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Karim R, Choudhury S, Bari F, Klausner JD, Nargis M, Khatun HA, Parveen S, Sheddika SA, Choudhury S, Rahman F. Feasibility and acceptability of sexually transmitted infection screening during antenatal care of women in Dhaka, Bangladesh. Int J STD AIDS 2024; 35:689-695. [PMID: 38709824 DOI: 10.1177/09564624241248674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are a major public health concern worldwide. Untreated STIs may have serious sequelae, particularly in pregnant women. The objective of this study was to assess the feasibility and acceptability of screening and treating common STIs in women during pregnancy in Bangladesh. METHODS Women were enrolled from four maternity clinics/hospitals serving the lower-middle class population in Dhaka, Bangladesh. The participants were interviewed, and vaginal swab samples were collected by clinical staff. Specimens were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and high-risk Human Papilloma Viruses (HPVs) using GeneXpert (Cepheid, Sunnyvale, California). Women were informed of their test results and were provided treatment for curable infections. A test of cure was performed. RESULTS Out of 1157 pregnant women approached, 1000 (86.4%) participated. Ninety-one percent women learned of their test results on the same day of testing. Out of the 996 valid results, 7 (0.7%) tested positive for Chlamydia trachomatis and 1 (0.1%) for Trichomonas vaginalis. There were no gonorrhoea cases. Out of the 971 women with valid results for high-risk HPVs, 46 (4.7%) tested positive. CONCLUSIONS Screening women for STIs during antenatal care was highly feasible and well-accepted in Bangladesh. While the prevalence of common curable STIs was very low, hrHPV infection prevalence was moderately high. Our findings support period monitoring of STIs and continued prevention efforts for cervical cancer in Bangladesh.
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Affiliation(s)
- Roksana Karim
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angels, CA, USA
| | - Sameena Choudhury
- Obstetrical and Gynecological Society of Bangladesh (OGSB) Hospital and Institute of Reproductive and Child Health, Dhaka, Bangladesh
| | - Farzana Bari
- Centre for Injury Prevention and Research, Dhaka, Bangladesh
| | - Jeffrey D Klausner
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angels, CA, USA
| | - Mahbuba Nargis
- Maternal and Child Health Training Institute (MCHTI), Dhaka, Bangladesh
| | | | - Shohela Parveen
- Obstetrical and Gynecological Society of Bangladesh (OGSB) Hospital, Dhaka, Bangladesh
| | - Sayda Aysha Sheddika
- Obstetrical and Gynecological Society of Bangladesh (OGSB) Hospital and Institute of Reproductive and Child Health, Dhaka, Bangladesh
| | - Sameena Choudhury
- Obstetrical and Gynecological Society of Bangladesh (OGSB) Hospital and Institute of Reproductive and Child Health, Dhaka, Bangladesh
| | - Fazlur Rahman
- Centre for Injury Prevention and Research, Dhaka, Bangladesh
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Xuan Y, Zhao J, Hong X, Yan T, Zhang Y, Zhou X, Zhang J, Wang B. Transition of the genital mollicutes from the second to the third trimester of pregnancy and its association with adverse pregnancy outcomes in GDM women: a prospective, single-center cohort study from China. BMC Pregnancy Childbirth 2024; 24:233. [PMID: 38570745 PMCID: PMC10993520 DOI: 10.1186/s12884-024-06418-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/13/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND The association of genital Mollicutes infection transition with adverse pregnancy outcomes was insignificant among general pregnant women, but there remains a paucity of evidence linking this relationship in gestational diabetes mellitus (GDM) women. The aim was to investigate the association between genital Mollicutes infection and transition and adverse pregnancy outcomes in GDM women, and to explore whether this association still exist when Mollicutes load varied. METHODS We involved pregnant women who attended antenatal care in Chongqing, China. After inclusion and exclusion criteria, we conducted a single-center cohort study of 432 GDM women with pregnancy outcomes from January 1, 2018 to December 31, 2021. The main outcome was adverse pregnancy outcomes, including premature rupture of membrane (PROM), fetal distress, macrosomia and others. The exposure was Mollicutes infection, including Ureaplasma urealyticum (Uu) and Mycoplasma hominis (Mh) collected in both the second and the third trimesters, and testing with polymerase chain reaction method. The logistic regression models were used to estimate the relationship between Mollicutes infection and adverse pregnancy outcomes. RESULTS Among 432 GDM women, 241 (55.79%) were infected with genital Mollicutes in either the second or third trimester of pregnancy. At the end of the pregnancy follow-up, 158 (36.57%) participants had adverse pregnancy outcomes, in which PROM, fetal distress and macrosomia were the most commonly observed adverse outcomes. Compared with the uninfected group, the Mollicutes (+/-) group showed no statistical significant increase in PROM (OR = 1.05, 95% CI:0.51 ∼ 2.08) and fetal distress (OR = 1.21, 95% CI: 0.31 ∼ 3.91). Among the 77 participants who were both Uu positive in the second and third trimesters, 38 participants presented a declined Uu load and 39 presented an increased Uu load. The Uu increased group had a 2.95 odds ratio (95% CI: 1.10~8.44) for adverse pregnancy outcomes. CONCLUSION Mollicutes infection and transition during trimesters were not statistically associated with adverse pregnancy outcomes in GDM women. However, among those consistent infections, women with increasing Uu loads showed increased risks of adverse pregnancy outcomes. For GDM women with certain Mollicutes infection and colonization status, quantitative screening for vaginal infection at different weeks of pregnancy was recommended to provide personalized fertility treatment.
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Affiliation(s)
- Yan Xuan
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Statistics, School of Public Health, Southeast University, No. 87 Dingjiaqiao Road, Gulou District, Nanjing, Jiangsu, China
| | - Jun Zhao
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Xiang Hong
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Statistics, School of Public Health, Southeast University, No. 87 Dingjiaqiao Road, Gulou District, Nanjing, Jiangsu, China
| | - Tao Yan
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Statistics, School of Public Health, Southeast University, No. 87 Dingjiaqiao Road, Gulou District, Nanjing, Jiangsu, China
| | - Yue Zhang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Xu Zhou
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Statistics, School of Public Health, Southeast University, No. 87 Dingjiaqiao Road, Gulou District, Nanjing, Jiangsu, China
| | - Junhui Zhang
- Health Management Center, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Bei Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Statistics, School of Public Health, Southeast University, No. 87 Dingjiaqiao Road, Gulou District, Nanjing, Jiangsu, China.
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Yang K, Babalola CM, Mussa A, Ryan R, Wynn A, Simon S, Bame B, Morroni C, Klausner JD. Case series and literature review of chlamydial ophthalmia neonatorum in Botswana. Int J STD AIDS 2023; 34:860-868. [PMID: 37338101 DOI: 10.1177/09564624231173028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND We describe 12 cases of chlamydial ophthalmia neonatorum and the current scientific evidence on its prevention and treatment. The data presented were obtained from the "Maduo" study, a prospective observational study of the relationship between curable sexually transmitted infections and adverse neonatal outcomes at four antenatal clinics in Gaborone, Botswana. METHODS Infants of mothers with perinatal chlamydia infection were evaluated for chlamydial ophthalmia neonatorum based on clinical presentation of conjunctivitis or positive test via GeneXpert CT/NG assay. Data on 29 infants born to mothers with postnatal C. trachomatis infection were analysed. RESULTS 12 infants were diagnosed with chlamydial ophthalmia neonatorum. Eight of those cases were confirmed with the GeneXpert CT/NG assay while four were identified as probable cases based on clinical history and presentation. Overall, nine infants presented with signs of conjunctivitis, while three who had a positive diagnostic test result had asymptomatic infection. All but one infant had received ocular 1% tetracycline prophylaxis at birth, and four infants had signs suggestive of chlamydial pneumonia at presentation. Two out of five symptomatic cases whose mothers reported completion of their treatment course with erythromycin had lingering symptoms. CONCLUSIONS Our findings affirm that the current prophylaxis and treatment modalities for chlamydial ophthalmia neonatorum are inadequate. To the extent feasible in low- and middle-income countries, we recommend implementation of routine C. trachomatis screening and treatment in pregnant women.
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Affiliation(s)
- Kevin Yang
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Chibuzor M Babalola
- Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Aamirah Mussa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecca Ryan
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Adriane Wynn
- University of California, San Diego, Division of Infectious Diseases and Global Public Health, La Jolla, CA, USA
| | | | - Bame Bame
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Chelsea Morroni
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Jeffrey D Klausner
- Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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Gamberini C, Juliana NCA, de Brouwer L, Vogelsang D, Al-Nasiry S, Morré SA, Ambrosino E. The association between adverse pregnancy outcomes and non-viral genital pathogens among women living in sub-Saharan Africa: a systematic review. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1107931. [PMID: 37351522 PMCID: PMC10282605 DOI: 10.3389/frph.2023.1107931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/18/2023] [Indexed: 06/24/2023] Open
Abstract
Adverse pregnancy outcomes are the main causes of maternal and neonatal morbidity and mortality, including long-term physical and psychological sequelae. These events are common in low- and middle-income countries, particularly in Sub Saharan Africa, despite national efforts. Maternal infections can cause complications at any stage of pregnancy and contribute to adverse outcomes. Among infections, those of the genital tract are a major public health concern worldwide, due to limited availability of prevention, diagnosis and treatment approaches. This applies even to treatable infections and holds true especially in Sub-Saharan Africa. As late as 2017, the region accounted for 40% of all reported treatable non-viral genital pathogens worldwide, many of which have been independently associated with various adverse pregnancy outcomes, and that include Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Treponema pallidum. Two databases (PubMed and Embase) were examined to identify eligible studies published up to October 2022. This study reviewed findings on the association between infections by treatable non-viral genital pathogens during pregnancy and adverse pregnancy outcomes among women living in Sub-Saharan Africa. Articles' title and abstract were screened at first using keywords as "sexually transmitted infections", "non-viral", "adverse pregnancy outcome", "Africa", "sub-Saharan Africa", "pregnant women", "pregnancy", and "pregnancy outcome". Subsequently, according to the eligibility criteria, potential articles were read in full. Results showed that higher risk of preterm birth is associated with Treponema pallidum, Chlamydia trachomatis and Candida albicans infections. Additionally, rates of stillbirth, neonatal death, low birth weight and intrauterine growth restriction are also associated with Treponema pallidum infection. A better insight on the burden of non-viral genital pathogens and their effect on pregnancy is needed to inform antenatal care guidelines and screening programs, to guide the development of innovative diagnostic tools and other strategies to minimize transmission, and to prevent short- and long-term complications for mothers and children.
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Affiliation(s)
- Carlotta Gamberini
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Research School GROW for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Naomi C. A. Juliana
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Research School GROW for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Lenya de Brouwer
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
| | - Dorothea Vogelsang
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
| | - Salwan Al-Nasiry
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Department of Obstetrics and Gynecology, Research School GROW for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Servaas A. Morré
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Research School GROW for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, UP, India
- Dutch Chlamydia trachomatis Reference Laboratory on Behalf of the Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Elena Ambrosino
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Research School GROW for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
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González-Fernández MD, Escarcega-Tame MA, López-Hurtado M, Flores-Salazar VR, Escobedo-Guerra MR, Giono-Cerezo S, Guerra-Infante FM. Identification of Chlamydia trachomatis genotypes in newborns with respiratory distress. An Pediatr (Barc) 2023:S2341-2879(23)00101-1. [PMID: 37169687 DOI: 10.1016/j.anpede.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/30/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION One hundred thirty million Chlamydia trachomatis infections are reported worldwide each year. Nineteen serotypes of this pathogen can cause infection in pregnant women and neonates. The distribution of these genotypes in newborns with respiratory infections in Mexico is unknown. MATERIAL AND METHODS We tested 1062 bronchial lavage samples from neonates with respiratory distress syndrome for Chlamydia infection. The diagnosis of Chlamydia was made by plasmid detection with an in-house PCR assay, and genotypes were identified using a PCR-RFLP assay for the ompA gene. RESULTS The genotyping of 40 strains identified 14 as I/Ia (35%), 13 as E (32.5%), 7 as D (17.5%), 5 as F (12.5%), and 1 as L2 (2.5%). The relative risk analysis showed that genotype D was associated with neonatal sepsis (RR, 5.83; 95% confidence interval [CI], 1.51-25.985; P < .02), while the I/Ia genotype was significantly associated with chorioamnionitis in the mother (2.8; 95% CI, 1.4-5.5; P < .05). CONCLUSIONS Although C. trachomatis genotypes I/Ia and E of were the strains involved most frequently in respiratory infections in Mexican neonates, 80% of patients with genotype F developed respiratory disease. In contrast, genotype D was associated with neonatal sepsis, and genotype I/Ia with chorioamnionitis.
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Affiliation(s)
- Melissa D González-Fernández
- Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico.
| | - Marco A Escarcega-Tame
- Laboratorio de Virología, Instituto Nacional de Perinatología, Ciudad de México, Mexico.
| | - Marcela López-Hurtado
- Laboratorio de Virología, Instituto Nacional de Perinatología, Ciudad de México, Mexico.
| | | | | | - Silvia Giono-Cerezo
- Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico.
| | - Fernando M Guerra-Infante
- Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico; Laboratorio de Virología, Instituto Nacional de Perinatología, Ciudad de México, Mexico.
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Campaner AB, de Castro MA, Lucarelli AP. Chlamydia trachomatis prevalence in females in São Paulo, Brazil: 11 years' surveillance of the infection. Braz J Microbiol 2023; 54:151-158. [PMID: 36574206 PMCID: PMC9944148 DOI: 10.1007/s42770-022-00865-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 10/29/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis (CT) infection is the most prevalent sexually transmitted bacterial disease worldwide whose greatest impact is on the female reproductive system. The objective was to assess the prevalence of Chlamydia infection in a large population of female patients from a private health service in São Paulo (Brazil), identifying the main age groups affected by the agent and the evolution of the prevalence. METHODS A cross-sectional study was conducted based on the results of all molecular biology tests. The tests were carried out between January 2005 and December 2015. The positivity of test results was determined by year and age group. RESULTS A total of 85,292 patients who performed 103,576 tests for Chlamydia were considered eligible for the statistical data. The overall prevalence of C. trachomatis infection in the study population was 2.2% (95% CI: 2.07-2.25). A higher prevalence of infection was observed in the ≤ 25 years and ≤ 30 years age groups, with rates of 6.0% (95% CI: 5.59-6.35) and 4.4% (95% CI: 4.08-4.50), respectively. There was a significant increase in the positivity of the exams over time, especially in the ≤ 35 years age group. The prevalence at 26-30 years was 3.1% (95% CI: 2.82-3.30); 31-35 years 1.7% (95% CI: 1.50-1.82); 36-40 years 1.0% (95% CI: 0.86-1.16); 41-60 years 0.6% (95% CI: 0.50-0.70) and the prevalence at ≥ 61 years was 0.4% (95% CI: 0.11-0.75). CONCLUSION The screening of asymptomatic young women would have the potential to reduce infection, transmission, and sequelae of infection by this agent.
