Sexually transmitted infections in pregnant women from sub-Saharan Africa

Abstract

Background: Sexually transmitted infections (STIs) are a major health problem in most countries of the world, particularly in developing countries where the resources and technology to diagnose and treat them are limited. Currently, there is limited data on STIs and risk factors for these infections in pregnant women living with human immunodeficiency virus (HIV), especially in sub-Saharan Africa (SSA). This review provides data on the prevalence and risk factors for STIs in pregnant women living with HIV from SSA. This review also describes the association between STIs and HIV on pregnancy and birth outcomes as well as highlights the importance of laboratory-based diagnosis of STIs.Method: An electronic search of online databases was used to find and collect relevant research articles connected to the prevalence, adverse pregnancy and birth outcomes, health complications and risk factors associated with STIs and HIV in pregnant women from SSA. The search was limited to articles published in English. Relevant studies were identified by searching literature from January 2001 to date. The search yielded 4709 results.Results: In SSA, STIs are highly prevalent in pregnant women and are widely known to be linked with an increased risk of poor maternal and neonatal outcomes. These infections are often asymptomatic and highly prevalent in pregnant women. The screening of STIs in pregnant women living with HIV can reduce the risk of mother-to-child transmission (MTCT) and screening and treatment for STIs can also prevent adverse perinatal outcomes. It is important to recognise regional and national STI epidemics in order to promote STI prevention and control interventions considering the test and treat approach as opposed to syndromic management.Conclusion: This review highlights the need to use diagnostic screening methods instead of syndromic STI management in SSA. Moreover, more research into effective prevention and treatment measures for STIs in pregnant women is urgently required.

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.…”

“…Furthermore, assessing syndromic management's effectiveness in detecting CT and NG cases among pregnant women in Kenya can uncover missed clinical intervention chances and support broader CT and NG testing in this population. To date, studies among pregnant women in Kenya, South Africa, Botswana, Tanzania, and Congo identified early sex debut ≤17 years, younger age, being single, having <3 children, having ≥1 sexual partner, being unemployed, and having frequent alcohol and tobacco use as correlates of curable STIs including CT and/or NG 16–18 …”

“…To date, studies among pregnant women in Kenya, South Africa, Botswana, Tanzania, and Congo identified early sex debut ≤17 years, younger age, being single, having <3 children, having ≥1 sexual partner, being unemployed, and having frequent alcohol and tobacco use as correlates of curable STIs including CT and/or NG. [16][17][18] We measured the prevalence and identified potential predictors of CT and/or NG infection among a cohort of pregnant Kenyan women. We also evaluated the performance of syndromic algorithms using laboratory-based diagnosis as the gold standard to identify missed infections of current syndromic management guidelines in Kenya.…”

Trimethoprim-Sulfamethoxazole Plus Azithromycin to Prevent Malaria and Sexually Transmitted Infections in Pregnant Women With HIV (PREMISE): A Randomized, Double-Masked, Placebo-Controlled, Phase IIB Clinical Trial

“…AZ has been studied as an adjunctive IPTp agent in combination with chloroquine and dihydroartemisinin-piperaquine (DP) and it has activity against bacterial STI [ 11–13 ]. STI prevalence in pregnancy in SSA ranges from 3% to 37% for Chlamydia trachomatis (CT) and 1% to 21% for Neisseria gonorrhoeae (NG) [ 14 ]. Adverse birth outcomes of malaria and STI in pregnancy include low birthweight, preterm delivery, and neonatal infections but access to STI testing in SSA is limited [ 15–17 ].…”

Low prevalence of Schistosoma haematobium infection in pregnant women in Buffalo City district

“…Studies have shown an increased risk of adverse pregnancy outcomes associated with sexually transmitted infection (STI) during pregnancy. 1 Urogenital Schistosoma haematobium is another infection that should be considered for adverse pregnancy outcomes. 2 …”