Trichomoniasis in pregnant human immunodeficiency virus–infected and human immunodeficiency virus–uninfected Congolese women: Prevalence, risk factors, and association with low birth weight

doi:10.1016/S0002-9378(99)70509-0

American Journal of Obstetrics and Gynecology

Volume 181, Issue 3, September 1999, Pages 656-662

https://doi.org/10.1016/S0002-9378(99)70509-0 Get rights and content

Abstract

Objective: We sought to assess the prevalence of and risk factors for vaginal trichomoniasis in human immunodeficiency virus–infected and human immunodeficiency virus–uninfected pregnant Congolese women and its relationship to pregnancy outcomes. Study Design: We performed a nested case-control study of 215 infected and 206 uninfected mothers who responded to questionnaires, underwent sexually transmitted disease testing (including culture for trichomoniasis shortly after delivery), and underwent assessment of infant outcomes. Maternal variables and birth outcomes were assessed according to presence or absence of trichomoniasis and human immunodeficiency virus. Results: Trichomoniasis was present in 18.6% of human immunodeficiency virus–positive and 10.2% of human immunodeficiency virus–negative women, respectively (odds ratio, 2.0; 95% confidence interval, 1.1-3.6), and was significantly associated with low birth weight (odds ratio, 2.4; 95% confidence interval, 1.2-4.5). In multivariate analyses trichomoniasis remained associated with low birth weight, and adjustments were made for other risk factors associated with low birth weight. Conclusion: These findings suggest an association between trichomoniasis and low birth weight independent of human immunodeficiency virus infection and other risk factors. Further studies are needed to assess the impact of antenatal screening and treatment for trichomoniasis on pregnancy outcomes. (Am J Obstet Gynecol 1999;181:656-62.)

Section snippets

Study population

This analysis was designed as a nested case-control study of mothers of singletons, with trichomoniasis data available within the previously described Projet SIDA Perinatal HIV transmission cohort study.¹³ The Projet SIDA perinatal study was a collaborative effort by the Centers for Disease Control and Prevention, the National Institutes of Health, the Armed Forces Institute of Pathology, and the Ministry of Health of Zaire to evaluate how maternal and obstetric factors interact to influence

Results

Trichomoniasis data were available for 215 HIV-infected (patients) and 206 HIV-uninfected (control subjects) mothers of singletons who were enrolled within 1 to 2 days after delivery (73% of the parent Projet SIDA Perinatal study population). Those patients with and those without T vaginalis cultures performed did not differ significantly in terms of age, number of cigarettes smoked, infant gestational age at delivery, or infant birth weight. No patient data were collected on trichomoniasis

Comment

Vaginal trichomoniasis is highly prevalent in pregnant women in the Democratic Republic of Congo and was detected almost twice as often in HIV-seropositive women (18.6%) as in HIV-negative women (10.2%). The prevalence of trichomoniasis in this group of pregnant women in the Democratic Republic of Congo is similar to estimates of trichomoniasis in HIV-uninfected pregnant US women.⁵ Also, finding a higher prevalence of trichomoniasis in HIV-infected women is consistent with data from previous

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Cited by (51)

