Risk of Ectopic Pregnancy and Tubal Infertility Following Gonorrhea and Chlamydia Infections

Reekie, Joanne; Donovan, Basil; Guy, Rebecca; Hocking, Jane; Kaldor, John; Mak, Donna B; Preen, David B.; Ward, James; Liu, Bette; Liu, B; Hocking, Jane S; Roberts, C; Guy, Rebecca; Pearson, Sallie Anne; Stewart, Louise M.; Wand, Handan

doi:10.1093/cid/ciz145

Cited by 50 publications

(39 citation statements)

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“…Interestingly, all of the vaginal samples with multiple pathogens infection were positive for the C. trachomatis one. Previous studies mostly researched the interaction between C. trachomatis and N. gonorrhoeae solely and did not consider including other sexually transmitted pathogens in their analysis [45,46]. From these previous studies, the exact pathogenesis of C. trachomatis in the pathogen-pathogen and pathogen-host interaction is still not well understood [45].…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Chlamydia trachomatis and Three Other Non-Viral Sexually Transmitted Infections among Pregnant Women in Pemba Island Tanzania

et al. 2020

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Efforts to map the burden of infections globally have shown a high prevalence of genital infections, including Chlamydia trachomatis, in sub-Saharan Africa. This retrospective study aimed to investigate the prevalence of selected non-viral genital infections among pregnant women in Pemba Island, Tanzania. Vaginal swabs were collected during pregnancy and stored in eNAT buffer. Detection of C. trachomatis, Neisseria gonorrheae, Trichomonas vaginalis, and Mycoplasma genitalium pathogens was performed by PCR using validated detection kits. Vaginal samples of 439 pregnant women between 16 and 48 years were tested. In fifty-five (12.5%) of them, at least one genital pathogen was detected. The most prevalent pathogen was T. vaginalis (7.1%), followed by C. trachomatis (4.6%) and M. genitalium (2.1%). None of the vaginal samples tested positive for N. gonorrheae. Consequently, among positive samples, 7.3% were for C. trachomatis and at least one other genital pathogen. This study provides insights on the burden of the four studied genital infections, and on the coinfections among pregnant women in Pemba Island, Tanzania. These results offer a starting point that can be useful to design further research in the field of maternal and child health in Pemba Island.

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Section: Discussionmentioning

confidence: 99%

The Prevalence of Chlamydia trachomatis and Three Other Non-Viral Sexually Transmitted Infections among Pregnant Women in Pemba Island Tanzania

et al. 2020

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“…[4][5][6][7] STIs during pregnancy have been associated with several adverse pregnancy and birth outcomes, including stillbirth, prematurity, low birth weight and several secondary life-threatening conditions in surviving neonates. [8][9][10][11] STIs can cause chronic abdominal pain, and when left untreated they can cause damage to reproductive organs, resulting in long-term complications such as tubal factor infertility. 10 12 STIs have also been shown to increase the risk of HIV acquisition and transmission.…”

Section: Introductionmentioning

confidence: 99%

Prevalence, incidence and associated risk factors of STIs during pregnancy in South Africa

