Systematic Screening of Lower Genital Tract Infections

May 17, 2026 updated by: Rita de Cássia Fossati Silveira Evaldt, Universidade Federal do Pampa

Systematic Screening of Lower Genital Tract Infections in Low-Risk Pregnant Women for Gestational and Neonatal Outcomes: a Randomized Controlled Trial

Introduction: The investigation of systematic screening for asymptomatic genital infections in low-risk pregnant women is justified by the relevance of these conditions in determining adverse neonatal outcomes, such as prematurity, low birth weight, and perinatal morbidity and mortality. Despite its importance, previous studies have shown inconsistent results, largely due to methodological limitations related to sample size, lack of standardized treatment protocols, and insufficient follow-up of pregnant women. There is also divergence among national and international guidelines, which vary between universal and selective recommendations, highlighting gaps in the standardization of clinical practices.

Objectives: To investigate the effectiveness of implementing systematic screening protocol for asymptomatic genital infections in low-risk pregnant women in preventing adverse gestational and neonatal outcomes. The specific objectives are: to identify the most prevalent infections in this group; to evaluate the relationship between treatment and the incidence of complications; to compare outcomes between participants assigned to systematic screening and those receiving standard care and to propose recommendations for clinical practice and health policies based on a critical review of the literature and the results obtained.

Methods: This is a randomized controlled trial that will recruit 250 low-risk pregnant women, followed from the first trimester until delivery. Participants will be randomized into two groups: an intervention group, undergoing systematic screening with protocol-guided treatment, and a control group, managed according to current standard care practices, following the municipality's protocol for screening and treatment of genital infections. Primary outcomes include preterm birth, preterm premature rupture of membranes, low birth weight, intra-amniotic infection, puerperal infection, neonatal infection, and fetal and neonatal mortality. Statistical analysis will follow the intention-to-treat principle, and differences in outcomes between groups will be estimated.

Expected Results: This study is expected to provide evidence on whether systematic screening reduces (or does not reduce) maternal and neonatal complications. The randomized controlled trial will be prospectively registered prior to the enrollment of the first participant, in accordance with current ethical standards.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

This randomized controlled trial will evaluate whether systematic microbiological screening and protocol-based treatment of asymptomatic lower genital tract infections during pregnancy can reduce adverse gestational and neonatal outcomes among low-risk pregnant women.

The study will be conducted in Uruguaiana, a municipality in southern Brazil, within the municipal prenatal care network. Low-risk pregnant women receiving care through the Family Health Strategy will be referred to a Women's Health referral service and followed from first-trimester enrollment until delivery. The study is linked to the Graduate Program in Pathology at São Paulo State University "Júlio de Mesquita Filho" (UNESP), Botucatu Medical School.

Participants will be randomized in a 1:1 allocation ratio to either an experimental arm or an active comparator arm. The random allocation sequence will be generated electronically and managed by a designated nursing technician. The physician responsible for clinical care will not have prior access to the allocation sequence, and group assignment will be revealed only after participant enrollment, in order to preserve allocation concealment.

Participants assigned to the experimental arm will undergo enhanced microbiological screening during prenatal follow-up. Vaginal samples will be collected at scheduled prenatal visits for Gram stain-based evaluation of vaginal microbiota. Endocervical samples will be collected once per trimester for real-time polymerase chain reaction detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis. Samples positive for Mycoplasma genitalium will undergo additional analysis for 23S rRNA gene mutations associated with macrolide resistance. Vaginal and cervical infections identified during follow-up will be managed according to a predefined study protocol based on current clinical guidelines.

Participants assigned to the active comparator arm will receive standard prenatal care according to the current municipal clinical protocol. In this group, screening for Chlamydia trachomatis and Neisseria gonorrhoeae will be performed during the first trimester only for pregnant women younger than 30 years, as established by the municipal protocol. Management of vulvovaginal infections will be based on clinical criteria, and treatment will follow the standard municipal protocol.

Study data will be obtained from clinical interviews, biological sample collection, laboratory testing, and review of maternal and neonatal medical records. Clinical interviews will collect sociodemographic, obstetric, and relevant clinical information. Vaginal samples will be analyzed by Gram staining and classified according to predefined microbiological criteria. Endocervical samples will be processed for molecular detection of selected sexually transmitted pathogens. Neonatal and delivery-related outcomes will be collected through review of hospital medical records after delivery at the reference maternity hospital.

All study procedures will be performed by trained personnel in appropriate clinical settings and in accordance with biosafety standards. No additional blood samples will be collected exclusively for research purposes; blood tests will be limited to those routinely performed during prenatal care according to current Brazilian Ministry of Health guidelines.

Participants in both groups will be followed until delivery. The study will compare maternal, obstetric, and neonatal outcomes between the experimental and active comparator groups. Data will be recorded using standardized electronic case report forms and stored in an anonymized electronic database with restricted access to authorized research personnel.

The statistical analysis will follow the intention-to-treat principle, with participants analyzed according to their originally assigned groups, regardless of adherence to the assigned protocol. Categorical variables will be described using absolute and relative frequencies, and continuous variables will be summarized using measures of central tendency and dispersion, as appropriate. Between-group comparisons will be performed using suitable statistical tests according to variable type and distribution. Logistic regression models may be used to estimate the association between the intervention and study outcomes, adjusting for potential confounding variables when applicable. Results will be reported with effect estimates and 95% confidence intervals.

The study will be conducted in accordance with the Declaration of Helsinki and applicable Brazilian regulations for research involving human participants. Written informed consent will be obtained before enrollment. For participants younger than 18 years, written informed consent will be obtained from a legal guardian, and assent will be obtained from the minor participant. Participant confidentiality and data protection will be ensured in accordance with the Brazilian General Data Protection Law.

