 2020

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ObjectiveSTIs during pregnancy increase adverse pregnancy and birth outcomes and may increase HIV risk. STI syndromic management is standard of care in South Africa. Our study evaluated the prevalence and incidence of STIs in pregnant women and the associated risk factors.MethodsWe combined data from two prospective observational studies of pregnant women enrolled while attending their first antenatal clinic (ANC) visit in Tshwane District and Cape Town. Women ≥18 years were tested at first ANC visit and at their first postpartum visit for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis using Xpert assays (Cepheid, USA). We evaluated the prevalence and incidence of STI and the associated risk factors using multivariable regression models.ResultsWe enrolled 669 pregnant women, 64% (n=427) from Tshwane District and 36% (n=242) from Cape Town; 80% (n=534) were women living with HIV (WLHIV) and 20% (n=135) without HIV. At enrolment, 37% (n=250) were diagnosed with at least one STI, of which 76% (n=190) were asymptomatic. STI prevalence was 40% (n=213) in WLHIV and 27% (n=37) in women without HIV (p=0.01). Baseline STI infection was associated with younger age (OR=0.95 per year, 95% CI 0.92 to 0.98), higher gestational age (adjusted OR (aOR)=1.03 per week, 95% CI 1.00 to 1.05), single relationship status (aOR=1.53, 95% CI 1.09 to 2.15) and HIV status (aOR=1.86, 95% CI 1.17 to 2.95). Of 419 participants with no STI at baseline, 21 had an incident STI during follow-up, with a mean follow-up time of 140 days. The incidence rate of STI during pregnancy and early post partum was 15 infections per 100 women-years (95% CI 9 to 23). Younger age was associated with STI incidence.ConclusionOur study shows high prevalence and incidence of STIs in pregnancy, especially in WLHIV, demonstrating the need for STI screening in ANC to prevent adverse pregnancy and birth outcomes. Most STI cases were asymptomatic and would have gone untreated with syndromic management. Aetiological STI screening is urgently needed to reduce the burden of STIs in pregnancy.

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Section: Introductionmentioning

confidence: 99%

Prevalence, incidence and associated risk factors of STIs during pregnancy in South Africa

et al. 2020

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“…CT DNA was observed to be more common in products of conception and the placenta in women with miscarriage than in their control counterparts (15). Miscarriage, stillbirth and ectopic pregnancy were reported to be higher in CT infected pregnant women than their uninfected counterparts (10,19,20). One such study found CT antibodies in 33.3% of mothers with stillbirths in comparison to 10.4% of mothers with live births (?…”

Section: Resultsmentioning

confidence: 99%

Trans-Placental Transmission and Survival at Birth among Neonates of Chlamydia trachomatis Infected Mothers: A Cohort Study

Siakwa¹,

Bruce

Owoo³

et al. 2020

Preprint

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Objective The study aimed at assessing trans-placental transmission of Chlamydia trachomatis (CT) and fetal survival at birth among CT infected mothers. Study Design This is a non-interventional prospective cohort study. Population /Study Setting The study was conducted among two thousand and fourteen pregnant women attending antenatal clinic at the Cape Coast Teaching Hospital. Methodology Cord blood from neonates born to one hundred and twelve (112) pregnant women whose cervical samples were positive for CT at first ANC visit were screened by Polymerase Chain Reaction (PCR) for CT infection. Transplacental transmission of CT was considered when CT DNA type-specific agreement was observed between the samples of maternal cervical specimen and the corresponding neonatal cord blood. A neonate who did not survive at birth at > 28weeks

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“…They increase the risk of developing genital cancers, and are a severe medical, social, and economic burden to thousands of adults and babies worldwide (Warr et al, 2019). To date, more than 30 pathogens such as bacteria, viruses, and parasites have been shown to be transmitted through sexual contact.…”

Section: Introductionmentioning

confidence: 99%

Design and Evaluation of a Novel Multiplex Real-Time PCR Melting Curve Assay for the Simultaneous Detection of Nine Sexually Transmitted Disease Pathogens in Genitourinary Secretions

Jiang

et al. 2019

Front. Cell. Infect. Microbiol.

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Background: Sexually transmitted diseases (STD) are a major cause of infertility, long-term disability, ectopic pregnancy, and premature birth. Therefore, the development of fast and low-cost laboratory STD diagnostic screening methods will contribute to reducing STD-induced reproductive tract damage and improve women's health worldwide. In this study, we evaluated a novel multiplex real-time PCR melting curve assay method for the simultaneous detection of 9 STD pathogens, including Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum, and herpes simplex virus.Methods: The analytical performance of the method, including its limit of detection (LOD), specificity, repeatability, and effect on different DNA extraction kits were evaluated. Additionally, we obtained 1,328 clinical specimens from 3 hospitals to detect the 9 STD pathogens using multiplex real-time PCR melting curve and Sanger sequencing, to evaluate the sensitivity, specificity, and consistency of the assay method.Results: The results showed that the analytical sensitivity of the novel multiplex real-time PCR melting curve assay is very excellent, with LOD of DNA corresponding to <200 copies/μL for the DNA of the 9 STDs and 1.00 × 104 color change unit /ml for those of UU and UP. Additionally, this assay demonstrated excellent analytical specificity, excellent repeatability, and its results had no effect of different DNA extraction kits. The performance, in terms of sensitivity (91.06–100%) and specificity (99.14–100%), was remarkable, since the consistency between it and Sanger sequencing was more than 0.85 in the clinic.Conclusion: The novel multiplex real-time PCR melting curve assay method has high sensitivity and specificity, relatively low cost, and simple to use for the simultaneous detection of 9 STD pathogens in genitourinary secretions.

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Sexually transmitted infections during pregnancy and subsequent risk of stillbirth and infant mortality in Kenya: a prospective study

Abstract: STIs and genital infections were common, frequently asymptomatic and some associated with stillbirth or infant mortality. Expediting diagnosis and treatment of STIs in pregnancy may improve infant outcomes.

Cited by 49 publications

References 24 publications

Prevalence, incidence and associated risk factors of STIs during pregnancy in South Africa

Prevalence, incidence and associated risk factors of STIs during pregnancy in South Africa

Trans-Placental Transmission and Survival at Birth among Neonates of Chlamydia trachomatis Infected Mothers: A Cohort Study

Design and Evaluation of a Novel Multiplex Real-Time PCR Melting Curve Assay for the Simultaneous Detection of Nine Sexually Transmitted Disease Pathogens in Genitourinary Secretions

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