High prevalence of rectal chlamydia among pregnant adolescents in La Romana, Dominican Republic warrants extragenital STI testing

Abstract

To our knowledge, there are no studies estimating the prevalence of extragenital sexually transmitted infections (STIs) among pregnant adolescents in the Caribbean. This study sought to fill this gap by assessing the prevalence and correlates of oral, genital, and rectal chlamydia (CT) among a sample of pregnant adolescents in La Romana, Dominican Republic. Two hundred pregnant youths, aged 15–24 years, were recruited by systematic sampling during their first prenatal visit to a maternal care unit. A sociodemographic and behavioral questionnaire was administered and urine and oral/anal swabs were collected and tested for CT. Descriptive analyses and Fisher’s exact tests were performed. The prevalence of oral, genital, and rectal CT was 6%, 15%, and 23%, respectively, although less than 5% of participants reported ever engaging in receptive anal intercourse. This discrepancy could be explained by autoinoculation, concurrent transmission during sex, undertreatment of rectal CT, or underreporting of anal sex. Almost half of CT infections would have been missed if only genital samples were collected, as current protocol dictates. More research is needed to understand sexual behaviors and rectal STI risk factors among heterosexual adolescent women. STI screening procedures for pregnant and sexually active adolescents should include routine testing of extragenital sites.

High burden of sexually transmitted infections among under-resourced populations in the Dominican Republic

“…We also identified high prevalence of HIV (6.1%) among MSM. Concerningly, chlamydia was most common in pregnant youth, 9 but was also prevalent among MSM, TW, and FSW. The prevalence of HBV among BRs was high (5.7%), which may partially be a result of a lack of adult HBV vaccinations programs in the DR.…”

“…[13][14][15] Similarly, these sexually active adolescents are less likely to take measures to prevent STIs and are affected with high prevalence of STIs including Chlamydia, Gonorrhea, and Syphilis, among others. 9,16,17 As an example, globally the prevalence of chlamydia among ages 13-49 is 3.8%, but in Latin America and the Caribbean, it is estimated to be as high as 11.2%. This may be even worse in the DR. As we found in a substudy from the same sample presented in this article, pregnant adolescents in the DR had a prevalence of rectal chlamydia of 23.2%.…”

“…IN addition to HIV, populations that experience higher burdens of STI risk generally, when compared to the general population, are pregnant youth, MSM, trans women, people living with HIV (PLWH), batey residents, and FSW. 1,6,9,10 In the DR, bateyes are geographically and socioeconomically isolated current or former sugar cane industry worker settlements inhabited primarily by people of Haitian descent. Their residents experience higher incidence of HIV and other STIs.…”