Study Type

Interventional

Enrollment (Estimated)

250

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • First-trimester pregnant women.
  • Low-risk pregnancy, defined as absence of comorbidities associated with medically indicated preterm birth.
  • Receiving care at the Women's Health service.
  • Willingness to participate in the study.

Exclusion Criteria:

#No specific exclusion criteria.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Screening
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Experimental: Enhanced microbiological screening and protocol-based treatment
Participants in this arm will undergo enhanced microbiological screening as part of prenatal care. Vaginal samples will be collected at each scheduled prenatal visit for Gram stain-based assessment, and endocervical samples will be collected once per trimester for real-time PCR detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis. Vaginal and cervical infections identified during follow-up will be managed according to the predefined study protocol. Participants will be followed from first-trimester enrollment until delivery.
Diagnostic test: Enhanced microbiological screening
Participants assigned to this intervention will undergo enhanced microbiological screening during prenatal care. Vaginal samples will be collected at all each scheduled prenatal visit for Gram stain-based evaluation, and endocervical samples will be collected once per trimester for real-time PCR detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis. Samples positive for Mycoplasma genitalium will undergo additional analysis for 23S rRNA gene mutations associated with macrolide resistance.
Active Comparator: Standard prenatal care according to municipal protocol
Pregnant women in this arm will receive standard prenatal care according to the current municipal clinical protocol. Screening for Chlamydia trachomatis and Neisseria gonorrhoeae will be performed only during the first trimester and only for pregnant women younger than 30 years. Management of vulvovaginal infections will be based on clinical criteria, and treatment will follow the standard municipal protocol. Participants will be followed at quarterly intervals for data collection until delivery.
Other: Standard prenatal care
Participants assigned to this intervention will receive standard prenatal care according to the current municipal clinical protocol. Screening for Chlamydia trachomatis and Neisseria gonorrhoeae will be performed only during the first trimester and only for pregnant women younger than 30 years. Management of vulvovaginal infections will be based on clinical criteria, and treatment will follow the standard municipal protocol. Participants will be followed at quarterly intervals for data collection until delivery.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Preterm birth
Time Frame: From randomization until delivery, assessed up to approximately 22 weeks after randomization or until 37 completed weeks of gestation, whichever occurs first.
Occurrence of preterm birth, defined as delivery before 37 completed weeks of gestation.
From randomization until delivery, assessed up to approximately 22 weeks after randomization or until 37 completed weeks of gestation, whichever occurs first.
Preterm premature rupture of membranes (PPROM)
Time Frame: Occurrence of preterm premature rupture of membranes before 37 completed weeks of gestation.
From randomization until delivery, assessed up to approximately 22 weeks after randomization or until 37 completed weeks of gestation, whichever occurs first.
Occurrence of preterm premature rupture of membranes before 37 completed weeks of gestation.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Miscarriage
Time Frame: Occurrence of pregnancy loss before fetal viability, defined as spontaneous pregnancy loss before 22 completed weeks of gestation, according to local clinical criteria.
Occurrence of pregnancy loss before fetal viability, as defined by local clinical criteria, 22 weeks.
Occurrence of pregnancy loss before fetal viability, defined as spontaneous pregnancy loss before 22 completed weeks of gestation, according to local clinical criteria.
Intra-amniotic infection
Time Frame: From randomization until delivery, assessed up to approximately 22 weeks after randomization or until birth, whichever occurs first.
Occurrence of clinically diagnosed intra-amniotic infection during pregnancy or labor.
From randomization until delivery, assessed up to approximately 22 weeks after randomization or until birth, whichever occurs first.
Puerperal infection
Time Frame: From delivery until maternal hospital discharge, assessed up to 7 days postpartum.
Occurrence of puerperal infection diagnosed during postpartum hospitalization, based on clinical assessment and/or medical record documentation.
From delivery until maternal hospital discharge, assessed up to 7 days postpartum.
Neonatal infection
Time Frame: From birth until neonatal hospital discharge, assessed up to 28 days of life.
Occurrence of clinically diagnosed neonatal infection during the neonatal hospitalization period, based on clinical assessment and/or medical record documentation.
From birth until neonatal hospital discharge, assessed up to 28 days of life.
Fetal death
Time Frame: From randomization until delivery, assessed up to approximately 22 weeks after randomization or until birth, whichever occurs first.
Occurrence of fetal death during pregnancy or at delivery.
From randomization until delivery, assessed up to approximately 22 weeks after randomization or until birth, whichever occurs first.
Neonatal mortality
Time Frame: From birth until neonatal hospital discharge, assessed up to 28 days of life.
Occurrence of neonatal death during the neonatal hospitalization period, based on medical record documentation.
From birth until neonatal hospital discharge, assessed up to 28 days of life.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Universidade Federal do Pampa

Collaborators

Faculdade de Medicina de Botucatu, UNESP, Botucatu, Brasil

Investigators

  • Study Chair: Marcia da Silva, Dra, São Paulo State University (UNESP), Botucatu Medical School

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

June 15, 2026

Primary Completion (Estimated)

July 30, 2028

Study Completion (Estimated)

December 30, 2028

Study Registration Dates

First Submitted

April 18, 2026

First Submitted That Met QC Criteria

May 13, 2026

First Posted (Actual)

May 18, 2026

Study Record Updates

Last Update Posted (Actual)

May 20, 2026

Last Update Submitted That Met QC Criteria

May 17, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • RCT Rita

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual participant data will not be shared publicly. Requests for additional information may be evaluated by the study team according to ethical and institutional regulations.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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