Department of Obstetrics and Gynecology, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa.
Center for the AIDS Program of Research in South Africa (CAPRISA), Durban, South Africa.
Int J Gynaecol Obstet. 2024 Jul;166(1):62-70. doi: 10.1002/ijgo.15529. Epub 2024 Apr 4.
There is a high prevalence and incidence rate of asymptomatic sexually transmitted infections (STIs) during pregnancy in adolescent girls and young women in Africa. The association between STIs and pregnancy outcomes in a hyperepidemic HIV setting has not been well described.
Pregnant women, HIV-1 negative and <28 weeks' gestation at three primary health clinics in KwaZulu-Natal, South Africa were enrolled from February 2017 to March 2018. Vaginal swabs collected at the first and later antenatal visits were stored and retrospectively tested for HSV-2, Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae at the end of the study. The association between STIs detected at first and later antenatal visits and pregnancy outcome was assessed using multivariable logistic regression models adjusted for maternal age and treatment received for symptomatic STIs.
Testing positive Mycoplasma genitalium at the first antenatal visit was significantly associated with low birth weight (odds ratio [OR] 5.22; 95% confidence interval [CI]: 1.10-15.98). Testing positive for T. vaginalis at the repeat visit was significantly associated with preterm births (OR 2.37; 95% CI: 1.11-5.03), low birth weight (OR 2.56; 1.16-5.63) and a composite adverse pregnancy outcome (OR 2.11; 95% CI: 1.09-4.08). Testing positive for HSV-2 at the repeat visit was also likely associated with experiencing a preterm birth or any adverse pregnancy outcome (OR 3.39; 95% CI: 0.86-13.3) (P = 0.096).
Among predominantly asymptomatic STIs, M. genitalium detected at baseline visit was significantly associated with low birth weight, while T. vaginalis detected at the repeat visit in later pregnancy was significantly associated with preterm birth. Further research is warranted to study the impact of etiological testing of STIs at more than one antenatal visit and empirical treatment on pregnancy outcomes.
在非洲，青少年女孩和年轻女性在怀孕期间患有无症状性传播感染（STI）的流行率和发病率都很高。在艾滋病毒高度流行的环境中，STI 与妊娠结局之间的关系尚未得到很好的描述。
2017 年 2 月至 2018 年 3 月，在南非夸祖鲁-纳塔尔省的三个初级保健诊所招募了 HIV-1 阴性且妊娠<28 周的孕妇。在第一次和以后的产前就诊时采集阴道拭子，在研究结束时对其进行疱疹病毒 2 型（HSV-2）、阴道毛滴虫、沙眼衣原体和淋病奈瑟菌的回顾性检测。使用多变量逻辑回归模型评估首次和以后的产前就诊时检测到的 STI 与妊娠结局之间的关联，并根据母亲年龄和接受治疗的症状性 STI 进行调整。
首次产前就诊时检测到解脲支原体阳性与低出生体重显著相关（比值比[OR] 5.22；95%置信区间[CI]：1.10-15.98）。在重复就诊时检测到阴道毛滴虫阳性与早产（OR 2.37；95% CI：1.11-5.03）、低出生体重（OR 2.56；95% CI：1.16-5.63）和不良妊娠综合结局（OR 2.11；95% CI：1.09-4.08）显著相关。在重复就诊时检测到单纯疱疹病毒 2 型阳性也可能与早产或任何不良妊娠结局相关（OR 3.39；95% CI：0.86-13.3）（P=0.096）。
在主要为无症状的 STI 中，基线就诊时检测到的解脲支原体与低出生体重显著相关，而在妊娠后期重复就诊时检测到的阴道毛滴虫与早产显著相关。需要进一步研究在不止一次产前就诊时进行 STI 病因学检测和经验性治疗对妊娠结局的影响。
