Research Unit, Foundation for Professional Development, East London, South Africa.
Department of Medical Microbiology, CAPRHI School of Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands.
BJOG. 2021 Jul;128(8):1335-1342. doi: 10.1111/1471-0528.16617. Epub 2020 Dec 22.
To measure the frequencies of sexually transmitted infections (STIs) and adverse pregnancy outcomes among women receiving either aetiological testing or syndromic management for STIs.
Non-randomised prospective cohort study.
Primary healthcare facilities in Tshwane, South Africa.
HIV-infected pregnant women attending antenatal care services.
Participants were enrolled to receive aetiological testing using Xpert® CT/NG and Xpert® TV assays or standard syndromic management. Outcome data were collected at the postnatal care visit (≤30 days from delivery) and from maternity records. Enrolment gestational age-adjusted relative risk (aRR) was calculated.
STI prevalence at postnatal visit, and frequency of adverse pregnancy outcomes (preterm birth, low birthweight).
We enrolled 841 women. The prevalence of any STI at baseline was 40%; Chlamydia trachomatis 30%, Neisseria gonorrhoeae 5.6%, Trichomonas vaginalis 20%. The prevalence of STIs at postnatal care was lower among those receiving aetiological testing compared with those receiving syndromic management (14% versus 23%; aRR 0.61; 95% CI 0.35-1.05). No difference was observed between study groups for frequency of preterm birth (23% versus 23%; aRR 1.2, 95% CI 0.81-1.8) and low birth weight (15% versus 13%; aRR 1.1, 95% CI 0.66-1.7).
Aetiological testing provides an effective intervention to reduce the high burden of STIs in pregnant women in South Africa; however, the optimal implementation strategy remains to be determined.
Aetiological testing effectively reduces the burden of sexually transmitted infections in pregnancy.
测量接受病因学检测或性传播感染（STI）综合征管理的女性的 STI 频率和不良妊娠结局。
非随机前瞻性队列研究。
南非茨瓦内的初级保健设施。
接受产前保健服务的 HIV 感染孕妇。
参与者被招募接受 Xpert® CT/NG 和 Xpert® TV 检测或标准综合征管理的病因学检测。在产后护理就诊时（分娩后≤30 天）和从产妇记录中收集结局数据。计算了 enrolment 妊娠年龄调整相对风险（aRR）。
产后就诊时的 STI 患病率，以及不良妊娠结局（早产、低出生体重）的发生率。
我们招募了 841 名女性。基线时任何 STI 的患病率为 40%；沙眼衣原体 30%，淋病奈瑟菌 5.6%，阴道毛滴虫 20%。接受病因学检测的女性在产后护理时 STI 的患病率低于接受综合征管理的女性（14%比 23%；aRR 0.61；95%CI 0.35-1.05）。两组之间早产（23%比 23%；aRR 1.2，95%CI 0.81-1.8）和低出生体重（15%比 13%；aRR 1.1，95%CI 0.66-1.7）的频率没有差异。
病因学检测为降低南非孕妇 STI 的高负担提供了有效的干预措施；然而，最佳实施策略仍有待确定。
病因学检测有效地降低了妊娠中的性传播感染负担。