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Affiliation(s)
- Adriana Bittencourt Campaner
- Department of Gynecology and Obstetrics, Santa Casa de São Paulo Medical School, Rua Dr Cesário Mota Jr, 112 - Vila Buarque, São Paulo, 01221- 020 Brazil
| | - Marco Antonio de Castro
- Department of Gynecology and Obstetrics, Santa Casa de São Paulo Medical School, Rua Dr Cesário Mota Jr, 112 - Vila Buarque, São Paulo, 01221- 020 Brazil
| | - Adrienne Pratti Lucarelli
- Department of Gynecology and Obstetrics, Santa Casa de São Paulo Medical School, Rua Dr Cesário Mota Jr, 112 - Vila Buarque, São Paulo, 01221- 020 Brazil
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de Campos LJ, Seleem MA, Feng J, Pires de Oliveira KM, de Andrade Dos Santos JV, Hayer S, Clayton JB, Kathi S, Fisher DJ, Ouellette SP, Conda-Sheridan M. Design, Biological Evaluation, and Computer-Aided Analysis of Dihydrothiazepines as Selective Antichlamydial Agents. J Med Chem 2023; 66:2116-2142. [PMID: 36696579 PMCID: PMC10056257 DOI: 10.1021/acs.jmedchem.2c01894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Chlamydia trachomatis (CT) causes the most prevalent sexually transmitted bacterial disease in the United States. The lack of drug selectivity is one of the main challenges of the current antichlamydial pharmacotherapy. The metabolic needs of CT are controlled, among others, by cylindrical proteases and their chaperones (e.g., ClpX). It has been shown that dihydrothiazepines can disrupt CT-ClpXP. Based on this precedent, we synthesized a dihydrothiazepine library and characterized its antichlamydial activity using a modified semi-high-throughput screening assay. Then, we demonstrated their ability to inhibit ClpX ATPase activity in vitro, supporting ClpX as a target. Further, our lead compound displayed a promising selectivity profile against CT, acceptable cytotoxicity, no mutagenic potential, and good in vitro stability. A two-dimensional quantitative structure-activity relationship (2D QSAR) model was generated as a support tool in the identification of more potent antichlamydial molecules. This study suggests dihydrothiazepines are a promising starting point for the development of new and selective antichlamydial drugs.
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Affiliation(s)
- Luana Janaína de Campos
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Mohamed A Seleem
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Jiachen Feng
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Kelly Mari Pires de Oliveira
- Faculty of Biological and Environmental Science, Federal University of Grande Dourados, Dourados, MS 79804-970, Brazil
| | | | - Shivdeep Hayer
- Department of Biology, University of Nebraska at Omaha, Omaha, Nebraska 68182, United States
| | - Jonathan B Clayton
- Department of Biology, University of Nebraska at Omaha, Omaha, Nebraska 68182, United States
- Department of Food Science and Technology, University of Nebraska─Lincoln, Lincoln, Nebraska 68588, United States
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
- Nebraska Food for Health Center, University of Nebraska─Lincoln, Lincoln, Nebraska 68508, United States
| | - Sharvath Kathi
- School of Biological Sciences, Southern Illinois University, Carbondale, Illinois 62901, United States
| | - Derek J Fisher
- School of Biological Sciences, Southern Illinois University, Carbondale, Illinois 62901, United States
| | - Scot P Ouellette
- Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Martin Conda-Sheridan
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
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Liu L, Li C, Sun X, Yang B, Zheng H, Li M, Huang S, Wang C, Tang W. Effectiveness of chlamydia Test and Treat strategy in preventing adverse pregnancy outcomes: protocol for a randomized controlled trial. Front Public Health 2023; 11:1121888. [PMID: 37181719 PMCID: PMC10174107 DOI: 10.3389/fpubh.2023.1121888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Chlamydia trachomatis is one of the most common bacterial sexually transmitted infections worldwide, and is associated with an increased risk of adverse pregnancy outcomes. However, whether providing chlamydia screening and treatment during the first trimester of pregnancy could reduce adverse pregnancy outcomes is still not clear. This study reports a randomized controlled trial (RCT) protocol to evaluate the effectiveness of chlamydia Test and Treat during early pregnancy in preventing adverse pregnancy outcomes in China. Methods and analysis This trial is a multi-center two-arm RCT targeting 7,500 pregnant women in early pregnancy (6-20 weeks). The inclusion criteria included: 18-39 years old, on their first antenatal visit, in the first trimester, and plan to deliver in the study cities. Following a block randomization procedure, every block of twenty women will be randomly assigned in a 1:1 ratio into two arms: (1) a Test and Treat arm in which women receive free chlamydia testing immediately after enrollment and people tested as chlamydia positive will receive standardized treatment and partner treatment; (2) a control arm in which women receive regular prenatal care without receiving testing during the pregnancy period, but collect urine samples and test them after delivery or indicating a chlamydia-related complication during pregnancy happens. The primary outcome is a composite of eight adverse events rate at delivery between two arms, including stillbirth, infant death, spontaneous abortion, preterm labor, low birth weight, premature rupture of membranes, postpartum endometritis, and ectopic pregnancy. Secondary outcomes include the cost-effectiveness of the intervention, the proportion of people tested with chlamydia infection, the proportion of tested-positive patients that received treatment, and the proportion of people who were cured 1 month after the treatment initiation. Urine specimens will be collected and tested for chlamydia by using Nucleic Acid Amplification Test. Data will be analyzed according to the intention-to-treat principle. Discussion This trial will test the hypothesis that early testing and treating of chlamydia can reduce the risk for adverse pregnancy outcomes and may help in developing chlamydia screening guidelines in China and other countries with a similar prevalence of chlamydia infection. Trial registration Chinese Clinical Trials Registry, ChiCTR2000031549. Registered on April 4, 2020.
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Affiliation(s)
- Lijun Liu
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Changchang Li
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Xuewan Sun
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Heping Zheng
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Meng Li
- Department of Obstetrics, The Seventh Affiliated Hospital of Southern Medical University, Foshan, China
| | - Shujie Huang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Cheng Wang
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
- *Correspondence: Weiming Tang
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Hume-Nixon M, Ratu T, Clark S, Nguyen CD, Neal EFG, Pell CL, Bright K, Watts E, Hart J, Mulholland K, Fong J, Rafai E, Sakumeni K, Tuibeqa I, Satzke C, Steer A, Russell FM. Prevention of young infant infections using oral azithromycin in labour in Fiji (Bulabula MaPei): study protocol of a randomised control trial. BMJ Open 2022; 12:e061157. [PMID: 36456016 PMCID: PMC9716885 DOI: 10.1136/bmjopen-2022-061157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Infections are a leading cause of neonatal mortality globally and can be transmitted from mother-to-child vertically or horizontally. Fiji has higher rates of serious neonatal infections and infant skin and soft tissue infections (SSTIs) than high-income countries. Research from the Gambia found that a single dose of oral azithromycin in labour decreased bacterial carriage and infections in mothers and infants, particularly infant skin infections. The Bulabula MaPei clinical trial evaluates the safety and efficacy of a single dose of azithromycin in labour in reducing the incidence of maternal and infant SSTIs and other infections and the impact on bacterial carriage. It will also describe the effect of azithromycin on antimicrobial (AMR) resistance, the maternal and infant microbiome, and infant dysbiosis. METHODS AND ANALYSIS We are conducting a blinded, placebo-controlled randomised clinical trial administering 2 g of oral azithromycin, or placebo, given to healthy, pregnant women (≥18 years) in labour in Suva, Fiji. The primary outcome is the cumulative incidence of SSTIs in infants by 3 months of age. Secondary outcomes include the incidence of other infant and maternal infections, and safety and tolerability of azithromycin in mother and infant. Following informed consent, 2110 pregnant women will be randomised in a 1:1 ratio, with all study staff and participants masked to group allocation. Mother/infant pairs will be followed up for 12 months over six visits collecting clinical data on infections, antimicrobial use, safety and anthropometrics, in addition to nasopharyngeal, oropharyngeal, rectovaginal and vaginal swabs, maternal breastmilk and infant stool samples, in order to compare bacterial carriage, AMR rates and microbiome. Recruitment for Bulabula MaPei started in June 2019. ETHICS AND DISSEMINATION This trial was approved and is being conducted according to the protocol approved by The Royal Children's Hospital Human Research Ethics Committee, Australia, and the Fiji National Health Research and Ethics Review Committee. The findings of this study will be disseminated in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER NCT03925480.
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Affiliation(s)
- Maeve Hume-Nixon
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Asia-Pacific Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Tupou Ratu
- Asia-Pacific Health, Murdoch Children's Research Institute, Suva, Fiji
| | - Stephanie Clark
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji
| | - Cattram Duong Nguyen
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Asia-Pacific Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Eleanor F G Neal
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Asia-Pacific Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Casey L Pell
- Translational Microbiology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kathryn Bright
- Asia-Pacific Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Emma Watts
- Asia-Pacific Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - John Hart
- Asia-Pacific Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kim Mulholland
- New Vaccines, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - James Fong
- Ministry of Health and Medical Services, Suva, Fiji
| | - Eric Rafai
- Ministry of Health and Medical Services, Suva, Fiji
| | | | - Ilisapeci Tuibeqa
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji
| | - Catherine Satzke
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Translational Microbiology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Microbiology and Immunology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Steer
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, Royal Children's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Fiona M Russell
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Asia-Pacific Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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10
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Genital Tract Infections in Women, Pregnancy and Neonates. Obstet Gynecol Clin North Am 2022; 49:751-769. [DOI: 10.1016/j.ogc.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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11
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Nyemba DC, Haddison EC, Wang C, Johnson LF, Myer L, Davey DJ. Prevalence of curable STIs and bacterial vaginosis during pregnancy in sub-Saharan Africa: a systematic review and meta-analysis. Sex Transm Infect 2022; 98:484-491. [PMID: 34887350 PMCID: PMC9177894 DOI: 10.1136/sextrans-2021-055057] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/12/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE STIs remain a global public health problem with a high burden among pregnant women. STIs in pregnant women may lead to various adverse pregnancy outcomes. In most sub-Saharan African countries, syndromic management is used for screening and treatment of STIs. We aimed to update and summarise pooled prevalence of curable STIs and bacterial vaginosis (BV) among pregnant women in sub-Saharan Africa. METHODS Electronic databases and reference lists of relevant published and unpublished studies were searched from March 2015 to October 2020. Studies were included if they estimated prevalence of Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), Neisseria gonorrhoeae (NG), Treponema pallidum (syphilis), Mycoplasma genitalium (MG) and BV among pregnant women in sub-Saharan Africa. Meta-analyses were performed with observed prevalences corrected for diagnostic errors to estimate the pooled prevalence of diagnosed infections by region. RESULTS A total of 48 studies met the inclusion criteria, providing 85-point prevalence estimates for curable STIs and BV. Pooled prevalence estimates (with 95% CI and number of women tested) were as follows: MG: 13.5% (4.0-27.2, n=1076); CT: 10.8% (6.9-15.5, n=6700); TV: 13.8% (10.0-18.0, n=9264); NG: 3.3% (2.1-4.7, n=6019); syphilis: 2.9% (2.0-4.0, n=95 308) and BV: 36.6% (27.1-46.6, n=5042). By region, BV was the most prevalent and ranged from 28.5% (24.5-32.8, n=1030) in Eastern Africa to 52.4% (33.5-70.9, n=2305) in Southern Africa; NG had the lowest prevalence, ranging from 1.4% (95% CI 0.1 to 3.1, n=367) in Central Africa to 4.4% (95% CI 2.6 to 6.4, n=4042) in Southern Africa. CONCLUSION The prevalence of curable STIs and BV in sub-Saharan Africa is substantial in pregnant women but most prevalent in Southern Africa where HIV prevalence is highest. It is crucial to integrate screening of curable STIs into antenatal care programmes that have previously focused on diagnosis and treatment of syphilis and HIV.
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Affiliation(s)
- Dorothy Chiwoniso Nyemba
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
- Centre for Infectious Disease Epidemiology, University of Cape Town, Rondebosch, South Africa
| | - Eposi C Haddison
- Saa Health District, Centre Regional Delegation of Public Health, Buea, Cameroon
| | - Colin Wang
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Leigh Francis Johnson
- Centre for Infectious Disease Epidemiology, University of Cape Town, Rondebosch, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
| | - Dvora Joseph Davey
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, USA
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12
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Saweri OP, Batura N, Pulford J, Khan MM, Hou X, Pomat WS, Vallely AJ, Wiseman V. Investigating health service availability and readiness for antenatal testing and treatment for HIV and syphilis in Papua New Guinea. BMC Pregnancy Childbirth 2022; 22:780. [PMID: 36261790 PMCID: PMC9580192 DOI: 10.1186/s12884-022-05097-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Papua New Guinea (PNG) has one of the highest burdens of HIV and syphilis in pregnancy in the Asia-Pacific region. Timely and effective diagnosis can alleviate the burden of HIV and syphilis and improve maternal and newborn health. Supply-side factors related to implementation and scale up remain problematic, yet few studies have considered their impact on antenatal testing and treatment for HIV and syphilis. This study explores health service availability and readiness for antenatal HIV and/or syphilis testing and treatment in PNG. METHODS Using data from two sources, we demonstrate health service availability and readiness. Service availability is measured at a province level as the average of three indicators: infrastructure, workforce, and antenatal clinic utilization. The readiness score comprises 28 equally weighted indicators across four domains; and is estimated for 73 health facilities. Bivariate and multivariate robust linear regressions explore associations between health facility readiness and the proportion of antenatal clinic attendees tested and treated for HIV and/or syphilis. RESULTS Most provinces had fewer than one health facility per 10 000 population. On average, health worker density was 11 health workers per 10 000 population per province, and approximately 22% of pregnant women attended four or more antenatal clinics. Most health facilities had a composite readiness score between 51% and 75%, with urban health facilities faring better than rural ones. The multivariate regression analysis, when controlling for managing authority, catchment population, the number of clinicians employed, health facility type and residence (urban/rural) indicated a weak positive relationship between health facility readiness and the proportion of antenatal clinic attendees tested and treated for HIV and/or syphilis. CONCLUSION This study adds to the limited evidence base for the Asia-Pacific region. There is a need to improve antenatal testing and treatment coverage for HIV and syphilis and reduce healthcare inequalities faced by rural and urban communities. Shortages of skilled health workers, tests, and medicines impede the provision of quality antenatal care. Improving service availability and health facility readiness are key to ensuring the effective provision of antenatal care interventions.
