From the Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA.
UCLA Department of Medicine Biostats.
Sex Transm Dis. 2021 Feb 1;48(2):128-133. doi: 10.1097/OLQ.0000000000001276.
Porto Alegre, Brazil, has the highest rates of congenital syphilis and HIV in the country. Other treatable sexually transmitted infections (STIs) are associated with poor pregnancy and neonatal outcomes, but are only diagnosed by syndromic algorithms.
Between September 2018 and November 2019, we offered all pregnant women clinic-based STI testing for HIV antibody and treponemal antibody (via lateral flow assay rapid tests provided by the Brazilian Government) and for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis (via polymerase chain reaction-based testing provided by Gene Xpert, Sunnyvale, CA) in 10 public prenatal health clinics in Porto Alegre. Participating women answered a brief survey via audio computer-assisted survey instrument regarding demographics, partnerships, and sexual behaviors. All infected individuals received appropriate treatment and referrals.
Of 400 pregnant women recruited, 94 (24%) were diagnosed with an STI, including 2% with HIV, 11% with syphilis, 9% with chlamydia, 1% with gonorrhea, 5% with trichomoniasis, and 3% with more than 1 STI. In our multivariate analysis, younger age (adjusted odds ratio [AOR], 1.1; 95% confidence interval [CI], 1-1.2), being non-White (AOR, 1.8; 95% CI, 1.1-3.1), having less education (AOR, 2; 95% CI, 1.2-3.4), and having a relationship <1 year (AOR, 2; 95% CI, 1.1-3.6) were all independent predictors of women having an STI. Endorsing symptoms of an STI (e.g., vaginal ulcers/lesions and vaginal discharge) was not predictive of having a laboratory-diagnosed STI (OR, 1.1; 95% CI, 0.7-1.7).
Etiologic-based screening for STIs was uniformly accepted by women attending both hospital-based and primary health clinics in the south of Brazil and can result in appropriate treatment of pregnant women.
巴西阿雷格里港的先天性梅毒和艾滋病毒感染率位居全国之首。其他可治疗的性传播感染（STI）也与不良妊娠和新生儿结局有关，但仅通过综合征算法进行诊断。
2018 年 9 月至 2019 年 11 月期间，我们在阿雷格里港的 10 家公立产前保健诊所为所有孕妇提供了基于诊所的 STI 检测，包括 HIV 抗体和梅毒螺旋体抗体（通过巴西政府提供的侧向流动分析快速检测），以及淋病奈瑟菌、沙眼衣原体和阴道毛滴虫（通过 Gene Xpert，加利福尼亚州森尼韦尔提供的聚合酶链反应检测）。参与的女性通过音频计算机辅助调查工具回答了一份关于人口统计学、伴侣关系和性行为的简短调查。所有感染个体均接受了适当的治疗和转介。
在招募的 400 名孕妇中，有 94 名（24%）被诊断患有性传播感染，包括 2%的 HIV 感染、11%的梅毒、9%的衣原体感染、1%的淋病、5%的滴虫病和 3%的多重感染。在多变量分析中，年龄较小（调整后的优势比 [AOR]，1.1；95%置信区间 [CI]，1-1.2）、非白人（AOR，1.8；95%CI，1.1-3.1）、受教育程度较低（AOR，2；95%CI，1.2-3.4）和关系持续时间<1 年（AOR，2；95%CI，1.1-3.6）均是女性感染性传播感染的独立预测因素。出现性传播感染的症状（例如，阴道溃疡/病变和阴道分泌物）并不能预测实验室诊断的性传播感染（OR，1.1；95%CI，0.7-1.7）。
在巴西南部，以病因学为基础的 STI 筛查得到了在医院和初级保健诊所就诊的女性的普遍接受，并可对孕妇进行适当的治疗。
