Between March 2021 and March 2022, 251 pregnant women were tested for Chlamydia trachomatis and Neisseria gonorrhoeae infection in Botswana. Fifty-eight (23%) tested positive for at least 1 infection, and 57 (98%) were treated. No participants tested positive at test of cure. In some settings, cost of test of cure may outweigh the benefits.C hlamydia trachomatis and Neisseria gonorrhoeae are curable sexually transmitted infections (STIs) that are linked to adverse pregnancy and neonatal outcomes, including preterm birth, premature membrane rupture, miscarriage, low birth weight, and conjunctivitis and pneumonia in exposed newborns. [1][2][3][4][5] In most low-and middle-income countries (LMICs), including Botswana, a World Health Organization-endorsed algorithmic syndromic management approach has been adapted for STI diagnosis and management. 6 In few countries, C. trachomatis and N. gonorrhoeae screening is routinely offered in antenatal care. 7 In most high-income countries where STI testing is offered, repeat testing for pregnant women after a C. trachomatis/N. gonorrhoeae-positive test result is recommended because of risk of reinfection and treatment failure. [8][9][10][11] Current US Centers for Disease Prevention and Control guidelines recommend a test of cure at approximately 4 weeks after treatment and a rescreen at 3 months after treatment for pregnant women who have been diagnosed with C. trachomatis infection to document eradication of the infection. 9 A rescreen at 3 months after treatment is recommended for pregnant women who test positive for N. gonorrhoeae. 9 Current World Health Organization treatment guidelines do not include guidance on the need for a test of cure and repeat screening after a positive C. trachomatis or N. gonorrhoeae test result.Multiple studies have evaluated integration of diagnostic C. trachomatis and N. gonorrhoeae testing into antenatal care in LMICs. [12][13][14][15][16][17][18][19][20][21] In resource-constrained settings, repeat testing for test of cure may not be feasible because of the added costs of testing. 22 Within this context, we evaluated the rate of microbiological cure after a positive C. trachomatis/N. gonorrhoeae test result among pregnant women enrolled in an STI testing and treatment intervention study in Gaborone, Botswana. We also assessed factors that may be associated with cure, including partner treatment.

We would like to congratulate Asare et al [1] on their analysis of the outcomes of point-of-care (POC) testing for sexually transmitted infections (STIs) among women in South Africa during an HIV vaccine trial. They found that, in one clinic, 92% of women with a positive test result for

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Background We describe 12 cases of chlamydial ophthalmia neonatorum and the current scientific evidence on its prevention and treatment. The data presented were obtained from the “Maduo” study, a prospective observational study of the relationship between curable sexually transmitted infections and adverse neonatal outcomes at four antenatal clinics in Gaborone, Botswana. Methods Infants of mothers with perinatal chlamydia infection were evaluated for chlamydial ophthalmia neonatorum based on clinical presentation of conjunctivitis or positive test via GeneXpert CT/NG assay. Data on 29 infants born to mothers with postnatal C. trachomatis infection were analysed. Results 12 infants were diagnosed with chlamydial ophthalmia neonatorum. Eight of those cases were confirmed with the GeneXpert CT/NG assay while four were identified as probable cases based on clinical history and presentation. Overall, nine infants presented with signs of conjunctivitis, while three who had a positive diagnostic test result had asymptomatic infection. All but one infant had received ocular 1% tetracycline prophylaxis at birth, and four infants had signs suggestive of chlamydial pneumonia at presentation. Two out of five symptomatic cases whose mothers reported completion of their treatment course with erythromycin had lingering symptoms. Conclusions Our findings affirm that the current prophylaxis and treatment modalities for chlamydial ophthalmia neonatorum are inadequate. To the extent feasible in low- and middle-income countries, we recommend implementation of routine C. trachomatis screening and treatment in pregnant women.

Objective To evaluate the impact of screening and treating asymptomatic pregnant women for C. trachomatis and N. gonorrhoeae infections on the frequency of preterm birth or low birth weight infants in Botswana. Design Non-randomized, cluster-controlled trial. Setting Four antenatal care clinics in Gaborone, Botswana. Population Pregnant women aged ≥15 years, attending a first antenatal care visit, ≤27 weeks gestation, and without urogenital symptoms were eligible. Methods Participants in the intervention clinics received screening (GeneXpert®, Cepheid) during pregnancy and at the post-natal visit. Participants in the standard-of-care clinics received screening at the postnatal visit only. We used multivariable logistic regression and post-estimation predictive margins analysis. Post-hoc analysis was conducted among sub-samples stratified by parity. Main outcome measures Preterm birth (<37 weeks gestation) and low birth weight (<2500g). Results After controlling for parity, hypertension, antenatal care visits, and clinic site, the predicted prevalence of preterm or low birth weight was lower in the intervention arm (11%) compared to the standard-of-care (16%) (AOR: 0.59; 95% CI: 0.28 to 1.24), but confidence intervals were wide. In post-hoc analysis, the intervention was more effective than the standard-of-care (AOR: 0.20; 95% CI: 0.07-0.64) among nulliparous participants. Conclusion A C. trachomatis and N. gonorrhoeae infection screening and treatment intervention among asymptomatic pregnant women did not significantly reduce preterm or low birth weight outcomes. Post hoc analysis found the intervention reduced adverse outcomes among nulliparous participants.