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Affiliation(s)
- Olga Pm Saweri
- The Kirby Institute, University of New South Wales, Sydney, Australia.
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Neha Batura
- Institute for Global Health, University College London, London, UK
| | | | | | | | - William S Pomat
- The Kirby Institute, University of New South Wales, Sydney, Australia
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Andrew J Vallely
- The Kirby Institute, University of New South Wales, Sydney, Australia
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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13
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Chen X, Yuan W, Zhou Q, Tan Y, Wang R, Dong S. Sensitive and visual identification of Chlamydia trachomatis using multiple cross displacement amplification integrated with a gold nanoparticle-based lateral flow biosensor for point-of-care use. Front Cell Infect Microbiol 2022; 12:949514. [PMID: 35937700 PMCID: PMC9355032 DOI: 10.3389/fcimb.2022.949514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Chlamydia trachomatis is the leading cause of bacterial sexually transmitted infection (STI) and remains a major public health challenge, especially in less-developed regions. Establishing a rapid, inexpensive, and easy-to-interpret point-of-care (POC) testing system for C. trachomatis could be critical for its treatment and limiting further transmission. Here, we devised a novel approach termed a multiple cross displacement amplification integrated with gold nanoparticle-based lateral flow biosensor (MCDA-AuNPs-LFB) for the highly specific, sensitive, user-friendly, and rapid identification of C. trachomatis in clinical samples. A suite of MCDA primers based on the C. trachomatis ompA gene from 14 serological variants (serovar A-K, L1, L2, and L3) were successfully designed and used to establish the assay. Optimal assay conditions were identified at 67°C, and the detection procedure, including nucleic acid preparation (approximately 5 min), MCDA amplification (30 min), and AuNPs-LFB visual readout (within 2 min), was completed within 40 min. The all-in cost for each test was approximately $5.5 USD. The limit of detection (LoD) was 10 copies/reaction, and no cross-reaction was observed with non-C. trachomatis microbes. A total of 135 suspected C. trachomatis-infection genital secretion samples were collected and simultaneously detected using real-time quantitative PCR (qPCR) in our assay. Compared with the qPCR technology, the MCDA-AuNPs-LFB sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 96.20%, 94.92%, and 100%, respectively. Hence, our MCDA-AuNP-LFB assay exhibited considerable potential for POC testing and could be used to identify C. trachomatis in clinical settings, particularly in low-income regions.
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Affiliation(s)
- Xu Chen
- The Second Clinical College, Guizhou University of Traditional Chinese Medicine, Guiyang, China
- Clinical Medical Laboratory of the Second Affiliated Hospital, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Wei Yuan
- Quality Control Department, Guizhou Provincial Center for Clinical Laboratory, Guiyang, China
| | - Qingxue Zhou
- Clinical Laboratory, Hangzhou Women’s Hospital, Hangzhou, China
| | - Yan Tan
- Quality Control Department, Guizhou Provincial Center for Clinical Laboratory, Guiyang, China
| | - Ronghua Wang
- Department of Clinical Laboratory, Longli people’s Hospital, Qianlan, China
| | - Shilei Dong
- Department of Clinical Laboratory, Zhejiang Hospital, Hangzhou, China
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14
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Chen X, Zhou Q, Tan Y, Wang R, Wu X, Liu J, Liu R, Wang S, Dong S. Nanoparticle-Based Lateral Flow Biosensor Integrated With Loop-Mediated Isothermal Amplification for Rapid and Visual Identification of Chlamydia trachomatis for Point-of-Care Use. Front Microbiol 2022; 13:914620. [PMID: 35903464 PMCID: PMC9318599 DOI: 10.3389/fmicb.2022.914620] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Chlamydial infection, caused by Chlamydia trachomatis, is the most common bacterial sexually transmitted infection and remains a major public health problem worldwide, particularly in underdeveloped regions. Developing a rapid and sensitive point-of-care (POC) testing for accurate screening of C. trachomatis infection is critical for earlier treatment to prevent transmission. In this study, a novel diagnostic assay, loop-mediated isothermal amplification integrated with gold nanoparticle-based lateral flow biosensor (LAMP-LFB), was devised and applied for diagnosis of C. trachomatis in clinical samples. A set of LAMP primers based on the ompA gene from 14 C. trachomatis serological variants (serovar A-K, L1, L2, L3) was successfully designed and used for the development of C. trachomatis-LAMP-LFB assay. The optimal reaction system can be performed at a constant temperature of 67°C for 35 min. The total assay process, including genomic DNA extraction (~15 min), LAMP reaction (35 min), and LFB readout (~2 min), could be finished within 60 min. The C. trachomatis-LAMP-LFB could detect down to 50 copies/ml, and the specificity was 100%, no cross-reactions with other pathogens were observed. Hence, our C. trachomatis-LAMP-LFB was a rapid, reliable, sensitive, cost-effective, and easy-to-operate assay, which could offer an attractive POC testing tool for chlamydial infection screening, especially in resource starvation settings.
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15
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Kumar M, Saadaoui M, Al Khodor S. Infections and Pregnancy: Effects on Maternal and Child Health. Front Cell Infect Microbiol 2022; 12:873253. [PMID: 35755838 PMCID: PMC9217740 DOI: 10.3389/fcimb.2022.873253] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/04/2022] [Indexed: 12/22/2022] Open
Abstract
Pregnancy causes physiological and immunological adaptations that allow the mother and fetus to communicate with precision in order to promote a healthy pregnancy. At the same time, these adaptations may make pregnant women more susceptible to infections, resulting in a variety of pregnancy complications; those pathogens may also be vertically transmitted to the fetus, resulting in adverse pregnancy outcomes. Even though the placenta has developed a robust microbial defense to restrict vertical microbial transmission, certain microbial pathogens have evolved mechanisms to avoid the placental barrier and cause congenital diseases. Recent mechanistic studies have begun to uncover the striking role of the maternal microbiota in pregnancy outcomes. In this review, we discuss how microbial pathogens overcome the placental barrier to cause congenital diseases. A better understanding of the placental control of fetal infection should provide new insights into future translational research.
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Affiliation(s)
- Manoj Kumar
- Research Department, Sidra Medicine, Doha, Qatar
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16
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Significant Associations between Chlamydia trachomatis and Neisseria gonorrhoeae Infections in Human Immunodeficiency Virus-Infected Pregnant Women. Infect Dis Obstet Gynecol 2022; 2022:7930567. [PMID: 35754526 PMCID: PMC9232329 DOI: 10.1155/2022/7930567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
There is a lack of data on the burden of Chlamydia trachomatis and Neisseria gonorrhoeae among human immunodeficiency virus- (HIV-) infected pregnant women in South Africa. We conducted a cross-sectional study which included 385 HIV-infected pregnant women attending antenatal clinic at the King Edward VIII Hospital in Durban, South Africa. The women provided vaginal swabs which were tested for C. trachomatis and N. gonorrhoeae. The prevalence of the individual STIs was as follows: C. trachomatis (47/385, 12.2%) and N. gonorrhoeae (16/385, 4.1%). Having a circumcised partner, testing positive for N. gonorrhoeae, and perceiving themselves of being at risk for infection were shown to increase the risk for C. trachomatis infection. Without controlling for the other factors, testing positive for N. gonorrhoeae increased the risk for C. trachomatis infection by 10-fold (OR: 10.17, 95% CI: 3.39-29.66, p < 0.001). Similarly, adjusting for the other factors, the risk for C. trachomatis infection in women who tested positive for N. gonorrhoeae was 9-fold (OR: 9.16, 95% CI: 2.19-40.18, p = 0.003). The following factors were associated with the increased risk of N. gonorrhoeae infection: not knowing their partner's HIV status, partner having other partners, and C. trachomatis infection status. Without controlling for the other factors, testing positive for C. trachomatis increased the risk for N. gonorrhoeae infection by 6-fold (OR: 6.52, 95% CI: 2.22-18.49, p < 0.001). Similarly, adjusting for the other factors, the risk for N. gonorrhoeae infection in women who tested positive for C. trachomatis was 6-fold (OR: 6.09, 95% CI: 1.73-22.03, p = 0.005). We found a significant association between C. trachomatis and N. gonorrhoeae in the pregnant women and the risk factors associated with these pathogens. Future studies are urgently required to investigate the impact of C. trachomatis/N. gonorrhoeae coinfections in HIV pregnant women since this data is lacking in our setting. In addition, etiological screening of C. trachomatis and N. gonorrhoeae during antenatal clinic is urgently required to prevent adverse pregnancy and birth outcomes associated with these infections.
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Hage A, Juliana NCA, Steenhof L, Voigt RR, Morré SA, Ambrosino E, Hammoud NM. Frequency of Chlamydia trachomatis and Neisseria gonorrhoeae in Patients with Imminent Preterm Delivery on the Island of Curaçao. Pathogens 2022; 11:pathogens11060670. [PMID: 35745524 PMCID: PMC9231326 DOI: 10.3390/pathogens11060670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Sexually transmitted infections are one of the important risk factors for preterm delivery, which is among the important contributors to perinatal morbidity and mortality. The aim of this study was to assess the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in women with imminent preterm delivery in Curaçao, an island of the Dutch Caribbean. All women from Curaçao with either preterm premature rupture of the membranes or preterm labor, common indications of imminent preterm delivery, and presenting at the Curaçao Medical Center between 15 November 2019 and 31 December 2020, were included in this single cohort study. Data were retrospectively collected from medical records. The presence of Chlamydia trachomatis and Neisseria gonorrhoeae was assessed by Cepheid GeneXpert ® (Xpert) CT/NG assay (Sunnyvale, CA, USA). In the included cohort, the prevalence of Chlamydia trachomatis infection was 15.5% and of Neisseria gonorrhoeae infection was 2.1%. All patients infected with Neisseria gonorrhoeae were co-infected with Chlamydia trachomatis. The prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in patients with imminent preterm delivery in Curaçao is high. It is recommended to test all patients with imminent preterm delivery for these sexually transmitted infections and possibly consider testing all women in early pregnancy on the island.
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Affiliation(s)
- Aglaia Hage
- Department of Obstetrics and Gynecology, Curaçao Medical Center, Willemstad, Curacao; (A.H.); (N.C.A.J.); (L.S.); (R.R.V.)
| | - Naomi C. A. Juliana
- Department of Obstetrics and Gynecology, Curaçao Medical Center, Willemstad, Curacao; (A.H.); (N.C.A.J.); (L.S.); (R.R.V.)
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6229 ER Maastricht, The Netherlands; (S.A.M.); (E.A.)
| | - Leonie Steenhof
- Department of Obstetrics and Gynecology, Curaçao Medical Center, Willemstad, Curacao; (A.H.); (N.C.A.J.); (L.S.); (R.R.V.)
| | - Ralph R. Voigt
- Department of Obstetrics and Gynecology, Curaçao Medical Center, Willemstad, Curacao; (A.H.); (N.C.A.J.); (L.S.); (R.R.V.)
| | - Servaas A. Morré
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6229 ER Maastricht, The Netherlands; (S.A.M.); (E.A.)
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad 211007, UP, India
- Dutch Chlamydia trachomatis Reference Laboratory on behalf of the Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3721 MA De Bilt, The Netherlands
| | - Elena Ambrosino
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6229 ER Maastricht, The Netherlands; (S.A.M.); (E.A.)
| | - Nurah M. Hammoud
- Department of Obstetrics and Gynecology, Curaçao Medical Center, Willemstad, Curacao; (A.H.); (N.C.A.J.); (L.S.); (R.R.V.)
- Correspondence: ; Tel.: +599-9-523-7012
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Dong HV, Leng M, Kreitchmann R, Klausner JD, Nielsen-Saines K, Yeganeh N. Adverse Neonatal Outcomes Associated With Maternal Sexually Transmitted Infections From a Public Health Clinic Cohort in Southern Brazil. J Pediatric Infect Dis Soc 2022; 11:345-348. [PMID: 35477777 PMCID: PMC9302697 DOI: 10.1093/jpids/piac027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/26/2022] [Indexed: 11/14/2022]
Abstract
Pregnant women at public medical centers in Porto Alegre, Brazil, were recruited for a study on screening and treatment of sexually transmitted infections (STIs). STIs were detected in 79 (23%) of 350 pregnant women and were found to be associated with infant low birth weight (adjusted odds ratio 5.8; 95% confidence interval 1.9-18).
