Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
PLoS One. 2019 Jul 1;14(7):e0218349. doi: 10.1371/journal.pone.0218349. eCollection 2019.
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.
性传播感染（STI）与妊娠不良结局相关，包括母婴 HIV 传播。然而，在中低收入国家，由于采用综合征性 STI 管理，因此关于 HIV 感染者中 STI 的患病率和相关因素的数据有限。
2017 年 11 月至 2018 年 7 月，我们对开普敦一家公立产前诊所（ANC）首次就诊的连续孕妇进行了一项横断面研究。我们对年龄≥18 岁的妇女进行了访谈，并使用 Xpert 检测（Cepheid，美国）检测了沙眼衣原体（CT）、淋病奈瑟菌（NG）和阴道毛滴虫（TV）；梅毒血清学检测结果来自常规检测记录。我们使用多变量逻辑回归来确定妊娠 STI 的相关因素。
在 242 名妇女（中位年龄 29 岁[IQR = 24-34]，中位孕龄 19 周[IQR = 14-24]）中，44%为 HIV 感染者。几乎所有孕妇都报告了妊娠期阴道性行为（93%）。STI 的患病率为 32%：HIV 感染者为 39%，HIV 未感染者为 28%（p = 0.036）。最常见的感染是 CT（20%），其次是 TV（15%），然后是 NG（5.8%）。在 78 名诊断为 STI 的妇女中，有 7 名（9%）在 ANC 中被识别并采用综合征治疗。调整年龄和孕龄后，HIV 感染（调整优势比[aOR] = 1.89；95%置信区间[CI] = 1.02-3.67）、未婚或与胎儿父亲未同居（aOR = 2.19；95% CI = 1.16-4.12）和过去三天有 STI 症状（aOR = 6.60；95% CI = 2.08-20.95）与 STI 诊断相关。
我们发现，妊娠中可治疗的 STI 患病率很高，尤其是在 HIV 感染者中。很少有孕妇在妊娠期间被识别和治疗。