et al. 2020

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ObjectiveSTIs during pregnancy increase adverse pregnancy and birth outcomes and may increase HIV risk. STI syndromic management is standard of care in South Africa. Our study evaluated the prevalence and incidence of STIs in pregnant women and the associated risk factors.MethodsWe combined data from two prospective observational studies of pregnant women enrolled while attending their first antenatal clinic (ANC) visit in Tshwane District and Cape Town. Women ≥18 years were tested at first ANC visit and at their first postpartum visit for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis using Xpert assays (Cepheid, USA). We evaluated the prevalence and incidence of STI and the associated risk factors using multivariable regression models.ResultsWe enrolled 669 pregnant women, 64% (n=427) from Tshwane District and 36% (n=242) from Cape Town; 80% (n=534) were women living with HIV (WLHIV) and 20% (n=135) without HIV. At enrolment, 37% (n=250) were diagnosed with at least one STI, of which 76% (n=190) were asymptomatic. STI prevalence was 40% (n=213) in WLHIV and 27% (n=37) in women without HIV (p=0.01). Baseline STI infection was associated with younger age (OR=0.95 per year, 95% CI 0.92 to 0.98), higher gestational age (adjusted OR (aOR)=1.03 per week, 95% CI 1.00 to 1.05), single relationship status (aOR=1.53, 95% CI 1.09 to 2.15) and HIV status (aOR=1.86, 95% CI 1.17 to 2.95). Of 419 participants with no STI at baseline, 21 had an incident STI during follow-up, with a mean follow-up time of 140 days. The incidence rate of STI during pregnancy and early post partum was 15 infections per 100 women-years (95% CI 9 to 23). Younger age was associated with STI incidence.ConclusionOur study shows high prevalence and incidence of STIs in pregnancy, especially in WLHIV, demonstrating the need for STI screening in ANC to prevent adverse pregnancy and birth outcomes. Most STI cases were asymptomatic and would have gone untreated with syndromic management. Aetiological STI screening is urgently needed to reduce the burden of STIs in pregnancy.

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“…A study of CT and NG as well as Mycoplasma genitalium, Ureaplasma urealyticum/ parvum, Gardnerella vaginalis, Trichomonas vaginalis, and herpes simplex virus-1/2 found that CT and co-infections with two or more of the evaluated organisms were associated with similarly high risk of EP [80]. Similarly, risk of TFI was shown to be similar for single infection or CT/NG coinfection [81], while others showed an increased risk of endometrial infection associated with NG co-infection, but not M. genitalium or T. vaginalis co-infection or bacterial vaginosis, in a group of CT-infected women [82]. Most studies only considered CT/NG infections [68, 76•, 77-79, 81] and did not consider/exclude other STIs and/or bacterial vaginosis, so their findings might be affected by unknown co-infections.…”

Section: Chlamydia and Gonorrhea Co-infection-potentially Important Imentioning

confidence: 99%

Pathogenic Interplay Between Chlamydia trachomatis and Neisseria gonorrhoeae that Influences Management and Control Efforts—More Questions than Answers?

Leonard

Schoborg

Low

et al. 2019

Curr Clin Micro Rpt

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Purpose of Review To emphasize key gaps in knowledge impacting efforts to control single infection and co-infections with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), the most common bacterial sexually transmitted infections (STIs) worldwide. Recent Findings Clinical and epidemiological studies describe gaps in understanding about female rectal CT infection, screening effectiveness, pelvic inflammatory disease, and influence of the microbiome. For NG, gaps in knowledge include factors increasing incidence in men who have sex with men, correlations between treatment and antibiotic resistance, the role of pharyngeal infection, and microbiome influence. CT/NG co-infections are poorly understood, and adequate models to explore pathophysiological consequences of co-infection urgently needed. The sole existing CT/NG co-infection mouse model showed that CT/NG interactions in vivo modulate host response and NG load/shedding-encouraging further consideration of this model and potential alternatives. Summary We stress key challenges in controlling these important STIs. Appropriate, quality-assured animal models are essential to improve understanding of the pathogenic interplay in CT/NG co-infections. Keywords Chlamydia trachomatis. Neisseria gonorrhoeae. Co-infection. Mouse model This article is part of the Topical Collection on Influences of Hormones and Other Microorganisms on Genital Tract Pathogens

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Risk of Ectopic Pregnancy and Tubal Infertility Following Gonorrhea and Chlamydia Infections

Cited by 50 publications

References 7 publications

The Prevalence of Chlamydia trachomatis and Three Other Non-Viral Sexually Transmitted Infections among Pregnant Women in Pemba Island Tanzania

The Prevalence of Chlamydia trachomatis and Three Other Non-Viral Sexually Transmitted Infections among Pregnant Women in Pemba Island Tanzania

Prevalence, incidence and associated risk factors of STIs during pregnancy in South Africa

Pathogenic Interplay Between Chlamydia trachomatis and Neisseria gonorrhoeae that Influences Management and Control Efforts—More Questions than Answers?

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