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Affiliation(s)
- Huan Vinh Dong
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Mei Leng
- Department of Medicine, Biostatistics at UCLA, Los Angeles, California, USA
| | - Regis Kreitchmann
- Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil,Federal University of Health Sciences, Porto Alegre, Brazil
| | - Jeffrey D Klausner
- Division of Preventative Medicine, USC Keck School of Medicine, Los Angeles, California, USA
| | - Karin Nielsen-Saines
- Division of Pediatric Infectious Diseases, David Geffen School of Medicine, Los Angeles, California, USA
| | - Nava Yeganeh
- Corresponding Author: Nava Yeganeh, MD, MPH, 10833 Le Conte Ave. MDCC22-442, Los Angeles, CA 9009-1752, USA. E-mail:
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Nyemba DC, Peters RPH, Medina-Marino A, Klausner JD, Ngwepe P, Myer L, Johnson LF, Joseph Davey DL. Impact of aetiological screening of sexually transmitted infections during pregnancy on pregnancy outcomes in South Africa. BMC Pregnancy Childbirth 2022; 22:194. [PMID: 35264142 PMCID: PMC8908701 DOI: 10.1186/s12884-022-04520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) during pregnancy may increase the risk of adverse pregnancy outcomes. STI syndromic management is standard of care in South Africa but has its limitations. We evaluated the impact of diagnosing and treating curable STIs during pregnancy on adverse pregnancy and birth outcomes. METHODS We combined data from two prospective studies of pregnant women attending public sector antenatal care (ANC) clinics in Tshwane District and Cape Town, South Africa. Pregnant women were enrolled, tested and treated for STIs. We evaluated the association between any STI at the first ANC visit and a composite adverse pregnancy outcome (miscarriage, stillbirth, preterm birth, early neonatal death, or low birthweight) using modified Poisson regression models, stratifying by HIV infection and adjusting for maternal characteristics. RESULTS Among 619 women, 61% (n = 380) were from Tshwane District and 39% (n = 239) from Cape Town; 79% (n = 486) were women living with HIV. The prevalence of any STI was 37% (n = 228); C. trachomatis, 26% (n = 158), T. vaginalis, 18% (n = 120) and N. gonorrhoeae, 6% (n = 40). There were 93% (n = 574) singleton live births, 5% (n = 29) miscarriages and 2% (n = 16) stillbirths. Among the live births, there were 1% (n = 3) neonatal deaths, 7% (n = 35) low birthweight in full-term babies and 10% (n = 62) preterm delivery. There were 24% (n = 146) for the composite adverse pregnancy outcome. Overall, any STI diagnosis and treatment at first ANC visit was not associated with adverse outcomes in women living with HIV (adjusted relative risk (aRR); 1.43, 95% CI: 0.95-2.16) or women without HIV (aRR; 2.11, 95% CI: 0.89-5.01). However, C. trachomatis (aRR; 1.57, 95% CI: 1.04-2.39) and N. gonorrhoeae (aRR; 1.69, 95% CI: 1.09-3.08), were each independently associated with the composite adverse outcome in women living with HIV. CONCLUSION Treated STIs at the first ANC visit were not associated with adverse pregnancy outcome overall. In women living with HIV, C. trachomatis or N. gonorrhoeae at first ANC were each independently associated with adverse pregnancy outcome. Our results highlights complex interactions between the timing of STI detection and treatment, HIV infection and pregnancy outcomes, which warrants further investigation.
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Affiliation(s)
- Dorothy C Nyemba
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. .,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Remco P H Peters
- Research Unit, Foundation for Professional Development, East London, South Africa.,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.,Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Andrew Medina-Marino
- Research Unit, Foundation for Professional Development, East London, South Africa.,Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, University of Southern California, Keck School of Medicine, Los Angeles, USA
| | - Phuti Ngwepe
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Dvora L Joseph Davey
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Department of Preventive Medicine, Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, USA
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20
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Wynn A, Mussa A, Ryan R, Hansman E, Simon S, Bame B, Moreri-Ntshabele B, Ramogola-Masire D, Klausner JD, Morroni C. Evaluating the diagnosis and treatment of Chlamydia trachomatis and Neisseria gonorrhoeae in pregnant women to prevent adverse neonatal consequences in Gaborone, Botswana: protocol for the Maduo study. BMC Infect Dis 2022; 22:229. [PMID: 35255814 PMCID: PMC8899784 DOI: 10.1186/s12879-022-07093-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are extremely common sexually transmitted infections (STIs) that are associated with adverse birth and neonatal outcomes, and the risk of vertical transmission of CT and NG during delivery is high. The majority of CT and NG infections are asymptomatic and missed by the standard of care in most countries (treatment based on symptoms). Thus, it is likely that missed maternal CT and NG infections contribute to preventable adverse health outcomes among women and children globally. This study aims to assess the effectiveness of CT and NG testing for asymptomatic pregnant women to prevent adverse neonatal outcomes, understand the inflammatory response linking CT and NG infections to adverse neonatal outcomes, and conduct an economic analysis of the CT and NG testing intervention. METHODS The Maduo ("results" in Setswana) is a prospective, cluster-controlled trial in Gaborone, Botswana to compare a near point-of-care CT and NG testing and treatment intervention implemented in "study clinics" with standard antenatal care (World Health Organization-endorsed "syndromic management" strategy based on signs and symptoms without laboratory confirmation) implemented in "standard of care clinics" among asymptomatic pregnant women. The primary outcome is vertical transmission of CT/NG infection. Secondary outcomes include preterm birth (delivery < 37 completed weeks of gestation) and/or low birth weight (< 2500 g). The trial will also evaluate immunological and inflammatory markers of adverse neonatal outcomes, as well as the costs and cost-effectiveness of the intervention compared with standard care. DISCUSSION The Maduo study will improve our understanding of the effectiveness and cost-effectiveness of CT and NG testing among asymptomatic pregnant women. It will also increase knowledge about the CT/NG-related immune responses that might drive adverse neonatal outcomes. Further, results from this study could encourage expansion of STI testing during antenatal care in low resource settings and improve maternal and neonatal health globally. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov (Identifier NCT04955717, First posted: July 9, 2021)).
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Affiliation(s)
- Adriane Wynn
- University of California, San Diego, USA. .,Botswana Sexual and Reproductive Health Initiative, Gaborone, Botswana.
| | - Aamirah Mussa
- Botswana Sexual and Reproductive Health Initiative, Gaborone, Botswana.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Rebecca Ryan
- Botswana Sexual and Reproductive Health Initiative, Gaborone, Botswana.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Selebaleng Simon
- Botswana Sexual and Reproductive Health Initiative, Gaborone, Botswana.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Bame Bame
- Botswana Sexual and Reproductive Health Initiative, Gaborone, Botswana.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | | | | | - Chelsea Morroni
- Botswana Sexual and Reproductive Health Initiative, Gaborone, Botswana.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,University of Edinburgh, Edinburgh, UK
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21
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Juliana NCA, Deb S, Juma MH, Poort L, Budding AE, Mbarouk A, Ali SM, Ouburg S, Morré SA, Sazawal S, Ambrosino E. The Vaginal Microbiota Composition and Genital Infections during and after Pregnancy among Women in Pemba Island, Tanzania. Microorganisms 2022; 10:microorganisms10030509. [PMID: 35336085 PMCID: PMC8951098 DOI: 10.3390/microorganisms10030509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/03/2022] [Accepted: 02/21/2022] [Indexed: 01/25/2023] Open
Abstract
We investigated the vaginal microbiota (VMB) composition, prevalence of genital pathogens and their association among pregnant and post-delivery women in Pemba Island, Tanzania. Vaginal swabs were collected from 90 women, at two time points during pregnancy (<20 weeks of gestational age [GA] and ≥20 weeks GA) and once after delivery, when possible. IS-pro assay was used for VMB characterization. Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) and human papillomavirus (HPV) were detected by qPCRs. VMB were mostly Lactobacillus dominant during pregnancy and non-Lactobacillus dominant post-delivery. A significant decrease in VMB richness was observed during pregnancy among paired and unpaired samples. Shannon diversity was significantly lower during pregnancy than post-delivery among unpaired samples. Klebsiella species and Streptococcus anginosus were the most commonly identified pathobionts at all timepoints. A high abundance of pathobionts was mostly seen in women with non-Lactobacillus dominant VMB. At ≥20 weeks GA timepoint during pregnancy, 63.0% of the women carrying one or more genital pathogen (either HPV, CT, TV, or MG) had L. iners dominant VMB. NG was not detected pre-delivery. This study contributes evidence on VMB composition, its changes during pregnancy and post-delivery, and their association with pathobionts and genital pathogens.
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Affiliation(s)
- Naomi C. A. Juliana
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Reproduction), Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6200 Maastricht, The Netherlands; (N.C.A.J.); (S.A.M.)
| | - Saikat Deb
- Public Health Laboratory—Ivo de Carneri, Chake Chake 74201, Pemba Island, Tanzania; (S.D.); (M.H.J.); (A.M.); (S.M.A.)
- Centre for Public Health Kinetics, New Delhi 110024, India;
| | - Mohamed H. Juma
- Public Health Laboratory—Ivo de Carneri, Chake Chake 74201, Pemba Island, Tanzania; (S.D.); (M.H.J.); (A.M.); (S.M.A.)
| | - Linda Poort
- inBiome, 1098 Amsterdam, The Netherlands; (L.P.); (A.E.B.)
| | | | - Abdalla Mbarouk
- Public Health Laboratory—Ivo de Carneri, Chake Chake 74201, Pemba Island, Tanzania; (S.D.); (M.H.J.); (A.M.); (S.M.A.)
| | - Said M. Ali
- Public Health Laboratory—Ivo de Carneri, Chake Chake 74201, Pemba Island, Tanzania; (S.D.); (M.H.J.); (A.M.); (S.M.A.)
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC, Location AMC, 1105 Amsterdam, The Netherlands;
| | - Servaas A. Morré
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Reproduction), Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6200 Maastricht, The Netherlands; (N.C.A.J.); (S.A.M.)
| | - Sunil Sazawal
- Centre for Public Health Kinetics, New Delhi 110024, India;
| | - Elena Ambrosino
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Reproduction), Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6200 Maastricht, The Netherlands; (N.C.A.J.); (S.A.M.)
- Correspondence: ; Tel.: +31-04-3388-4081
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22
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Ngobese B, Abbai NS. Sexually transmitted infections in pregnant women from sub-Saharan Africa. S Afr J Infect Dis 2021; 36:312. [PMID: 34917679 PMCID: PMC8664065 DOI: 10.4102/sajid.v36i1.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/06/2021] [Indexed: 11/05/2022] Open
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.
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Affiliation(s)
- Bongekile Ngobese
- Department of Clinical Medicine Laboratory, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Nathlee S Abbai
- Department of Clinical Medicine Laboratory, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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23
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Wand H, Ramjee G, Reddy T. Quantifying Vulnerabilities of Single Women and Sexually Transmitted Infections in South Africa (2002-2016): Is It Getting Better (or Worse)? ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3237-3245. [PMID: 34664154 DOI: 10.1007/s10508-021-01998-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 03/20/2021] [Accepted: 03/29/2021] [Indexed: 06/13/2023]
Abstract
Curable sexually transmitted infections (STIs) affect millions of people across the world. Besides unacceptably high HIV rates, South Africa also has the highest burden of STIs in the world. The aim of the study was to investigate temporal changes in STI incidence rates using the data from ~ 10,000 women who enrolled in several HIV prevention trials, KwaZulu-Natal, South Africa (2002-2016). We particularly focused on the changes in distribution of the most influential factors and their population-level impacts on STI incidence rates over time. Characteristics of the women were compared across the study periods: 2002-2004, 2005-2008, 2009-2011, and 2012-2016. Besides multivariable Cox regression models, population attributable risks were calculated for the significant factors. Despite the significant progress in prevention, testing, and treatment programs, infection rates increased substantially from 13.6 to 20.0 per 100 person-year over the study period. Our findings provided a compelling evidence for single/non-cohabiting South African women to be the most vulnerable population who consistently and substantially contributed to increasing STI rates during the 15 years of study duration (PAR%: 44%-47%). We also highlighted the impact of women's lack of knowledge related to their partner, using injectable contraceptives, less parity, and baseline STI positivity which were increased substantially over time. Our findings suggest that a significant proportion of STIs could be prevented by targeting single/non-cohabiting. These results may provide guidance in developing more effective STI prevention programs by targeting women at highest risk of infections and delivering more realistic messages.
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Affiliation(s)
- Handan Wand
- Kirby Institute, University of New South Wales, Kensington, NSW, 2052, Australia.
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Westville, KwaZulu-Natal, 3630, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, KwaZulu-Natal, 3630, South Africa
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24
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Shetty S, Kouskouti C, Schoen U, Evangelatos N, Vishwanath S, Satyamoorthy K, Kainer F, Brand A. Diagnosis of Chlamydia trachomatis genital infections in the era of genomic medicine. Braz J Microbiol 2021; 52:1327-1339. [PMID: 34164797 PMCID: PMC8221097 DOI: 10.1007/s42770-021-00533-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/17/2021] [Indexed: 11/02/2022] Open
Abstract
PURPOSE Chlamydial genital infections constitute significant sexually transmitted infections worldwide. The often asymptomatic status of C. trachomatis (CT) infections leads to an increased burden on human reproductive health, especially in middle- and low-income settings. Early detection and management of these infections could play a decisive role in controlling this public health burden. The objective of this review is to provide an insight into the evolution of diagnostic methods for CT infections through the development of new molecular technologies, emphasizing on -omics' technologies and their significance as diagnostic tools both for effective patient management and control of disease transmission. METHODS Narrative review of the diagnostic methodologies of CT infections and the impact of the introduction of -omics' technologies on their diagnosis by review of the literature. RESULTS Various methodologies are discussed with respect to working principles, required specifications, advantages, and disadvantages. Implementing the most accurate methods in diagnosis is highlighted as the cornerstone in managing CT infections. CONCLUSION Diagnostics based on -omics' technologies are considered to be the most pertinent modalities in CT testing when compared to other available methods. There is a need to modify these effective and accurate diagnostic tools in order to render them more available and feasible in all settings, especially aiming on turning them to rapid point-of-care tests for effective patient management and disease control.
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Affiliation(s)
- Seema Shetty
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Madhav Nagar, Manipal, 576104, Karnataka, India.
- United Nations University - Maastricht Economics and Social Research Institute On Innovation and Technology (UNU-MERIT), Maastricht, 6211, AX, The Netherlands.
