Objectives Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) are curable, mostly asymptomatic, STIs that cause adverse maternal and perinatal outcomes. Most countries do not test for those infections during antenatal care. We implemented a CT, NG and TV testing and treatment programme in an antenatal clinic in Gaborone, Botswana.
Methods We conducted a prospective study in the antenatal clinic at Princess Marina Hospital in Gaborone, Botswana. We offered pregnant women who were 18 years or older and less than 35 weeks of gestation, CT, NG and TV testing using self-collected vaginal swabs. Testing was conducted using a GeneXpert® CT/NG and TV system. Those who tested positive were given directly observed antibiotic therapy and asked to return for a test of cure. We determined the prevalence of infections, uptake of treatment and proportion cured. The relationships between positive STI test and participant characteristics were assessed.
Results We enrolled 400 pregnant women. Fifty-four (13.5%) tested positive for CT, NG and/or TV: 31 (8%) for CT, 5 (1.3%) for NG and 21 (5%) for TV. Among those who tested positive, 74% (40) received same-day, in person results and treatment. Among those who received delayed results (6), 67% (4) were treated. Statistical comparisons showed that being unmarried and HIV infected were positively association CT, NG and/or TV infection. Self-reported STI symptoms were not associated with CT, NG and/or TV infection.
Conclusion The prevalence of CT, NG and/or TV was high, particularly among women with HIV infection. Among women with CT, NG and/or TV infection, those who received same-day results were more likely to be treated than those who received delayed results. More research is needed on the costs and benefits of integrating highly sensitive and specific STI testing into antenatal care in Southern Africa.
- chlamydia trachomatis
- neisseria gonorrhoea
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Contributors AW managed the study, did the analyses and data collection and wrote the first and final draft. PG was the clinician on the study and approved the final draft. NM, OS, SD, EW and KD worked on the study, reviewed analyses, wrote sections and edited/approved the final version. DR-M helped conceive the study and data collection protocols, reviewed drafts of the manuscript and edited/approved of the final version. JDK was the PI on the study, supported analyses, wrote sections and approved the final draft. CM was the PI on the study, supported analyses, wrote sections and approved the final draft.
Funding This research was supported by AHRQ (2T32HS000046), the Center for HIV Identification, Prevention and Treatment Services (CHIPTS; P30MH058107). The content is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ.
Competing interests None declared.
Ethics approval University of Botswana, the Botswana Ministry of Health, Health Research Development Committee; and Princess Marina Hospital approved the study protocol. The University of California, Los Angeles, approved analyses using de-identified data.
Provenance and peer review Not commissioned; externally peer reviewed.
Author note Cepheid loaned testing equipment and donated thetesting reagents used in this study.