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

• Published in: PloS one Vol. 14; no. 7; p. e0218349
• Main Authors: Joseph Davey, Dvora L, Nyemba, Dorothy C, Gomba, Yolanda, Bekker, Linda-Gail, Taleghani, Sophia, DiTullio, David J, Shabsovich, David, Gorbach, Pamina M, Coates, Thomas J, Klausner, Jeffrey D, Myer, Landon
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.07.2019; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adult; Age; AIDS; Ambulatory Care Facilities - statistics & numerical data; Bacteria; Biology and Life Sciences; Chlamydia; Chlamydia Infections - epidemiology; Coinfection; Condoms; Correlation; Cross-Sectional Studies; Disease transmission; Female; Fetuses; Geffen, David; Gestation; Gestational age; Gonorrhea - epidemiology; HIV; HIV Infections - epidemiology; HIV patients; Human immunodeficiency virus; Humans; Infant; Infection; Infections; Infectious Disease Transmission, Vertical - statistics & numerical data; Logistic Models; Medical diagnosis; Medicine and Health Sciences; Perinatal infection; Pregnancy; Pregnancy Complications, Infectious - epidemiology; Pregnant women; Prenatal Care - statistics & numerical data; Prevalence; Public sector; Risk factors; Serology; Sexually transmitted diseases; Signs and symptoms; South Africa - epidemiology; Statistics; STD; Syphilis; Syphilis - epidemiology; Trichomonas Infections - epidemiology; Vagina; Women; Womens health; South Africa; Los Angeles California; Papua New Guinea; United Kingdom > UK; United States > US; England; California; Cape Town South Africa
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0218349

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. 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. 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. 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.