Donders G G, Desmyter J, De Wet D H, Van Assche F A
Department of Obstetrics and Gynaecology, Katholieke Universiteit Leuven, Belgium.
Genitourin Med. 1993 Apr;69(2):98-101. doi: 10.1136/sti.69.2.98.
Provide evidence from prospective data that Neisseria gonorrhoeae may be an important cause of premature delivery and low birth weight in areas with high prevalence of genital infections.
Department of Obstetrics and Gynaecology, Kalafong University Hospital, Pretoria, South Africa in collaboration with the Departments of Microbiology and of Gynaecology and Obstetrics, Katholieke Universiteit, Leuven, Belgium.
Two hundred and fifty six consecutive black pregnant women were examined during the first antenatal visit, and one to four weeks later a second culture for N gonorrhoeae was taken at random in 67 of them. Hundred and sixty seven were analysable, 75 were lost to follow up.
After obtaining detailed clinical history, an endocervical specimen for N gonorrhoeae culture (Thayer-Martin) and C trachomatis antigen detection (Chlamydiazyme (R)) was taken. Syphilis was diagnosed when both reactive plasma protein (RPR) and T pallidum haemagglutination inhibition assay (TPHA) were positive. Prematurity was defined as delivery at less than 37 gestational weeks.
Infection with N gonorrhoeae (n = 9) and untreated syphilis (n = 7) were both associated with prematurity and low birth weight. After multi-variate regression analysis, age-adjusted parity, late sexual debut, number of recent sexual partners, infection with N gonorrhoeae and infection with syphilis revealed significant associations with low birth weight. However, infection with C trachomatis, presence of abundant vaginal discharge, social class, Trichomonas vaginalis infection, gestational weeks at first antenatal visit and number of previous miscarriages did not reveal such an association. Attributable risk of untreated gonorrhoea for premature birth was 72% and routine cultures were cost-benefit efficient.
At least in countries where the prevalence is high, genital infections as well as the risk factors for acquiring them (young age, late sexual debut, number of recent partners) play a major role in the aetiogenesis of prematurity and low birth weight. N. gonorrhoeae is a main contributor, and in high prevalence areas it should be routinely looked for and treated for during pregnancy.
提供前瞻性数据证据，证明在生殖器感染高发地区，淋病奈瑟菌可能是早产和低出生体重的重要原因。
南非比勒陀利亚卡拉方大学医院妇产科，与比利时鲁汶天主教大学微生物学系及妇产科合作。
256名连续的黑人孕妇在首次产前检查时接受检查，其中67人在1至4周后随机进行第二次淋病奈瑟菌培养。167人可进行分析，75人失访。
获取详细临床病史后，采集宫颈内标本进行淋病奈瑟菌培养（Thayer-Martin培养基）和沙眼衣原体抗原检测（Chlamydiazyme（R）试剂）。当反应性血浆蛋白（RPR）和梅毒螺旋体血凝抑制试验（TPHA）均为阳性时诊断为梅毒。早产定义为妊娠周数少于37周。
淋病奈瑟菌感染（n = 9）和未经治疗的梅毒（n = 7）均与早产和低出生体重有关。多变量回归分析后，年龄校正后的产次、初次性行为较晚、近期性伴侣数量、淋病奈瑟菌感染和梅毒感染与低出生体重有显著关联。然而，沙眼衣原体感染、大量阴道分泌物、社会阶层、阴道毛滴虫感染、首次产前检查时的孕周以及既往流产次数未显示出此类关联。未经治疗的淋病导致早产的归因风险为72%，常规培养具有成本效益。
至少在患病率高的国家，生殖器感染及其获得风险因素（年轻、初次性行为较晚、近期伴侣数量）在早产和低出生体重的病因学中起主要作用。淋病奈瑟菌是主要促成因素，在高发地区，孕期应常规筛查并治疗。
