Olaleye Atinuke O, Babah Ochuwa A, Osuagwu Chioma S, Ogunsola Folasade T, Afolabi Bosede B
Department of Obstetrics and Gynecology, Babcock University, Ilishan, Nigeria.
Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Nigeria.
Eur J Obstet Gynecol Reprod Biol. 2020 Dec;255:1-12. doi: 10.1016/j.ejogrb.2020.10.002. Epub 2020 Oct 8.
Routine screening for Chlamydia and gonococcal infection in pregnancy is not widespread, especially in low- and middle-income countries (LMICs), despite their potential adverse consequences on pregnancy outcome. We conducted a systematic literature search of three major databases to review current literature surrounding Chlamydia trachomatis and Neisseria gonorrhoeae infections in pregnancy. We discuss the epidemiology and burden of both infections, detection methods, potential adverse feto-maternal and infant outcomes and provide an overview of treatment options. A total of 67 articles met the inclusion criteria. The prevalence of C. trachomatis and N. gonorrhoeae across all trimesters ranged between 1.0%-36.8% and 0-14.2% worldwide, respectively. The most common diagnostic method is the Nucleic acid amplification test (NAAT). In pregnancy, chlamydia is associated with preterm birth, spontaneous miscarriage, stillbirth and neonatal conjunctivitis, while gonorrhoea is mainly associated with preterm birth and stillbirth. Amoxicillin, erythromycin and azithromycin showed similar efficacy in the treatment of chlamydia in pregnancy, while ceftriaxone and cefixime were effective in treating gonorrhoea in pregnancy. Being largely asymptomatic infections in women, we opine that detection strategies with locally appropriate tools should be combined with the syndromic approach in LMICs, where there is a high burden of disease.
孕期沙眼衣原体和淋病奈瑟菌感染的常规筛查并不普遍，尤其是在低收入和中等收入国家（LMICs），尽管这些感染可能对妊娠结局产生不良后果。我们对三个主要数据库进行了系统的文献检索，以回顾当前有关孕期沙眼衣原体和淋病奈瑟菌感染的文献。我们讨论了这两种感染的流行病学和负担、检测方法、潜在的母婴和婴儿不良结局，并概述了治疗选择。共有67篇文章符合纳入标准。全球范围内，所有孕期沙眼衣原体和淋病奈瑟菌的患病率分别在1.0%-36.8%和0-14.2%之间。最常见的诊断方法是核酸扩增试验（NAAT）。在孕期，衣原体感染与早产、自然流产、死产和新生儿结膜炎有关，而淋病主要与早产和死产有关。阿莫西林、红霉素和阿奇霉素在治疗孕期衣原体感染方面显示出相似的疗效，而头孢曲松和头孢克肟在治疗孕期淋病方面有效。鉴于这些感染在女性中大多无症状，我们认为在疾病负担较高的低收入和中等收入国家，应将使用当地适用工具的检测策略与症状处理方法相结合。