- Manipal Centre for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
| | - Christina Kouskouti
- Department of Obstetrics and Perinatal Medicine, Klinik Hallerwiese, St. Johannis-Muhlgasse 19, 90419, Nuremberg, Germany
- Division of Maternal and Fetal Medicine Department of Obstetrics and Gynaecology, Mt. Sinai Hospital University of Toronto, Toronto, ON, Canada
| | - Uwe Schoen
- BioMedHeliX (Pty) Ltd., 3 Conifer Road, Cape Town, 8005, South Africa
| | - Nikolaos Evangelatos
- United Nations University - Maastricht Economics and Social Research Institute On Innovation and Technology (UNU-MERIT), Maastricht, 6211, AX, The Netherlands
- Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada
- Dr. TMA Pai Endowment Chair in Research Policy in Biomedical Sciences and Public Health, Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Shashidhar Vishwanath
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Madhav Nagar, Manipal, 576104, Karnataka, India
- Manipal Centre for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Kapaettu Satyamoorthy
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Franz Kainer
- Department of Obstetrics and Perinatal Medicine, Klinik Hallerwiese, St. Johannis-Muhlgasse 19, 90419, Nuremberg, Germany
| | - Angela Brand
- United Nations University - Maastricht Economics and Social Research Institute On Innovation and Technology (UNU-MERIT), Maastricht, 6211, AX, The Netherlands
- Dr. TMA Pai Endowment Chair in Public Health Genomics, Department of Public Health Genomics, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
- Department of International Health, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6229, GT, The Netherlands
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25
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Nyemba DC, Medina-Marino A, Peters RPH, Klausner JD, Ngwepe P, Myer L, Johnson LF, Davey DJ. Prevalence, incidence and associated risk factors of STIs during pregnancy in South Africa. Sex Transm Infect 2021; 97:375-381. [PMID: 33004610 PMCID: PMC8012394 DOI: 10.1136/sextrans-2020-054631] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/08/2020] [Accepted: 08/24/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE STIs 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. METHODS We 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. RESULTS We 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. CONCLUSION Our 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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Affiliation(s)
- Dorothy Chiwoniso Nyemba
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Andrew Medina-Marino
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Remco P H Peters
- Research Unit, Foundation for Professional Development, East London, South Africa
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
- Department of Medical Microbiology, CAPHRI School of Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jeffrey D Klausner
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Phuti Ngwepe
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Leigh Francis Johnson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Dvora Joseph Davey
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
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26
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 829] [Impact Index Per Article: 276.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs.
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Fennell C, Diseko M, Zash R, Mayondi G, Mabuta J, Mmalane M, Davey S, Luckett R, Morroni C, Dintwa EN, Lockman S, Makhema J, Caniglia E, Shapiro R. The Impact of Syndromic Management of Vaginal Discharge Syndrome on Adverse Birth Outcomes in Botswana. Open Forum Infect Dis 2021; 8:ofab366. [PMID: 34381845 PMCID: PMC8351807 DOI: 10.1093/ofid/ofab366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background Vaginal discharge syndrome (VDS) is a common clinical diagnosis during pregnancy in Botswana; it is treated with broad-spectrum antibiotics using a syndromic approach. We evaluated associations between the syndromic management of VDS and adverse birth outcomes. Methods The Tsepamo Study performs birth outcomes surveillance at government hospitals throughout Botswana. Obstetric record data collected from August 2014 to March 2019 were analyzed. Chi-square tests were conducted to compare proportions of maternal characteristics and infant outcomes. To avoid immortal time bias, all analyses were conducted among women who presented to care before 24 weeks gestation, with VDS categorized as present or absent by 24 weeks gestation. Log-binomial regression models were generated to determine associations between treated VDS and infant outcomes. Results VDS was diagnosed in 36 731 (30.7%) pregnant women, of whom 33 328 (90.7%) received antibiotics. Adjusted analyses yielded a harmful association between treated VDS and very preterm delivery (adjusted risk ratio, 1.11; 95% CI, 1.02-1.21). This association remained when restricting to women with VDS who received the recommended antibiotic treatment regimen. Sensitivity analyses produced nonsignificant associations when women with treated VDS were compared with women without VDS who received antibiotics for other indications. Conclusions A clinical diagnosis of VDS is common among pregnant women in Botswana, and the majority receive antibiotics in pregnancy. Although analyses of VDS occurring later in pregnancy are precluded by immortal time bias, a modest association between treated VDS and very preterm delivery was observed among women diagnosed with VDS by 24 weeks gestation.
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Affiliation(s)
- Christina Fennell
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Modeigi Diseko
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Rebecca Zash
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gloria Mayondi
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Judith Mabuta
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Mompati Mmalane
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Sonya Davey
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rebecca Luckett
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Scottish Livingston Hospital, Molepolole, Botswana.,Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana
| | - Chelsea Morroni
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Eldah N Dintwa
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Shahin Lockman
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joseph Makhema
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ellen Caniglia
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Roger Shapiro
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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28
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Saweri OPM, Batura N, Al Adawiyah R, Causer LM, Pomat WS, Vallely AJ, Wiseman V. Economic evaluation of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low- and middle-income countries: A systematic review. PLoS One 2021; 16:e0253135. [PMID: 34138932 PMCID: PMC8211269 DOI: 10.1371/journal.pone.0253135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 05/30/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sexually transmitted and genital infections in pregnancy are associated with adverse pregnancy and birth outcomes. Point-of-care tests for these infections facilitate testing and treatment in a single antenatal clinic visit and may reduce the risk of adverse outcomes. Successful implementation and scale-up depends on understanding comparative effectiveness of such programmes and their comparative costs and cost effectiveness. This systematic review synthesises and appraises evidence from economic evaluations of point-of-care testing and treatment for sexually transmitted and genital infections among pregnant women in low- and middle-income countries. METHODS Medline, Embase and Web of Science databases were comprehensively searched using pre-determined criteria. Additional literature was identified by searching Google Scholar and the bibliographies of all included studies. Economic evaluations were eligible if they were set in low- and middle-income countries and assessed antenatal point-of-care testing and treatment for syphilis, chlamydia, gonorrhoea, trichomoniasis, and/or bacterial vaginosis. Studies were analysed using narrative synthesis. Methodological and reporting standards were assessed using two published checklists. RESULTS Sixteen economic evaluations were included in this review; ten based in Africa, three in Latin and South America and three were cross-continent comparisons. Fifteen studies assessed point-of-care testing and treatment for syphilis, while one evaluated chlamydia. Key drivers of cost and cost-effectiveness included disease prevalence; test, treatment, and staff costs; test sensitivity and specificity; and screening and treatment coverage. All studies met 75% or more of the criteria of the Drummond Checklist and 60% of the Consolidated Health Economics Evaluation Reporting Standards. CONCLUSIONS Generally, point-of-care testing and treatment was cost-effective compared to no screening, syndromic management, and laboratory-based testing. Future economic evaluations should consider other common infections, and their lifetime impact on mothers and babies. Complementary affordability and equity analyses would strengthen the case for greater investment in antenatal point-of-care testing and treatment for sexually transmitted and genital infections.
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Affiliation(s)
- Olga P. M. Saweri
- The Kirby Institute, University of New South Wales, Sydney, Australia
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
- * E-mail:
| | - Neha Batura
- University College London, London, United Kingdom
| | | | - Louise M. Causer
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - William S. Pomat
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Andrew J. Vallely
- The Kirby Institute, University of New South Wales, Sydney, Australia
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, Australia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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29
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Adachi KN, Nielsen-Saines K, Klausner JD. Chlamydia trachomatis Screening and Treatment in Pregnancy to Reduce Adverse Pregnancy and Neonatal Outcomes: A Review. Front Public Health 2021; 9:531073. [PMID: 34178906 PMCID: PMC8222807 DOI: 10.3389/fpubh.2021.531073] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Chlamydial trachomatis infection has been associated with adverse pregnancy and neonatal outcomes such as premature rupture of membranes, preterm birth, low birth weight, conjunctivitis, and pneumonia in infants. This review evaluates existing literature to determine potential benefits of antenatal screening and treatment of C. trachomatis in preventing adverse outcomes. A literature search revealed 1824 studies with 156 full-text articles reviewed. Fifteen studies were selected after fulfilling inclusion criteria. Eight studies focused on chlamydial screening and treatment to prevent adverse pregnancy outcomes such as premature rupture of membranes, preterm birth, low birth weight, growth restriction leading to small for gestational age infants, and neonatal death. Seven studies focused on the effects of chlamydial screening and treatment on adverse infant outcomes such as chlamydial infection including positive mucosal cultures, pneumonia, and conjunctivitis. Given the heterogeneity of those studies, this focused review was exclusively qualitative in nature. When viewed collectively, 13 of 15 studies provided some degree of support that antenatal chlamydial screening and treatment interventions may lead to decreased adverse pregnancy and infant outcomes. However, notable limitations of these individual studies also highlight the need for further, updated research in this area, particularly from low and middle-income settings.
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Affiliation(s)
- Kristina N Adachi
- Division of Infectious Diseases, Department of Pediatrics, University of California, Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, CA, United States
| | - Karin Nielsen-Saines
- Division of Infectious Diseases, Department of Pediatrics, University of California, Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, CA, United States
| | - Jeffrey D Klausner
- Division of Disease Prevention, Policy and Global Health, Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
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30
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Wand H, Ramjee G, Reddy T. Quantifying geographical diversity in sexually transmitted infections using population attributable risk: results from HIV prevention trials in South Africa. Int J STD AIDS 2021; 32:600-608. [PMID: 33769896 DOI: 10.1177/0956462420968998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In this study, we investigated spatial diversities of sexually transmitted infections (STIs) and quantified their impacts on the STIs using population attributable risk (PAR%). The study population was 7,557 women who participated in several HIV prevention trials from KwaZulu-Natal, South Africa. Our results provide compelling evidence for substantial geographical diversities on STI incidence rates in the region. Their population-level impacts on the STIs exceeded the combined impacts of the individual risk factors considered in this study (PAR%: 41% (<25 years), 52% (25-34 years) and 34% (35+ years). When all these factors are considered together, PAR% was the highest among younger women (PAR%: 67%, 82% and 50% for <25, 25-34 and 35+ years old respectively). Results from our study will bring greater insight into the previous research by increasing our understanding of the impacts of the sub-geographical level variations of STI prevalence and incidence rates in the region.
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Affiliation(s)
- Handan Wand
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Westville, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
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31
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The Natural Course of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium in Pregnant and Post-Delivery Women in Pemba Island, Tanzania. Microorganisms 2021; 9:microorganisms9061180. [PMID: 34070767 PMCID: PMC8228750 DOI: 10.3390/microorganisms9061180] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 12/30/2022] Open
Abstract
This study aimed to determine the persistence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG) infections during pregnancy and after delivery in vaginal swabs of women from Pemba Island, Tanzania. In the context of an earlier biobanking effort, vaginal swabs were collected at two timepoints during pregnancy and once post-delivery. Detection of CT, NG, TV, and MG was performed by PCR using validated detection kits in samples from 441 pregnant women aged 16–48 years old. Among those, 202 samples were matched during pregnancy and 38 at the second timepoint of the pregnancy and post-delivery CT infection persistence during pregnancy was 100% (n = 11) after an average of eight weeks, that of TV infection 82% (n = 11) after ten weeks, and that of MG infection 75% (n = 4) after ten weeks. Post-delivery (after approximately 22 weeks) infection persistence was 100% for CT (n = 1) and 20% for TV (n = 5). NG was only detected at the last collection timepoint, its persistence rate could not be determined. These results show persistence and clearance of curable infections during and after pregnancy. Analysis of biobanked samples is a valuable approach in the investigation of the natural history of curable pathogens.
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32
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Antimicrobial Susceptibility Patterns in Neisseria gonorrhoeae Isolated from South African Pregnant Women. Infect Dis Obstet Gynecol 2021. [DOI: 10.1155/2021/6684680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Neisseria gonorrhoeae, a sexually transmitted infection, is associated with adverse pregnancy and neonatal outcomes. Emerging resistance towards various antibiotics has been observed globally. However, there is a lack of data on antimicrobial susceptibility patterns in N. gonorrhoeae isolated from pregnant women in our setting. This study fills in this gap in the literature. Methods. The study population included pregnant women, recruited from the antenatal clinic of the King Edward VIII hospital (KEH) in Durban. Endocervical swabs were obtained from 307 women. The swab was placed in Amies Charcoal media for culture assessments. Pure isolates of N. gonorrhoeae were subjected to antimicrobial susceptibility testing using the Etest™ method. The MIC values were assessed in accordance with the European Committee on Antimicrobial Susceptibility Testing (EUCAST, 2019) breakpoints. Results. The prevalence of N. gonorrhoeae by culture was 1.9%. High MIC values to penicillin G (12-64 mg/L) indicating a resistant phenotype were observed for all isolates tested, with 50% of the isolates displaying complete resistance. Isolates with intermediate (1 mg/L) and resistance (1.9-32 mg/L) profiles to tetracycline were observed. Resistance to ciprofloxacin (1.16-3 mg/L) was also observed. Isolates displayed either dual or triple resistance to penicillin G, tetracycline, or ciprofloxacin. All isolates showed susceptibility to spectinomycin (>64 mg/L), azithromycin (1 mg/L), ceftriaxone (>0.125 mg/L), and cefixime (>0.125 mg/L). Conclusion. Despite lack of resistance to ceftriaxone and azithromycin, continuous surveillance for emerging patterns of resistance to these antibiotics is needed since they form part of the treatment guidelines.
