Assessment of syndromic management of curable sexually transmitted and reproductive tract infections among pregnant women: an observational cross-sectional study

Abstract

Background This study estimated the prevalence of curable sexually transmitted and reproductive tract infections (STIs/RTIs) among pregnant women attending antenatal care (ANC) in rural Zambia, evaluated the effectiveness of syndromic management of STIs/RTIs versus reference-standard laboratory diagnoses, and identified determinants of curable STIs/RTIs during pregnancy. Methods A total of 1086 pregnant women were enrolled at ANC booking, socio-demographic information and biological samples were collected, and the provision of syndromic management based care was documented. The Piot-Fransen model was used to evaluate the effectiveness of syndromic management versus etiological testing, and univariate and multivariate logistic regression analyses were used to identify determinants of STIs/RTIs. Results Participants had a mean age of 25.6 years and a mean gestational age of 22.0 weeks. Of 1084 women, 700 had at least one STI/RTI (64.6%; 95% confidence interval [CI], 61.7, 67.4). Only 10.2% of infected women received any treatment for a curable STI/RTI (excluding syphilis). Treatment was given to 0 of 56 women with chlamydia (prevalence 5.2%; 95% CI, 4.0, 6.6), 14.7% of participants with gonorrhoea (prevalence 3.1%; 95% CI, 2.2, 4.4), 7.8% of trichomoniasis positives (prevalence 24.8%; 95% CI, 22.3, 27.5) and 7.5% of women with bacterial vaginosis (prevalence 48.7%; 95% CI, 45.2, 51.2). An estimated 7.1% (95% CI, 5.6, 8.7) of participants had syphilis and received treatment. Women < 20 years old were more likely (adjusted odds ratio [aOR] = 5.01; 95% CI: 1.23, 19.44) to have gonorrhoea compared to women ≥30. The odds of trichomoniasis infection were highest among primigravidae (aOR = 2.40; 95% CI: 1.69, 3.40), decreasing with each subsequent pregnancy. Women 20 to 29 years old were more likely to be diagnosed with bacterial vaginosis compared to women ≥30 (aOR = 1.58; 95% CI: 1.19, 2.10). Women aged 20 to 29 and ≥ 30 years had higher odds of infection with syphilis, aOR = 3.96; 95% CI: 1.40, 11.20 and aOR = 3.29; 95% CI: 1.11, 9.74 respectively, compared to women under 20. Conclusions Curable STIs/RTIs were common and the majority of cases were undetected and untreated. Alternative approaches are urgently needed in the ANC setting in rural Zambia.

Prevalence and predictors of Chlamydia trachomatis and Neisseria gonorrhoeae among HIV-negative pregnant women in Kenya

“…Similar findings have been reported in a recent meta-analysis of 22 studies among pregnant women from the WHO African Region, which indicated CT prevalence ranging from 4.6% to 14.9% with a pooled prevalence of 6.9 (95% CI, 5.1%–8.6%) in East and Southern Africa. In addition, the prevalence of NG ranged between 1% and 21.1%, with a pooled prevalence of 3.5 (95% CI, 2.84%–4.29%), although women living with HIV had a higher prevalence., 11,16,24 ,10w These findings are similar to a recent study conducted among nonpregnant women without HIV in South Africa that found a prevalence of CT and/or NG of 7.1%. Our study results suggest that curable STIs such as CT and NG are relatively common among pregnant women in Kenya and consistent with prevalence among pregnant HIV-negative women in the region.…”

“…Our study results suggest that curable STIs such as CT and NG are relatively common among pregnant women in Kenya and consistent with prevalence among pregnant HIV-negative women in the region. The asymptomatic nature of CT and NG is a common global phenomenon highlighted by several studies, particularly among women., 15,24 ,11w…”

Malaria and curable sexually transmitted and reproductive tract coinfection among pregnant women in rural Burkina Faso

“…The relatively low prevalence of malaria and STI/RTI coinfection in that study could be explained by the low prevalence of STI/RTI (4.0%) detected through the symptom-based approach [ 20 ]. It is very likely that the symptom based approach grossly underestimated the actual prevalence as several studies have demonstrated the poor performance of the syndrome-based diagnosis of STI/RTI in pregnancy [ 9 , 23 , 24 ].…”

“…The median age of participants was 24 years (IQR [interquartile range]: [21][22][23][24][25][26][27][28][29][30]. Nearly all women had partners (married or living together) at the time of the survey (95.3%) and 55.6% of them were unemployed Lingani et al Trop Med Health (2021) 49:90 (housewives).…”

Effects of maternal antenatal treatment with two doses of azithromycin added to monthly sulfadoxine-pyrimethamine for the prevention of low birth weight in Burkina Faso: an open-label randomized controlled trial

“…For intrauterine infections, there is no chemoprevention strategy as in malaria, and their management in pregnancy is based on a symptomatic approach [12]. Because these infections are in majority asymptomatic in pregnancy, the utility of the syndrome-based approach is very limited and other approaches are needed if we aim to achieve the sustainable development goal 3.2-to end preventable deaths of newborns and children under 5 years of age [13]. Azithromycin (AZ) is an azalide antibiotic of the macrolides group with a favorable profile for the majority of bacterial pathogens involved in intrauterine infections including gonorrhea, chlamydia and syphilis [14].…”