Incidence of sexually transmitted infections during pregnancy

Chloe A Teasdale, Elaine J Abrams, Mary Ann Chiasson, Jessica Justman, Kelly Blanchard, Heidi E Jones, Chloe A Teasdale, Elaine J Abrams, Mary Ann Chiasson, Jessica Justman, Kelly Blanchard, Heidi E Jones

Abstract

Prevalence of sexually transmitted infections (STI) is high among pregnant women in certain settings. We estimated STI incidence and compared STI risk in pregnant and non-pregnant women. Data came from the Methods for Improving Reproductive Health in Africa (MIRA) study conducted in South Africa and Zimbabwe 2003-2006. Women aged 18-50 years with at least one follow-up visit within 6 months of enrollment were included. Follow-up visits included laboratory testing for pregnancy, chlamydia, gonorrhea, trichomoniasis, and HIV, as well as self-report of hormonal contraceptive (HC) use, sexual behaviors and intravaginal practices. All visits were classified according to pregnancy status. Incidence of each STI was calculated using follow-up time. Cox proportional hazards models were fitted using pregnancy as a time-varying exposure and sexual behaviors and intravaginal practices as time-varying covariates. Among 4,549 women, 766 (16.8%) had a positive pregnancy test. Median follow-up time was 18 months [IQR: 12-24]. The overall incidence rate of chlamydia was 6.7 per 100 person years (py) and 9.9/100py during pregnancy; gonorrhea incidence was 2.7/100py and 4.9/100py during pregnancy; trichomoniasis incidence was 7.1/100py overall and 9.2/100py during pregnancy. Overall HIV incidence was 3.9/100py and 3.8/100py during pregnancy. In crude models, pregnancy increased risk for chlamydia (hazard ratio (HR) 1.5, 95%CI: 1.1-1.2), however there was no increased risk of any measured STI in adjusted models. STI Incidence was high during pregnancy however pregnancy did not increase STI risk after adjustment for sexual behaviors. Greater efforts are needed to help pregnant women avoid STIs.

Trial registration: ClinicalTrials.gov NCT00121459.

Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. Menendez C, Castellsague X, Renom M, Sacarlal J, Quinto L, Lloveras B, et al. Prevalence and risk factors of sexually transmitted infections and cervical neoplasia in women from a rural area of southern Mozambique. Infect Dis Obstet Gynecol. 2010. pii: 609315.
    1. Chico RM, Mayaud P, Ariti C, Mabey D, Ronsmans C, Chandramohan D. Prevalence of malaria and sexually transmitted and reproductive tract infections in pregnancy in sub-Saharan Africa: a systematic review. JAMA. 2012;307(19):2079–2086. doi:
    1. Looker KJ, Garnett GP, Schmid GP. An estimate of the global prevalence and incidence of herpes simplex virus type 2 infection. Bull World Health Organ. 2008;86(10):805–812, A. doi:
    1. Department of Health SA. The 2012 National Antenatal Sentinel HIV & Herpes Simplex Type-2 Prevalence Survey in South Africa. Pretoria, South Africa: DOH SA; 2012.
    1. Borges-Costa J, Matos C, Pereira F. Sexually transmitted infections in pregnant adolescents: prevalence and association with maternal and foetal morbidity. J Eur Acad Dermatol Venereol. 2012;26(8):972–975. doi:
    1. Mullick S, Watson-Jones D, Beksinska M, Mabey D. Sexually transmitted infections in pregnancy: prevalence, impact on pregnancy outcomes, and approach to treatment in developing countries. Sex Transm Infect. 2005;81(4):294–302. doi:
    1. Ament LA, Whalen E. Sexually transmitted diseases in pregnancy: diagnosis, impact, and intervention. J Obstet Gynecol Neonatal Nurs 1996;25(8):657–666.
    1. Black V, Brooke S, Chersich MF. Effect of human immunodeficiency virus treatment on maternal mortality at a tertiary center in South Africa: a 5-year audit. Obstet Gynecol. 2009;114(2 Pt 1):292–299.
    1. Newell ML, Brahmbhatt H, Ghys PD. Child mortality and HIV infection in Africa: a review. AIDS. 2004;18 Suppl 2:S27–34.
    1. James SH, Sheffield JS, Kimberlin DW. Mother-to-Child Transmission of Herpes Simplex Virus. J Pediatric Infect Dis Soc. 2014;3(Suppl 1):S19–S23.
    1. Moodley D, Esterhuizen T, Reddy L, Moodley P, Singh B, Ngaleka L, et al. Incident HIV infection in pregnant and lactating women and its effect on mother-to-child transmission in South Africa. J Infect Dis. 2011;203(9):1231–1234. doi:
    1. Brown ZA, Selke S, Zeh J, Kopelman J, Maslow A, Ashley RL, et al. The acquisition of herpes simplex virus during pregnancy. N Engl J Med. 1997;337(8):509–515. doi:
    1. Schmeink CE, Melchers WJ, Hendriks JC, Quint WG, Massuger LF, Bekkers RL. Human papillomavirus detection in pregnant women: a prospective matched cohort study. J Womens Health (Larchmt). 2012;21(12):1295–1301.
    1. Berggren EK, Patchen L. Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae and repeat infection among pregnant urban adolescents. Sex Trans Dis. 2011;38(3):172–174.
    1. Banura C, Franceschi S, van Doorn LJ, Arslan A, Kleter B, Wabwire-Mangen F, et al. Prevalence, incidence and clearance of human papillomavirus infection among young primiparous pregnant women in Kampala, Uganda. Int J Cancer. 2008;123(9):2180–2187. doi:
    1. Gardella C, Brown Z, Wald A, Selke S, Zeh J, Morrow RA, et al. Risk factors for herpes simplex virus transmission to pregnant women: a couples study. Am J Obstet Gynecol. 2005;193(6):1891–1899. doi:
    1. Mugo NR, Heffron R, Donnell D, Wald A, Were EO, Rees H, et al. Increased risk of HIV-1 transmission in pregnancy: a prospective study among African HIV-1-serodiscordant couples. AIDS. 2011;25(15):1887–1895. doi:
    1. Morrison CS, Wang J, Van Der Pol B, Padian N, Salata RA, Richardson BA. Pregnancy and the risk of HIV-1 acquisition among women in Uganda and Zimbabwe. AIDS. 2007;21(8):1027–1034. doi:
    1. Gray GE, McIntyre JA. HIV and pregnancy. BMJ. 2007;334(7600):950–953. doi:
    1. Keating MA, Hamela G, Miller WC, Moses A, Hoffman IF, Hosseinipour MC. High HIV incidence and sexual behavior change among pregnant women in Lilongwe, Malawi: implications for the risk of HIV acquisition. PloS One. 2012;7(6):e39109 doi:
    1. Teasdale CA, Abrams EJ, Chiasson MA, Justman J, Blanchard K, Jones HE. Sexual Risk and Intravaginal Practice Behavior Changes During Pregnancy. Arch Sex Behav. 2017;46(2):539–548. doi:
    1. Low N, Chersich MF, Schmidlin K, Egger M, Francis SC, van de Wijgert JH, et al. Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis. PLoS Med. 2011;8(2):e1000416 doi:
    1. Beagley KW, Gockel CM. Regulation of innate and adaptive immunity by the female sex hormones oestradiol and progesterone. FEMS Immunol Med Microbiol. 2003;38(1):13–22.