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Zenebe MH, Mekonnen Z, Loha E, Padalko E. Prevalence, risk factors and association with delivery outcome of curable sexually transmitted infections among pregnant women in Southern Ethiopia. PLoS One 2021; 16:e0248958. [PMID: 33760867 PMCID: PMC7990168 DOI: 10.1371/journal.pone.0248958] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/09/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Curable sexually transmitted infections (STIs) such as infection with Chlamydia trachomatis (C. trachomatis), Neisseria gonorrhoeae (N. gonorrhoeae), and Trichomonas vaginalis (T. vaginalis) can lead to adverse pregnancy and birth outcome. There are limited data on the prevalence and correlate of STI in Ethiopia, yet pregnant women are not screened for curable STI. Hence in this study, the prevalence of STIs and associated risk factors were assessed. METHODOLOGY A cross- sectional study was conducted on consecutive women attending the delivery ward at the Hawassa comprehensive and specialized hospital. Vaginal swabs collected at the time of labor and delivery were tested for C. trachomatis, N. gonorrhoeae and T. vaginalis using GeneXpert. Study participants responded to a questionnaire about their previous and current obstetric history and socio-demographic characteristics. Possible independent factors for curable STIs were assessed by chi-square, bivariable, and multivariable, logistic regression. RESULTS Of the 350 vaginal swabs tested, 51 (14.6%, 95% CI: 10.9-18.3) were positive for one or more curable STIs. The prevalence of C. trachomatis, N. gonorrhoeae and T. vaginalis were 8.3%, 4.3%, and 3.1%, respectively. STIs was associated (p<0.005) with the delivery outcomes birth weight and gestational age. A 3-fold increase in odds of acquisition STIs was found in currently unmarried women (AOR, 3.5; 95% CI: 1.1-10.4; p = 0.028), in women <25 years (AOR, 2.7; 95% CI 1.1-6.6; p = 0.031). Women reporting presence of vaginal discharge (AOR, 7.7; 95% CI: 3.2-18.6; p < 0.001) and reporting pain during urination (AOR, 6.5; 95% CI: 2.6-16.2; p <0.001) found to associate with curable STIs. CONCLUSION The higher magnitude of STIs found in this population, and the absence of symptoms in many illustrate the need for systematic follow-up during routine antenatal care primarily history taking and asking for signs and symptoms to provide early management and avoid long term sequelae.
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Affiliation(s)
- Mengistu Hailemariam Zenebe
- School of Medical Laboratory Sciences, Hawassa University college of Medicine and Health Sceinces, Hawassa, Ethiopia
- School of Medical Laboratory Sciences, Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences, Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Eskindir Loha
- Centre for International Health, University of Bergen, Bergen, Norway
- Chr. Michelsen Institute, Bergen, Norway
| | - Elizaveta Padalko
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
- Laboratory of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
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Smith-Norowitz TA, Ukaegbu C, Kohlhoff S, Hammerschlag MR. Neonatal prophylaxis with antibiotic containing ointments does not reduce incidence of chlamydial conjunctivitis in newborns. BMC Infect Dis 2021; 21:270. [PMID: 33731049 PMCID: PMC7971948 DOI: 10.1186/s12879-021-05974-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background Neonatal ocular prophylaxis with silver nitrate does not prevent neonatal conjunctivitis due to Chlamydia trachomatis. The efficacy of antibiotic containing preparations for prevention of neonatal chlamydial conjunctivitis (NCC) has not been established. Objective To examine published literature to determine whether antibiotic containing preparation are efficacious for prevention of NCC and C. trachomatis in the nasopharynx. Methods A literature search of MEDLINE and EMBASE. Articles were selected for review if their content included 4 key criteria: (1) Prospective/comparative study. (2) Prenatal screening of mothers for C. trachomatis with results reported. (3) Follow-up of infants born to chlamydia-positive women. (4) Infants prospectively followed at regular intervals and tested for C. trachomatis in the eye/ nasopharynx (NP). Results The search yielded 159 studies; 11 were selected for full reviews, eight were excluded; three addressed the four criteria. Rates of C. trachomatis conjunctivitis in infants in included studies who received silver nitrate was 20–33%; positive NP, 1–28% and pneumonia, 3–8%. Rates of C. trachomatis conjunctivitis in neonates who received erythromycin or tetracycline prophylaxis did not differ from silver nitrate; 0–15 and 11%, respectively, who received erythromycin or tetracycline developed NCC. Similarly, 4–33 and 5% of infants who received erythromycin or tetracycline, respectively, had positive NP cultures; 0–4% developed chlamydial pneumonia. Conclusion Neonatal ocular prophylaxis with erythromycin or tetracycline ophthalmic ointments does not reduce incidence of neonatal chlamydial conjunctivitis or respiratory infection in infants born to mothers with C. trachomatis infection compared to silver nitrate.
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Affiliation(s)
- Tamar A Smith-Norowitz
- Department of Pediatrics, State University of New York Downstate Medical Center, 450 Clarkson Ave., Box 49, Brooklyn, NY, 11203, USA.
| | - Crystal Ukaegbu
- Department of Pediatrics, State University of New York Downstate Medical Center, 450 Clarkson Ave., Box 49, Brooklyn, NY, 11203, USA.,School of Public Health, State University of New York Downstate Medical Center, New York, Brooklyn, USA
| | - Stephan Kohlhoff
- Department of Pediatrics, State University of New York Downstate Medical Center, 450 Clarkson Ave., Box 49, Brooklyn, NY, 11203, USA
| | - Margaret R Hammerschlag
- Department of Pediatrics, State University of New York Downstate Medical Center, 450 Clarkson Ave., Box 49, Brooklyn, NY, 11203, USA
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Pilo S, Zizelski Valenci G, Rubinstein M, Pichadze L, Scharf Y, Dveyrin Z, Rorman E, Nissan I. High-resolution multilocus sequence typing for Chlamydia trachomatis: improved results for clinical samples with low amounts of C. trachomatis DNA. BMC Microbiol 2021; 21:28. [PMID: 33461496 PMCID: PMC7814548 DOI: 10.1186/s12866-020-02077-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 12/20/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Several Multilocus Sequence Typing (MLST) schemes have been developed for Chlamydia trachomatis. Bom's MLST scheme for MLST is based on nested PCR amplification and sequencing of five hypervariable genes and ompA. In contrast to other Chlamydia MLST schemes, Bom's MLST scheme gives higher resolution and phylogenetic trees that are comparable to those from whole genome sequencing. However, poor results have been obtained with Bom's MLST scheme in clinical samples with low concentrations of Chlamydia DNA. RESULTS In this work, we present an improved version of the scheme that is based on the same genes and MLST database as Bom's MLST scheme, but with newly designed primers for nested-1 and nested-2 steps under stringent conditions. Furthermore, we introduce a third primer set for the sequencing step, which considerably improves the performance of the assay. The improved primers were tested in-silico using a dataset of 141 Whole Genome Sequences (WGS) and in a comparative analysis of 32 clinical samples. Based on cycle threshold and melting curve analysis values obtained during Real-Time PCR of nested-1 & 2 steps, we developed a simple scoring scheme and flow chart that allow identification of reaction inhibitors as well as to predict with high accuracy amplification success. The improved MLST version was used to obtain a genovars distribution in patients attending an STI clinic in Tel Aviv. CONCLUSIONS The newly developed MLST version showed great improvement of assay results for samples with very low concentrations of Chlamydia DNA. A similar concept could be applicable to other MLST schemes.
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Affiliation(s)
- Shlomo Pilo
- Ministry of Health, National Public Health Laboratory, Tel Aviv, Israel
| | | | - Mor Rubinstein
- Ministry of Health, National Public Health Laboratory, Tel Aviv, Israel
| | - Lea Pichadze
- Ministry of Health, National Public Health Laboratory, Tel Aviv, Israel
| | - Yael Scharf
- Ministry of Health, National Public Health Laboratory, Tel Aviv, Israel
| | - Zeev Dveyrin
- Ministry of Health, National Public Health Laboratory, Tel Aviv, Israel
| | - Efrat Rorman
- Ministry of Health, National Public Health Laboratory, Tel Aviv, Israel
| | - Israel Nissan
- Ministry of Health, National Public Health Laboratory, Tel Aviv, Israel.
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Armstrong-Mensah E, Ebiringa DP, Whitfield K, Coldiron J. Genital Chlamydia Trachomatis Infection: Prevalence, Risk Factors and Adverse Pregnancy and Birth Outcomes in Children and Women in sub-Saharan Africa. Int J MCH AIDS 2021; 10:251-257. [PMID: 34900393 PMCID: PMC8647192 DOI: 10.21106/ijma.523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Genital Chlamydia trachomatis (CT) has adverse health outcomes for women and children. In pregnant women, the infection causes adverse obstetric outcomes including pelvic inflammation, ectopic pregnancy, and miscarriage. In children, it causes adverse birth outcomes such as skin rash, lesions, limb abnormalities, conjunctivitis, neurological damage, and even death. This article discusses genital CT prevalence, risk factors, and adverse pregnancy and birth outcomes among women and children in sub-Saharan Africa as well as challenges associated with the mitigation of the disease. A comprehensive search of databases including PubMed, ResearchGate, and Google Scholar was conducted using keywords such as genital chlamydia trachomatis, adverse pregnancy outcomes, adverse birth outcomes, and sub-Saharan African. We found that genital CT prevalence rates in some sub-Saharan Africa countries were higher than others and that risk factors such as the lack of condom use, having multiple sexual partners, and low educational levels contribute to the transmission of the infection. We also found that negative cultural practices, illiteracy among women, and the lack of access to screening services during pregnancy are some of the challenges associated with CT mitigation in sub-Saharan Africa. To reduce genital CT transmission in sub-Saharan Africa, efforts must be made by country governments to eliminate negative cultural practices, promote female literacy, and provide access to screening services for pregnant women.
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Affiliation(s)
| | | | - Kaleb Whitfield
- Georgia State University, School of Public Health, Atlanta, Georgia 30303, USA
| | - Jake Coldiron
- Georgia State University, School of Public Health, Atlanta, Georgia 30303, USA
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Peters R, Klausner JD, de Vos L, Feucht UD, Medina-Marino A. Aetiological testing compared with syndromic management for sexually transmitted infections in HIV-infected pregnant women in South Africa: a non-randomised prospective cohort study. BJOG 2020; 128:1335-1342. [PMID: 33277768 PMCID: PMC8175473 DOI: 10.1111/1471-0528.16617] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 11/30/2022]
Abstract
Objective To measure the frequencies of sexually transmitted infections (STIs) and adverse pregnancy outcomes among women receiving either aetiological testing or syndromic management for STIs. Design Non‐randomised prospective cohort study. Setting Primary healthcare facilities in Tshwane, South Africa. Population HIV‐infected pregnant women attending antenatal care services. Methods Participants were enrolled to receive aetiological testing using Xpert® CT/NG and Xpert® TV assays or standard syndromic management. Outcome data were collected at the postnatal care visit (≤30 days from delivery) and from maternity records. Enrolment gestational age‐adjusted relative risk (aRR) was calculated. Main outcome measures STI prevalence at postnatal visit, and frequency of adverse pregnancy outcomes (preterm birth, low birthweight). Results We enrolled 841 women. The prevalence of any STI at baseline was 40%; Chlamydia trachomatis 30%, Neisseria gonorrhoeae 5.6%, Trichomonas vaginalis 20%. The prevalence of STIs at postnatal care was lower among those receiving aetiological testing compared with those receiving syndromic management (14% versus 23%; aRR 0.61; 95% CI 0.35–1.05). No difference was observed between study groups for frequency of preterm birth (23% versus 23%; aRR 1.2, 95% CI 0.81–1.8) and low birth weight (15% versus 13%; aRR 1.1, 95% CI 0.66–1.7). Conclusions Aetiological testing provides an effective intervention to reduce the high burden of STIs in pregnant women in South Africa; however, the optimal implementation strategy remains to be determined. Tweetable abstract Aetiological testing effectively reduces the burden of sexually transmitted infections in pregnancy. Aetiological testing effectively reduces the burden of sexually transmitted infections in pregnancy.
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Affiliation(s)
- Rph Peters
- Research Unit, Foundation for Professional Development, East London, South Africa.,Department of Medical Microbiology, CAPRHI School of Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J D Klausner
- Division of Infectious Diseases: Global Health, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - L de Vos
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - U D Feucht
- Department of Paediatrics, Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa.,Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - A Medina-Marino
- Research Unit, Foundation for Professional Development, East London, South Africa.,Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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Zango SH, Lingani M, Valea I, Samadoulougou OS, Bihoun B, Rouamba T, Derra K, Rouamba E, Donnen P, Dramaix M, Tinto H, Robert A. Malaria and curable sexually transmitted infections in pregnant women: A two-years observational study in rural Burkina Faso. PLoS One 2020; 15:e0242368. [PMID: 33196665 PMCID: PMC7668607 DOI: 10.1371/journal.pone.0242368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/30/2020] [Indexed: 01/26/2023] Open
Abstract
Background Malaria and curable sexually transmitted infections (STI) are the most common curable infections known to have a severe impact on pregnancy outcomes in sub-Saharan Africa. This study aims to assess the marginal and joint prevalence of symptomatic cases of malaria and STI in pregnant women living in rural settings of Burkina Faso and their associated factors, after more than a decade of the introduction of intermittent preventive treatment (IPT-SP). Methods We carried out an observational study in two health districts in rural Burkina, namely Nanoro and Yako. Routine data were collected during antenatal and delivery visits for all women who delivered in the year 2016 and 2017. Logistic regression models were used to assess factors associated with infections. Results We collected data from 31639 pregnant women attending health facilities. Malaria, curable STI and their coinfections were diagnosed in 7747 (24.5%; 95%CI: 24.0–25.0%), 1269 (4.0%; 95%CI: 3.8–4.2%) and 388 (1.2%; 95%CI: 1.1–1.4%) women, respectively. In multivariate logistic regression, malaria occurrence was significantly higher in pregnant women < 20 years (Adjusted OR = 2.36; 95% CI: 2.07–2.69) than in women ≥30 years. The prevalence of curable STI was also significantly higher in students (Adjusted OR = 1.93; 95% CI: 1.26–2.95) and compensated workers (Adjusted OR = 1.52; 95% CI: 1.01–2.17) than in uncompensated workers. Women who received no IPT-SP had higher prevalence of malaria (Adjusted OR = 3.33; 95%CI: 3.00–3.70), curable STI (Adjusted OR = 1.96 95%CI: 1.60–2.39) and coinfections (Adjusted OR = 2.11; 95% CI: 1.50–2.95) compared to women who received SP. Conclusion Malaria and curable STI remain highly prevalent in rural settings of Burkina Faso, with young pregnant women and women who received no IPT-SP being the most affected. Prevention must be reinforced to improve maternal and infant health.
