Goal of this study: To determine the prevalence of Chlamydia trachomatis urogenital infection and to identify behavioral, demographic, and clinical factors associated with the infection in pregnant women in Martinique.
Study design: One-thousand-four-hundred-eleven patients 15-39 years old, at 10-16 weeks of gestation and attending the prenatal clinic at Lamentin Hospital, were tested for Chlamydia trachomatis infection of the cervix and urethra using tissue culture.
Results: Chlamydia trachomatis was isolated from 375 (26.7%) women; 34% of them were positive in the cervix and urethra, 58% in the cervix only, and 8% in the urethra only. Factors found by multivariate analysis to be significantly associated with chlamydial infection were age less than 25 years, first intercourse at less than 18 years old, previous induced abortions, mucopurulent cervicitis, and repeated candidiasis.
Conclusions: None of the factors associated with chlamydial infection was sensitive enough to permit efficient selective screening. It is cost effective to recommend a routine screening for chlamydial infection together with an educational program.
PIP: To determine the prevalence of Chlamydia trachomatis urogenital infection among pregnant women in Martinique, 1411 consecutive women presenting to Lamentin Hospital for their initial prenatal visit between 1988-90 underwent specimen collection and extensive interviews. The mean age of study subjects was 27.1 years and the mean number of life-time sex partners was 3.2. C. trachomatis was isolated from 375 women (26.7%), two-thirds of whom were asymptomatic. There was an inverse correlation between age and infection rate; 164 (43.7%) infected women were under 25 years of age. 34% had evidence of infection in both the cervix and urethra, 58% in the cervix only, and 8% in the urethra only. Other sexually transmitted pathogens with a high prevalence in this group included Ureaplasma urealyticum (39.9%), Candida albicans (32%), and Trichomonas vaginalis (13.7%). Factors that correlated significantly with chlamydia infection by multivariate analysis were age less than 25 years, first intercourse less than 18 years, previous induced abortion, cervicitis, and repeated candidiasis. However, no single risk factor or constellation of risk factors was sufficiently sensitive to form the basis of a selective screening program. Considering the serious maternal and infant complications of C. trachomatis infection, routine screening in pregnant women is urged. Given a prevalence rate of 27%, 1630 infected pregnant women should be identified each year in Martinique. The cost of screening and treating these women and their partners would be US$250,000 compared to $1.2 million required to treat chlamydia-related conjunctivitis and pneumonia in infants and postpartum salpingitis in mothers.