High Cure Rate Among Pregnant Women in a Chlamydia trachomatis and Neisseria gonorrhoeae Testing and Treatment Intervention Study in Gaborone, Botswana

Abstract

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.

Prospective Cohort Study of Treatment Outcomes of Vaginal Discharge Syndrome in Women in Windhoek, Namibia

“…Other studies have demonstrated that azole resistance is an important cause of VVC treatment failure 27,28 . Finally, a repeat STI within 1 month from the same or a new sex partner may occur, but this likely only contributes to a small proportion of cases 29,30 . We did not observe an association between a new sexual partner and treatment failure, and only 1 incident of STI was detected among the small group of women with microbiological evaluation of their treatment failure.…”

Use of Expedited Partner Therapy for Pregnant Women Treated for Sexually Transmitted Infections in Gaborone, Botswana

“…The single untreated participant tested positive again at PNC. Further detailed findings from the Maduo Study have been reported elsewhere 23,24 …”

“…Further detailed findings from the Maduo Study have been reported elsewhere. 23,24 Participants testing positive at any time point were included in this analysis (n = 89; Table 1). Across all time points, there were 95 total positive test results.…”

Case series and literature review of chlamydial ophthalmia neonatorum in Botswana

“…Treatment was provided on the same day of results according to the United States Centers for Disease Control and Prevention (CDC) guidelines. 17 Mothers were treated with oral azithromycin 1 G for C. trachomatis , and 500 mg intramuscular ceftriaxone injection for N. gonorrhoeae . Infants were treated with oral erythromycin (liquid formulation) 50 mg/kg/day for 14 days in four divided doses per day for C. trachomatis , and intramuscular ceftriaxone single-dose 25–50 mg/kg for N. gonorrhoeae .…”

“…34 The few published antenatal STI prevalence studies suggest a baseline antenatal C. trachomatis prevalence ranging from 8% 16,35 to 23%. 17,36 There are no published epidemiological estimates for ophthalmia neonatorum.…”