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Affiliation(s)
- Serge Henri Zango
- Pôle d’Epidémiologie et biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCLouvain), Brussels, Belgique
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre Ouest (IRSS/DRCO), Bobo-Dioulasso, Burkina Faso
- Centre MURAZ, Institut National de Santé Publique (INSP), Bobo-Dioulasso, Burkina Faso
- * E-mail: ,
| | - Moussa Lingani
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre Ouest (IRSS/DRCO), Bobo-Dioulasso, Burkina Faso
- École de santé publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Innocent Valea
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre Ouest (IRSS/DRCO), Bobo-Dioulasso, Burkina Faso
- Centre MURAZ, Institut National de Santé Publique (INSP), Bobo-Dioulasso, Burkina Faso
| | - Ouindpanga Sékou Samadoulougou
- Pôle d’Epidémiologie et biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCLouvain), Brussels, Belgique
| | - Biebo Bihoun
- Pôle d’Epidémiologie et biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCLouvain), Brussels, Belgique
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre Ouest (IRSS/DRCO), Bobo-Dioulasso, Burkina Faso
| | - Toussaint Rouamba
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre Ouest (IRSS/DRCO), Bobo-Dioulasso, Burkina Faso
- École de santé publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Karim Derra
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre Ouest (IRSS/DRCO), Bobo-Dioulasso, Burkina Faso
| | - Eli Rouamba
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre Ouest (IRSS/DRCO), Bobo-Dioulasso, Burkina Faso
| | - Phillipe Donnen
- École de santé publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Michele Dramaix
- École de santé publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre Ouest (IRSS/DRCO), Bobo-Dioulasso, Burkina Faso
- Centre MURAZ, Institut National de Santé Publique (INSP), Bobo-Dioulasso, Burkina Faso
| | - Annie Robert
- Pôle d’Epidémiologie et biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCLouvain), Brussels, Belgique
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Chen X, Gan Y, Chang D, Mi X, Liu D. Availability of Chlamydia trachomatis Testing and Its Importance in the Surveillance of Genital Chlamydial Infection. Jpn J Infect Dis 2020; 74:209-213. [PMID: 33132299 DOI: 10.7883/yoken.jjid.2020.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The reported prevalence of genital Chlamydia trachomatis infection (GCTI) is much lower in low-income countries than that in high-income countries. This study surveyed the prevalence of GCTI in 456 hospitals in Shandong province, China in December 2018. Among the hospitals surveyed, antigen testing, PCR testing, and either antigen or PCR testing were available in 200 (43.9%), 88 (19.3%), and 268 (58.8%) hospitals, respectively. PCR testing was more available in tertiary hospitals than in primary and secondary hospitals (χ2 = 28.560, P = 0.000). Significant differences were observed in the availability of antigen testing (χ2 = 15.708, P = 0.003), PCR testing (χ2 = 22.494, P = 0.000), and either antigen or PCR testing (χ2 = 21.729, P = 0.000) among different types of hospitals. In 2018, 1532 cases of GCTI were reported in 99 hospitals. Tertiary hospitals reported more cases than those in primary and secondary hospitals (χ2 = 24.082, P = 0.000). The distribution of different types of hospitals that reported GCTI cases was consistent with that of hospitals that provided laboratory testing for GCTI. Antigen and PCR testing were only available in 200 (43.9%) and 88 (19.3%) hospitals, respectively. The results highlighted that the availability of laboratory testing for GCTI in Shandong province was poor, suggesting that the prevalence of GCTI in the province had been sorely underestimated.
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Affiliation(s)
- Xinlong Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, China.,Shandong Provincial Hospital for Skin Diseases and Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University and Shandong Academy of Medical Sciences, China
| | - Yanling Gan
- Shandong Provincial Hospital for Skin Diseases and Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University and Shandong Academy of Medical Sciences, China
| | - Degui Chang
- Hospital of Chengdu University of Traditional Chinese Medicine, China
| | - Xiongfei Mi
- Hospital of Chengdu University of Traditional Chinese Medicine, China
| | - Dianchang Liu
- Shandong Provincial Hospital for Skin Diseases and Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University and Shandong Academy of Medical Sciences, China
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Sexually transmitted infections in pregnancy - An update on Chlamydia trachomatis and Neisseria gonorrhoeae. Eur J Obstet Gynecol Reprod Biol 2020; 255:1-12. [PMID: 33059307 DOI: 10.1016/j.ejogrb.2020.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022]
Abstract
Routine screening for Chlamydia and gonococcal infection in pregnancy is not widespread, especially in low- and middle-income countries (LMICs), despite their potential adverse consequences on pregnancy outcome. We conducted a systematic literature search of three major databases to review current literature surrounding Chlamydia trachomatis and Neisseria gonorrhoeae infections in pregnancy. We discuss the epidemiology and burden of both infections, detection methods, potential adverse feto-maternal and infant outcomes and provide an overview of treatment options. A total of 67 articles met the inclusion criteria. The prevalence of C. trachomatis and N. gonorrhoeae across all trimesters ranged between 1.0%-36.8% and 0-14.2% worldwide, respectively. The most common diagnostic method is the Nucleic acid amplification test (NAAT). In pregnancy, chlamydia is associated with preterm birth, spontaneous miscarriage, stillbirth and neonatal conjunctivitis, while gonorrhoea is mainly associated with preterm birth and stillbirth. Amoxicillin, erythromycin and azithromycin showed similar efficacy in the treatment of chlamydia in pregnancy, while ceftriaxone and cefixime were effective in treating gonorrhoea in pregnancy. Being largely asymptomatic infections in women, we opine that detection strategies with locally appropriate tools should be combined with the syndromic approach in LMICs, where there is a high burden of disease.
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Abstract
BACKGROUND Ophthalmia neonatorum is an infection of the eyes in newborns that can lead to blindness, particularly if the infection is caused by Neisseria gonorrhoeae. Antiseptic or antibiotic medication is dispensed into the eyes of newborns, or dispensed systemically, soon after delivery to prevent neonatal conjunctivitis and potential vision impairment. OBJECTIVES 1. To determine if any type of systemic or topical eye medication is better than placebo or no prophylaxis in preventing ophthalmia neonatorum. 2. To determine if any one systemic or topical eye medication is better than any other medication in preventing ophthalmia neonatorum. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, LILACS, and three trials registers, date of last search 4 October 2019. We also searched references of included studies and contacted pharmaceutical companies. SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials of any topical, systemic, or combination medical interventions used to prevent ophthalmia neonatorum in newborns compared with placebo, no prophylaxis, or with each other. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane. Outcomes were: blindness or any adverse visual outcome at 12 months, conjunctivitis at 1 month (gonococcal (GC), chlamydial (CC), bacterial (BC), any aetiology (ACAE), or unknown aetiology (CUE)), and adverse effects. MAIN RESULTS: We included 30 trials with a total of 79,198 neonates. Eighteen studies were conducted in high-income settings (the USA, Europe, Israel, Canada), and 12 were conducted in low- and middle-income settings (Africa, Iran, China, Indonesia, Mexico). Fifteen of the 30 studies were quasi-randomised. We judged every study to be at high risk of bias in at least one domain. Ten studies included a comparison arm with no prophylaxis. There were 14 different prophylactic regimens and 12 different medications in the 30 included studies. Any prophylaxis compared to no prophylaxis Unless otherwise indicated, the following evidence comes from studies assessing one or more of the following interventions: tetracycline 1%, erythromycin 0.5%, povidone-iodine 2.5%, silver nitrate 1%. None of the studies reported data on the primary outcomes: blindness or any adverse visual outcome at any time point. There was only very low-certainty evidence on the risk of GC with prophylaxis (4/5340 newborns) compared to no prophylaxis (5/2889) at one month (risk ratio (RR) 0.79, 95% confidence interval (CI) 0.24 to 2.65, 3 studies). Low-certainty evidence suggested there may be little or no difference in effect on CC (RR 0.96, 95% CI 0.57 to 1.61, 4874 newborns, 2 studies) and BC (RR 0.84, 95% CI 0.37 to 1.93, 3685 newborns, 2 studies). Moderate-certainty evidence suggested a probable reduction in risk of ACAE at one month (RR 0.65, 95% 0.54 to 0.78, 9666 newborns, 8 studies assessing tetracycline 1%, erythromycin 0.5%, povidone-iodine 2.5%, silver nitrate 1%, colostrum, bacitracin-phenacaine ointment). There was only very low-certainty evidence on CUE (RR 1.75, 95% CI 0.37 to 8.28, 330 newborns, 1 study). Very low-certainty evidence on adverse effects suggested no increased nasolacrimal duct obstruction (RR 0.93, 95% CI 0.68 to 1.28, 404 newborns, 1 study of erythromycin 0.5% and silver nitrate 1%) and no increased keratitis (single study of 40 newborns assessing silver nitrate 1% with no events). Any prophylaxis compared to another prophylaxis Overall, evidence comparing different interventions did not suggest any consistently superior intervention. However, most of this evidence was of low-certainty and was extremely limited. AUTHORS' CONCLUSIONS There are no data on whether prophylaxis for ophthalmia neonatorum prevents serious outcomes such as blindness or any adverse visual outcome. Moderate-certainty evidence suggests that the use of prophylaxis may lead to a reduction in the incidence of ACAE in newborns but the evidence for effect on GC, CC or BC was less certain. Comparison of individual interventions did not suggest any consistently superior intervention, but data were limited. A trial comparing tetracycline, povidone-iodine (single administration), and chloramphenicol for GC and CC could potentially provide the community with an effective, universally applicable prophylaxis against ophthalmia neonatorum.
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Affiliation(s)
| | - Jennifer R Evans
- Cochrane Eyes and Vision, ICEH, London School of Hygiene & Tropical Medicine, London, UK
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Kassa ZY, Hussen S, Hadra N, Moges Y, Bonja F. Prevalence of Neisseria gonorrhoeae infection among women of reproductive age in sub-Saharan Africa: a systematic review and meta-analysis. EUR J CONTRACEP REPR 2020; 25:365-371. [PMID: 32845194 DOI: 10.1080/13625187.2020.1779688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Neisseria gonorrhoeae infection is a global, major public health problem. It is the second leading bacterial sexually transmitted infection (STI) in sub-Saharan Africa and worldwide. As study findings on the topic are inconsistent, we conducted a systematic review and meta-analysis to determine the pooled prevalence of N. gonorrhoeae infection in sub-Saharan Africa among reproductive-aged women. METHODS Published studies were systematically retrieved from PubMed, Embase, CINHAL and Science Direct. Their quality was measured using the Joanna Briggs Institute critical appraisal checklist for studies reporting prevalence data, and the score of each included study had to meet at least 4.5 out of 9 indicators of quality. RESULTS The meta-analysis of 35 studies showed that the pooled prevalence of N. gonorrhoeae infection among reproductive-aged women in sub-Saharan Africa was 3.28% (95% confidence interval 2.61%, 3.94%). CONCLUSION The prevalence of N. gonorrhoeae infection was higher than that found in other studies carried out in the region. The results suggest that greater attention should be paid to the primary prevention of N. gonorrhoeae. We recommend the implementation of STI education for reproductive-aged women and the use of specific and rapid diagnostic testing for N. gonorrhoeae infection in STI clinics. N. gonorrhoeae screening and treatment should be integrated into in- and outpatient clinics to reduce infection among reproductive-aged women.
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Affiliation(s)
- Zemenu Yohannes Kassa
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Siraj Hussen
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Nebiha Hadra
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Yohannes Moges
- Department of Midwifery, Institute of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Fisseha Bonja
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Hailu K, Gebretsadik A. Determinants of gonorrhea and syphilis infections among pregnant women attending antenatal clinic at Dilla University Referral Hospital, Ethiopia: Unmatched case-control study. ACTA ACUST UNITED AC 2020; 16:1745506520940095. [PMID: 32628574 PMCID: PMC7338641 DOI: 10.1177/1745506520940095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: This study was designed to determine the risk factors associated with
gonorrhea and syphilis infections among pregnant women attending antenatal
care clinic at Dilla University Referral Hospital. Method: A hospital-based unmatched case-control study (64 cases and 128 controls)
with 1:2 ratios was conducted from 29 January 2018 to 20 June 2018, at the
antenatal care clinic of the Dilla University Referral Hospital. Venous
blood and vaginal swab were collected to screen for gonorrhea and syphilis.
A pretested interviewer-administered questionnaire was used to gather data
on sociodemographic and predisposing factors. Logistic regression analysis
used to identify risk factors for sexually transmitted infections among
pregnant women at 95% confidence interval and
p-value < 0.05. Result: A total of 64 cases of syphilis or gonorrhea were identified with a mean age
of 26 years (±4.1 years.). Of those cases, 40 were syphilis seropositive and
the remaining were gonorrhea cases. Lower educational status (adjusted odds
ratio = 2.4, 95% confidence interval: 1.1–4.9), age of first sex
<18 years (adjusted odds ratio = 2.8, 95% confidence interval: 1.3–5.9),
history of abortion (adjusted odds ratio = 3.1, 95% confidence interval:
1.4–6.6), and having two or more sexual partners in the past year (adjusted
odds ratio = 2.5, 95% confidence interval: 1.1–5.7) were significantly
associated with gonorrhea and syphilis infection. Conclusion: Demographic, behavioral, and obstetric factors are associated with the
occurrence of syphilis or gonorrhea among pregnant women. Strengthening the
existing antenatal care services, providing health education on risk
factors, and prioritizing women with the risk characteristics and initiation
of gonorrhea and syphilis screening during antennal care are mandatory.