Perinatal outcomes associated with maternal HIV infection: A systematic review and meta-analysis
2016, The Lancet HIV
Citation Excerpt :
Our search yielded 60 750 citations, 35 of which were included in this meta-analysis (figure 1). These studies included data for 53 623 women in 18 countries in 20 prospective and 12 retrospective cohort studies, and three case-control studies.13,14,15,16–45,53,54 No randomised controlled trials were identified.
The HIV pandemic affects 36·9 million people worldwide, of whom 1·5 million are pregnant women. 91% of HIV-positive pregnant women reside in sub-Saharan Africa, a region that also has very poor perinatal outcomes. We aimed to establish whether untreated maternal HIV infection is associated with specific perinatal outcomes.
We did a systematic review and meta-analysis of the scientific literature by searching PubMed, CINAHL (Ebscohost), Global Health (Ovid), EMBASE (Ovid), and the Cochrane Central Register of Controlled Trials and four clinical trial databases (WHO International Clinical Trials Registry Platform, the Pan African Clinical Trials Registry, the ClinicalTrials.gov database, and the ISRCTN Registry) for studies published from Jan 1, 1980, to Dec 7, 2014. Two authors independently reviewed the studies retrieved by the scientific literature search, identified relevant studies, and extracted the data. We investigated the associations between maternal HIV infection in women naive to antiretroviral therapy and 11 perinatal outcomes: preterm birth, very preterm birth, low birthweight, very low birthweight, term low birthweight, preterm low birthweight, small for gestational age, very small for gestational age, miscarriage, stillbirth, and neonatal death. We included prospective and retrospective cohort studies and case-control studies reporting perinatal outcomes in HIV-positive women naive to antiretroviral therapy and HIV-negative controls. We used a random-effects model for the meta-analyses of specific perinatal outcomes. We did subgroup and sensitivity analyses and assessed the effect of adjustment for confounders. This systematic review and meta-analysis is registered with PROSPERO, number CRD42013005638.
Of 60 750 studies identified, we obtained data from 35 studies (20 prospective cohort studies, 12 retrospective cohort studies, and three case-control studies) including 53 623 women. Our meta-analyses of prospective cohort studies show that maternal HIV infection is associated with an increased risk of preterm birth (relative risk 1·50, 95% CI 1·24–1·82), low birthweight (1·62, 1·41–1·86), small for gestational age (1·31, 1·14–1·51), and stillbirth (1·67, 1·05–2·66). Retrospective cohort studies also suggest an increased risk of term low birthweight (2·62, 1·15–5·93) and preterm low birthweight (3·25, 2·12–4·99). The strongest and most consistent evidence for these associations is identified in sub-Saharan Africa. No association was identified between maternal HIV infection and very preterm birth, very small for gestational age, very low birthweight, miscarriage, or neonatal death, although few data were available for these outcomes. Correction for confounders did not affect the significance of these findings.
Maternal HIV infection in women who have not received antiretroviral therapy is associated with preterm birth, low birthweight, small for gestational age, and stillbirth, especially in sub-Saharan Africa. Research is needed to assess how antiretroviral therapy regimens affect these perinatal outcomes.
None.
Sexually transmitted diseases
2010, Antibiotic and Chemotherapy: Expert Consult
Commonly Encountered Medical Problems in Pregnancy
2008, Family Medicine Obstetrics
Molecular typing of the actin gene of Trichomonas vaginalis isolates by PCR-restriction fragment length polymorphism
2008, Clinical Microbiology and Infection
Human trichomoniasis, caused by the protozoan Trichomonas vaginalis, is a highly prevalent sexually transmitted infection. However, little is known about the degree of strain variability of T. vaginalis. A reliable classification method for T. vaginalis strains would be a useful tool in the study of the epidemiology, pathogenesis and transmission of T. vaginalis. A PCR–restriction fragment length polymorphism typing method was designed and evaluated using T. vaginalis isolates obtained after culture of vaginal specimens collected in the Democratic Republic of Congo and in Zambia. The variation of the actin gene of T. vaginalis was determined for three ATCC reference strains and 151 T. vaginalis isolates. Eight different types were identified, on the basis of the digestion patterns of the amplified actin gene, with each of the restriction enzymes HindII, MseI and RsaI. It was determined that the ATCC reference strains 30001, 30240 and 50141 were of actin genotypes G, H and E, respectively. The actin genotype type E was more common in the Democratic Republic of Congo, whereas type G was the commonest type in Zambia. Translation of the nucleotide sequence showed up to three amino acid substitutions. We developed a reproducible, sensitive and specific typing method for T. vaginalis, and were able to distinguish at least eight T. vaginalis actin genotypes. Further studies are needed to evaluate the method using clinical specimens and to determine the utility of the typing method for the genotypic characterization of T. vaginalis.
The frequency detection of opportunistic sexually transmitted infections among hiv-infected women planning pregnancy
2021, International Journal of Biomedicine
Urogenital schistosomiasis and sexually transmitted coinfections among pregnant women in a schistosome-endemic region of the Democratic Republic of Congo
2019, American Journal of Tropical Medicine and Hygiene

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^☆: From the Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention,^a Projet SIDA (Project AIDS),^b and the Armed Forces Institute of Pathology.^c

^☆☆: Reprint requests: Madeline Y. Sutton, MD, MPH, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E-02, Atlanta, GA 30333.

^★: 6/1/99914

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Trichomoniasis in pregnant human immunodeficiency virus–infected and human immunodeficiency virus–uninfected Congolese women: Prevalence, risk factors, and association with low birth weight☆,☆☆,★

Abstract

Section snippets

Study population

Results

Comment

Obstet Gynecol Clin North Am

Am J Obstet Gynecol

Am J Obstet Gynecol

Lancet

Am J Obstet Gynecol

J Pediatr

Int J Gynaecol Obstet

Am J Obstet Gynecol

Lancet

Trichomonas vaginalis associated with low birth weight and preterm delivery

Sex Transm Dis

Clinical and microbiological correlates of vaginal trichomoniasis during pregnancy

Clin Infect Dis

Clinical manifestations of vaginal trichomoniasis

JAMA

Detection of Trichomonas vaginalis in pregnant women with the inpouch TV culture system

J Clin Microbiol