Charlotte van der Veer, Chifundo Kondoni, Annie Kuyere, Fatima Mtonga, Vita Nyasulu, George Shaba, Chelsea Morroni, Gladys Gadama, Luis Gadama, Kondwani Kawaza, Queen Dube, Neil French, David Lissauer, Bridget Freyne
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Following recruitment of an infant with an ABO, the next born healthy infant was recruited as a control. Multiplex PCR for <i>Neisseria gonorrhoeae</i> (NG), <i>Chlamydia trachomatis</i> (CT) and <i>Trichomonas vaginalis</i> (TV) was performed on maternal vaginal swabs. HIV and syphilis status was determined on maternal and infant serum. For syphilis, we used combined treponemal/non-treponemal rapid point-of-care tests in parallel with rapid plasma reagin tests, PCR for <i>Treponema pallidum</i> and clinical parameters to diagnose and stage the infection. We compared STI positivity between cases and controls.</p><p><strong>Results: </strong>We included 259 cases and 251 controls. Maternal prevalence of STI was 3.1%, 2.7% and 17.1% for NG, CT and TV, respectively. Maternal prevalence of untreated syphilis was 2.0% and 6.1% for early stage and late/unknown stage, respectively; prevalence of treated syphilis was 2.7%. The HIV prevalence was 16.5%. HIV infection significantly increased the odds for ABO (OR=3.31; 95% CI 1.10 to 9.91) as did NG positivity (OR=4.30; 95% CI 1.16 to 15.99). We observed higher rates of ABO among women with untreated maternal syphilis (early: OR=7.13; 95% CI 0.87 to 58.39, late/unknown stage: OR=1.43; 95% CI 0.65 to 3.15). Maternal TV and CT infections were not associated with ABO.</p><p><strong>Conclusion: </strong>STI prevalence among pregnant women in Malawi is comparable to other SSA countries. 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引用次数: 0
摘要
背景：在撒哈拉以南非洲地区（SSA），有关性传播感染（STI）的流行病学及其对不良生育后果（ABO）的影响的数据十分有限。我们进行了一项病例对照研究，以评估马拉维布兰太尔伊丽莎白女王中心医院就诊妇女的性传播感染流行率及其与 ABO 的关系：ABO病例的综合定义包括死胎、早产儿、低出生体重儿以及出生后24小时内入住新生儿重症监护室的婴儿。在招募到一名 ABO 婴儿后，再招募下一名出生时健康的婴儿作为对照。对母体阴道拭子进行淋病奈瑟菌（NG）、沙眼衣原体（CT）和阴道毛滴虫（TV）多重 PCR 检测。对母婴血清进行艾滋病毒和梅毒检测。对于梅毒，我们在使用快速血浆试剂检测、苍白螺旋体聚合酶链反应（PCR）和临床参数的同时，还使用了三联/非三联快速床旁检测法来诊断和分期梅毒感染。我们对病例和对照组之间的性传播感染阳性率进行了比较：我们纳入了 259 例病例和 251 例对照。在 NG、CT 和 TV 中，孕产妇的性传播感染率分别为 3.1%、2.7% 和 17.1%。孕产妇未经治疗的梅毒患病率（早期和晚期/未知期）分别为 2.0% 和 6.1%；经治疗的梅毒患病率为 2.7%。艾滋病毒感染率为 16.5%。艾滋病病毒感染与 NG 阳性（OR=4.30；95% CI 1.16 至 15.99）一样，都会明显增加 ABO 感染的几率（OR=3.31；95% CI 1.10 至 9.91）。我们观察到，孕产妇梅毒未经治疗的妇女中 ABO 阳性率较高（早期：OR=7.13；95% CI=1.16-15.99）：早期：OR=7.13；95% CI 0.87 至 58.39，晚期/阶段不明：OR=1.43；95% CI 0.65 至 3.15）。孕妇的 TV 和 CT 感染与 ABO 无关：马拉维孕妇的性传播感染率与其他撒南非洲国家相当。与有健康婴儿的妇女相比，有ABO血型的妇女中艾滋病毒、NG和未经治疗的梅毒感染率较高。
Prevalence of sexually transmitted infection in pregnancy and their association with adverse birth outcomes: a case-control study at Queen Elizabeth Central Hospital, Blantyre, Malawi.
Background: There are limited data on the epidemiology of sexually transmitted infections (STI) and their contribution to adverse birth outcomes (ABO) in sub-Saharan Africa (SSA). We performed a case-control study to assess the prevalence of STI and their association with ABO among women attending Queen Elizabeth Central Hospital, Blantyre, Malawi.
Methods: A composite case definition for ABO included stillborn, preterm and low birthweight infants and infants admitted to neonatal intensive care unit within 24 hours of birth. Following recruitment of an infant with an ABO, the next born healthy infant was recruited as a control. Multiplex PCR for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and Trichomonas vaginalis (TV) was performed on maternal vaginal swabs. HIV and syphilis status was determined on maternal and infant serum. For syphilis, we used combined treponemal/non-treponemal rapid point-of-care tests in parallel with rapid plasma reagin tests, PCR for Treponema pallidum and clinical parameters to diagnose and stage the infection. We compared STI positivity between cases and controls.
Results: We included 259 cases and 251 controls. Maternal prevalence of STI was 3.1%, 2.7% and 17.1% for NG, CT and TV, respectively. Maternal prevalence of untreated syphilis was 2.0% and 6.1% for early stage and late/unknown stage, respectively; prevalence of treated syphilis was 2.7%. The HIV prevalence was 16.5%. HIV infection significantly increased the odds for ABO (OR=3.31; 95% CI 1.10 to 9.91) as did NG positivity (OR=4.30; 95% CI 1.16 to 15.99). We observed higher rates of ABO among women with untreated maternal syphilis (early: OR=7.13; 95% CI 0.87 to 58.39, late/unknown stage: OR=1.43; 95% CI 0.65 to 3.15). Maternal TV and CT infections were not associated with ABO.
Conclusion: STI prevalence among pregnant women in Malawi is comparable to other SSA countries. HIV, NG and untreated syphilis prevalence was higher among women with ABO compared with women with healthy infants.
期刊介绍：
Sexually Transmitted Infections is the world’s longest running international journal on sexual health. It aims to keep practitioners, trainees and researchers up to date in the prevention, diagnosis and treatment of all STIs and HIV. The journal publishes original research, descriptive epidemiology, evidence-based reviews and comment on the clinical, public health, sociological and laboratory aspects of sexual health from around the world. We also publish educational articles, letters and other material of interest to readers, along with podcasts and other online material. STI provides a high quality editorial service from submission to publication.
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