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Tang W, Mao J, Li KT, Walker JS, Chou R, Fu R, Chen W, Darville T, Klausner J, Tucker JD. Pregnancy and fertility-related adverse outcomes associated with Chlamydia trachomatis infection: a global systematic review and meta-analysis. Sex Transm Infect 2020; 96:322-329. [PMID: 31836678 PMCID: PMC7292777 DOI: 10.1136/sextrans-2019-053999] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 11/11/2019] [Accepted: 11/25/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Genital chlamydia infection in women is often asymptomatic, but may result in adverse outcomes before and during pregnancy. The purpose of this study was to examine the strength of the relationships between chlamydia infection and different reproductive health outcomes and to assess the certainty of the evidence. METHODS This review was registered and followed the Cochrane guidelines. We searched three databases to quantitatively examine adverse outcomes associated with chlamydia infection. We included pregnancy and fertility-related outcomes. We performed meta-analyses on different study designs for various adverse outcomes using unadjusted and adjusted analyses. RESULTS We identified 4730 unique citations and included 107 studies reporting 12 pregnancy and fertility-related outcomes. Sixty-eight studies were conducted in high-income countries, 37 studies were conducted in low-income or middle-income countries, and 2 studies were conducted in both high-income and low-income countries. Chlamydia infection was positively associated with almost all of the 12 included pregnancy and fertility-related adverse outcomes in unadjusted analyses, including stillbirth (OR=5.05, 95% CI 2.95 to 8.65 for case-control studies and risk ratio=1.28, 95% CI 1.09 to 1.51 for cohort studies) and spontaneous abortion (OR=1.30, 95% CI 1.14 to 1.49 for case-control studies and risk ratio=1.47, 95% CI 1.16 to 1.85 for cohort studies). However, there were biases in the design and conduct of individual studies, affecting the certainty of the overall body of evidence. The risk of adverse outcomes associated with chlamydia is higher in low-income and middle-income countries compared with high-income countries. CONCLUSION Chlamydia is associated with an increased risk of several pregnancy and fertility-related adverse outcomes in unadjusted analyses, especially in low-income and middle-income countries. Further research on how to prevent the sequelae of chlamydia in pregnant women is needed. TRIAL REGISTRATION NUMBER CRD42017056818.
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Affiliation(s)
- Weiming Tang
- Project-China, University of North Carolina, Guangzhou, China
- STI Control, Guangdong Provincial Center for Skin Diseases and STIs control, Guangzhou, Guangdong, China
| | - Jessica Mao
- Depatment of Obstetrics and Gynecology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Katherine T Li
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jennifer S Walker
- Health Sciences Library, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Roger Chou
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Rong Fu
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Weiying Chen
- Social Entrepreneurship to Spur Health, Guangzhou, Guangdong, China
- Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Toni Darville
- Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jeffrey Klausner
- Medicine, University of California, Los Angeles, San Francisco, California, USA
| | - Joseph D Tucker
- UNC Project-China, Guangzhou, Guangdong, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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The Prevalence of Chlamydia trachomatis and Three Other Non-Viral Sexually Transmitted Infections among Pregnant Women in Pemba Island Tanzania. Pathogens 2020; 9:pathogens9080625. [PMID: 32751883 PMCID: PMC7459925 DOI: 10.3390/pathogens9080625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 11/20/2022] Open
Abstract
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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He W, Jin Y, Zhu H, Zheng Y, Qian J. Effect of Chlamydia trachomatis on adverse pregnancy outcomes: a meta-analysis. Arch Gynecol Obstet 2020; 302:553-567. [PMID: 32643040 DOI: 10.1007/s00404-020-05664-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/18/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To analyze the effect of Chlamydia trachomatis (C. trachomatis) on adverse pregnancy outcomes based on the currently available evidence. METHODS Multiple databases were comprehensively searched from the available date of inception through December 9, 2019. The effect of C. trachomatis on adverse pregnancy outcomes was assessed using pooled odds rations (ORs) and 95% confidence intervals (CIs). Egger's test was used for publication bias. RESULTS Fifty studies involving 502,141 participants were identified. C. trachomatis infection was found to be associated with preterm birth in antibody detection [OR (95% CI): 1.571 (1.112-2.220), P = 0.010] and high-quality assessment [OR (95% CI): 1.734 (1.295-2.321), P < 0.001], preterm premature rupture of membranes (PPROM) in culture detection [OR (95% CI): 4.339 (1.806-10.424), P = 0.001] and high-quality assessment [OR (95% CI): 2.822 (1.333-5.973), P = 0.007], stillbirth [OR (95% CI): 1.585 (1.219-2.062), P = 0.001], low-birthweight babies [OR (95% CI): 2.205 (1.137-4.274), P = 0.019], and babies small for gestational age [OR (95% CI): 1.193 (1.091-1.305), P < 0.001]. No publication bias was exhibited in miscarriage (P = 0.170), preterm birth (P = 0.303), PPROM (P = 0.341), stillbirth (P = 0.533), and low-birthweight babies (P = 0.535). CONCLUSIONS C. trachomatis infection during pregnancy is associated with a higher risk of preterm birth, PPROM, stillbirth, low-birthweight babies, and babies small for gestational age.
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MESH Headings
- Abortion, Spontaneous
- Chlamydia Infections/diagnosis
- Chlamydia Infections/epidemiology
- Chlamydia Infections/microbiology
- Chlamydia trachomatis/isolation & purification
- Female
- Fetal Membranes, Premature Rupture/epidemiology
- Fetal Membranes, Premature Rupture/microbiology
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Small for Gestational Age
- Obstetric Labor, Premature/epidemiology
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/microbiology
- Pregnancy Outcome/epidemiology
- Premature Birth/epidemiology
- Stillbirth
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Affiliation(s)
- Weihua He
- Department of Gynecology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Yue Jin
- Department of Gynecology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Haibin Zhu
- Department of Gynecology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Yan Zheng
- Department of Gynecology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Jianhua Qian
- Department of Gynecology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, People's Republic of China.
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Hanna J, Yassine R, El-Bikai R, Curran MD, Azar M, Yeretzian J, Skaf R, Afif C, Saber T, Itani S, Hubeish M, El Jisr T, Hamzeh F, El Chaar M. Molecular epidemiology and socio-demographic risk factors of sexually transmitted infections among women in Lebanon. BMC Infect Dis 2020; 20:375. [PMID: 32460721 PMCID: PMC7251815 DOI: 10.1186/s12879-020-05066-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) cause a major public health problem that affect both men and women in developing and developed countries. The aim of the study was to estimate the prevalence of 11 STIs among women who voluntarily participated in the study, while seeking gynecological checkup. The existence of an association between the presence of pathogens and symptoms and various sociodemographic risk factors was assessed. METHODS A total of 505 vaginal and cervical specimens were collected from women above 18 years of age, with or without symptoms related to gynecological infections. Nucleic acid was extracted and samples were tested by real-time PCR for the following pathogens: Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Ureaplasma urealyticum, Urealplasma parvum, Trichomonas vaginalis, Mycoplasma hominis, Mycoplasma girerdii, Gardnerella vaginalis, Candida albicans and Human Papillomavirus (HPV). Positive HPV samples underwent genotyping using a microarray system. RESULTS Of the 505 samples, 312 (62%) were screened positive for at least one pathogen. Of these, 36% were positive for Gardnerella vaginalis, 35% for Ureaplasma parvum, 8% for Candida albicans, 6.7% for HPV, 4.6% for Ureaplasma urealyticum, 3.6% for Mycoplasma hominis, 2% for Trichomonas vaginalis, 0.8% for Chlamydia trachomatis, 0.4% for Mycoplasma girerdii, 0.2% for Mycoplasma genitalium and 0.2% for Neisseria gonorrhoeae. Lack of symptoms was reported in 187 women (37%), among whom 61% were infected. Thirty-four samples were HPV positive, with 17 high risk HPV genotypes (HR-HPV); the highest rates being recorded for types 16 (38%), 18 (21%) and 51 (18%). Out of the 34 HPV positives, 29 participants had HR-HPV. Association with various risk factors were reported. CONCLUSIONS This is the first study that presents data about the presence of STIs among women in Lebanon and the MENA region by simultaneous detection of 11 pathogens. In the absence of systematic STI surveillance in Lebanon, concurrent screening for HPV and PAP smear is warranted.
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Affiliation(s)
- Jessica Hanna
- Faculty of Health Sciences, University of Balamand, P.O.Box 166378 Ashrafieh, Beirut, 1100-2807, Lebanon
| | - Ruba Yassine
- Faculty of Health Sciences, University of Balamand, P.O.Box 166378 Ashrafieh, Beirut, 1100-2807, Lebanon
| | - Rana El-Bikai
- Faculty of Health Sciences, University of Balamand, P.O.Box 166378 Ashrafieh, Beirut, 1100-2807, Lebanon
| | - Martin D Curran
- Public Health England Clinical Microbiology Laboratory, Addenbrooke's Hospital, Cambridge, UK
| | - Mathilde Azar
- Faculty of Health Sciences, University of Balamand, P.O.Box 166378 Ashrafieh, Beirut, 1100-2807, Lebanon
| | - Joumana Yeretzian
- Faculty of Health Sciences, University of Balamand, P.O.Box 166378 Ashrafieh, Beirut, 1100-2807, Lebanon
| | - Rana Skaf
- Faculty of Medicine, University of Balamand, Beirut, Lebanon
- Department of Obstetrics and Gynecology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Claude Afif
- Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Toufic Saber
- Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | | | | | | | - Fadia Hamzeh
- National Institution of Social Care and Vocational Training, Beirut, Lebanon
| | - Mira El Chaar
- Faculty of Health Sciences, University of Balamand, P.O.Box 166378 Ashrafieh, Beirut, 1100-2807, Lebanon.
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Medina-Marino A, Glockner K, Grew E, De Vos L, Olivier D, Klausner J, Daniels J. The role of trust and health literacy in nurse-delivered point-of-care STI testing for pregnant women living with HIV, Tshwane District, South Africa. BMC Public Health 2020; 20:577. [PMID: 32345293 PMCID: PMC7189538 DOI: 10.1186/s12889-020-08689-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/13/2020] [Indexed: 01/28/2023] Open
Abstract
Background Sexually transmitted infections (STIs) during pregnancy result in neonatal morbidity and mortality, and may increase mother-to-child-transmission of HIV. Yet the World Health Organization’s current syndromic management guidelines for STIs leaves most pregnant women undiagnosed and untreated. Point-of-care (POC) diagnostic tests for STIs can drastically improve detection and treatment. Though acceptable and feasible, poor medication adherence and re-infection due to lack of partner treatment threaten the programmatic effectiveness of POC diagnostic programmes. Methods To engender patient-provider trust, and improve medication adherence and disclosure of STI status to sexual partners, we trained study nurses in compassionate care, good clinical practices and motivational interviewing. Using qualitative methods, we explored the role patient-provider communications may play in supporting treatment adherence and STI disclosure to sexual partners. Nurses were provided training in motivational interviewing, compassionate care and good clinical practices. Participants were interviewed using a semi-structured protocol, with domains including STI testing experience, patient-provider communication, and HIV and STI disclosure. Interviews were audio-recorded, transcribed and analyzed using a constant comparison approach. Results Twenty-eight participants treated for Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), and/or Neisseria gonorrhea (NG) were interviewed. Participants described strong communications and trusting relationships with nurses trained in patient-centered care training and implementing POC STI diagnostic testing. However, women described a delayed trust in treatment until their symptoms resolved. Women expressed a limited recall of their exact diagnosis, which impacted their ability to fully disclose their STI status to sexual partners. Conclusions We recommend implementing patient health literacy programmes as part of POC services to support women in remembering and disclosing their specific STI diagnosis to sexual partners, which may facilitate partner treatment uptake and thus decrease the risk of re-infection.
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Affiliation(s)
- Andrew Medina-Marino
- Fundation for Professional Development, 10 Rochester Road, East London, 5217, South Africa. .,The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
| | - Katherine Glockner
- Fundation for Professional Development, 10 Rochester Road, East London, 5217, South Africa.,Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Emily Grew
- Northeastern University, Boston, MA, USA
| | - Lindsey De Vos
- Fundation for Professional Development, 10 Rochester Road, East London, 5217, South Africa
| | - Dawie Olivier
- Fundation for Professional Development, 10 Rochester Road, East London, 5217, South Africa
| | - Jeffrey Klausner
- David Geffen School of Medicine and Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Joseph Daniels
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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Saweri OP, Batura N, Adawiyah RA, Causer L, Pomat W, Vallely A, Wiseman V. Cost and cost-effectiveness of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low-income and middle-income countries: a systematic review protocol. BMJ Open 2019; 9:e029945. [PMID: 31727649 PMCID: PMC6887066 DOI: 10.1136/bmjopen-2019-029945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The economic and health burden of sexually transmitted and genital infections (henceforth, STIs) in low-income and middle-income countries (LMICs) is substantial. Left untreated, STIs during pregnancy may result in several adverse pregnancy and birth outcomes. Timely diagnosis and treatment at point-of-care (POC) can potentially improve these outcomes. Despite the availability and promotion of POC diagnostics for STIs as a key component of antenatal care in LMICs, their widespread use has been limited, owing to the high economic costs faced by individuals and health systems. To date, there have been no systematic reviews which explore the cost or cost-effectiveness of POC testing and treatment of STIs in pregnancy in LMICs. The objective of this protocol is to outline the methods that will compare, synthesise and appraise the existing literature in this domain. METHODS AND ANALYSIS We will conduct literature searches in MEDLINE, Embase and Web of Science. To find additional literature, we will search Google Scholar and hand search reference lists of included papers. Two reviewers will independently search databases, screen titles, abstracts and full texts; when necessary a third reviewer will resolve disputes. Only cost and cost-effectiveness studies of POC testing and treatment of STIs, including syphilis, chlamydia, trichomonas, gonorrhoea and bacterial vaginosis, in pregnancy in LMICs will be included. Published checklists will be used to assess quality of reporting practices and methodological approaches. We will also assess risk of publication bias. Interstudy heterogeneity will be assessed and depending on variation between studies, a meta-analysis or narrative synthesis will be conducted. ETHICS AND DISSEMINATION Ethical approval is not required as the review will use published literature. The results will be published in a peer-reviewed open source journal and presented at an international conference. PROSPERO REGISTRATION NUMBER CRD42018109072.
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Affiliation(s)
- Olga Pm Saweri
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Population Health and Demography, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Neha Batura
- Institute for Global Health, University College London, London, UK
| | - Rabiah Al Adawiyah
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Louise Causer
- Sexual Health Program, Kirby Insitute, Sydney, New South Wales, Australia
| | - Willie Pomat
- Infection and Immunity, PNG Institute of Medical Research, Goroka, Papua New Guinea
| | - Andrew Vallely
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Virginia Wiseman
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Health Ecoomics, LSHTM, London, UK
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50
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Fabra Garrido C, Dorado Criado M, González Arboleya C, Calvo Rey C. [Is the vertical transmission of Chlamydia trachomatis a problem in Spain?]. An Pediatr (Barc) 2019; 92:119. [PMID: 31678035 DOI: 10.1016/j.anpedi.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022] Open
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