    1. Bouman A, Heineman MJ, Faas MM. Sex hormones and the immune response in humans. Hum Reprod Update. 2005;11(4):411–423. doi:
    1. Pazos M, Sperling RS, Moran TM, Kraus TA. The influence of pregnancy on systemic immunity. Immunol Res. 2012. December;54(1–3):254–256. doi:
    1. Moench TR, Chipato T, Padian NS. Preventing disease by protecting the cervix: the unexplored promise of internal vaginal barrier devices. AIDS. 2001;15(13):1595–1602.
    1. Shacklett BL, Greenblatt RM. Immune responses to HIV in the female reproductive tract, immunologic parallels with the gastrointestinal tract, and research implications. Am J Reprod Immunol. 2011;65(3):230–241. doi:
    1. Patterson BK, Landay A, Andersson J, Brown C, Behbahani H, Jiyamapa D, et al. Repertoire of chemokine receptor expression in the female genital tract: implications for human immunodeficiency virus transmission. Am J Pathol. 1998. 153(2):481–490. doi:
    1. Walter J, Fraga L, Orin MJ, Decker WD, Gipps T, Stek A, et al. Immunomodulatory factors in cervicovaginal secretions from pregnant and non-pregnant women: a cross-sectional study. BMC Infect Dis. 2011;11:263 doi:
    1. De Schacht C, Mabunda N, Ferreira OC, Ismael N, Calu N, Santos I, et al. High HIV incidence in the postpartum period sustains vertical transmission in settings with generalized epidemics: a cohort study in Southern Mozambique. J Int AIDS Soc. 2014;17:18808 doi:
    1. Burkman RT Jr. Noncontraceptive effects of hormonal contraceptives: bone mass, sexually transmitted disease and pelvic inflammatory disease, cardiovascular disease, menstrual function, and future fertility. Am J Obstet Gynecol. 1994; 170(5 Pt 2):1569–1575.
    1. Heffron R, Donnell D, Rees H, Celum C, Mugo N, Were E, et al. Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study. Lancet Infect Dis. 2012;12(1):19–26. doi:
    1. Newman L, Rowley J, Vander Hoorn S, et al. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012. PLoS ONE 2015;10:e013304.
    1. Kaydos SC, Swygard H, Wise SL, Sena AC, Leone PA, Miller WC, Cohen MS, Hobbs MM. Development and validation of a PCR-based enzyme-linked immunosorbent assay with urine for use in clinical research settings to detect Trichomonas vaginalis in women. J Clin Microbiol. 2002. January; 40(1):89–95. doi:
    1. Cook RL, Hutchison SL, Østergaard L, Braithwaite RS, Ness RB. Systematic review: noninvasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Ann Intern Med. 2005;142(11):914–925.
    1. Feldblum PJ, Latka MH, Lombaard J, Chetty C, Chen PL, Sexton C, et al. HIV incidence and prevalence among cohorts of women with higher risk behaviour in Bloemfontein and Rustenburg, South Africa: a prospective study. BMJ Open. 2012;2(1):e000626 doi:
    1. Feldblum PJ, Enosse S, Dube K, Arnaldo P, Muluana C, Banze R, et al. HIV prevalence and incidence in a cohort of women at higher risk for HIV acquisition in Chokwe, southern Mozambique. PloS One. 2014;9(5):e97547 doi:
    1. Dube K, Zango A, van de Wijgert J, Mequel I, Ferro JJ, Cumbe F, et al. HIV incidence in a cohort of women at higher risk in Beira, Mozambique: prospective study 2009–2012. PloS One. 2014;9(1):e84979 doi:
    1. Tanser F, Barnighausen T, Grapsa E, Zaidi J, Newell ML. High coverage of ART associated with decline in risk of HIV acquisition in rural KwaZulu-Natal, South Africa. Science. 2013;339(6122):966–971. doi:
    1. Reid SE, Dai JY, Wang J, Sichalwe BN, Akpomiemie G, Cowan FM, et al. Pregnancy, contraceptive use, and HIV acquisition in HPTN 039: relevance for HIV prevention trials among African women. J Acquir Immune Defic Syndr. 2010. April;53(5):606–13. doi:
    1. Zimmerman RS, Morisky DE, Harrison L, Mark HD. Validity of Behavioral Measures as Proxies for HIV-Related Outcomes. J Acquir Immune Defic Syndr. 2014;66 Suppl 3:S285–292.
    1. McCoy SI, Zheng W, Montgomery E, Blanchard K, van der Straten A, de Bruyn G, et al. Oral and injectable contraception use and risk of HIV acquisition among women in the methods for improving reproductive health in Africa (MIRA) study. AIDS. 2013;27(6):1001–1009. doi:
    1. Sande S, Zimba M, Mberikunashe J, Tangwena A, Chimusoro A. Progress towards malaria elimination in Zimbabwe with special reference to the period 2003–2015. Malar J. 2017;16(1):295 doi:
    1. Chico RM, Chaponda EB1, Ariti C, Chandramohan D. Sulfadoxine-Pyrimethamine Exhibits Dose-Response Protection Against Adverse Birth Outcomes Related to Malaria and Sexually Transmitted and Reproductive Tract Infections. Clin Infect Dis. 2017;64(8):1043–1051. doi:

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