Sexually transmitted infections in pregnancy : prevalence , impact on pregnancy outcomes , and approach to treatment in developing countries

Sexually transmitted infections (STIs) are common in the developing world. Management of STIs in pregnancy in many developing countries has, however, been complicated by the lack of simple and affordable diagnostic tests. This review examines the prevalence and impact on pregnancy outcome of STIs in developing countries and recommends approaches to management of STIs in pregnancy for resource poor settings.

[1]  G. Garnett,et al.  Why is Trichomonas vaginalis ignored? , 1999, Sexually transmitted infections.

[2]  L. Myer,et al.  Impact of on-site testing for maternal syphilis on treatment delays, treatment rates, and perinatal mortality in rural South Africa: a randomised controlled trial , 2003, Sexually transmitted infections.

[3]  G. Donders Bacterial vaginosis during pregnancy: screen and treat? , 1999, European journal of obstetrics, gynecology, and reproductive biology.

[4]  T. Farley,et al.  Asymptomatic sexually transmitted diseases: the case for screening. , 2003, Preventive medicine.

[5]  E. Karita,et al.  Effect of HIV‐1 infection on pregnancy outcome in women in Kigali, Rwanda, 1992–1994 , 1998, AIDS.

[6]  K. O'Brien,et al.  Randomized trial of presumptive sexually transmitted disease therapy during pregnancy in Rakai, Uganda. , 2001, American journal of obstetrics and gynecology.

[7]  M. Hobbs,et al.  Trichomoniasis: clinical manifestations, diagnosis and management , 2004, Sexually Transmitted Infections.

[8]  S. Larsen,et al.  A case-control study of stillbirths at a teaching hospital in Zambia, 1979-80: serological investigations for selected infectious agents. , 1984, Bulletin of the World Health Organization.

[9]  R. Steketee,et al.  Syphilis-associated perinatal and infant mortality in rural Malawi. , 1993, Bulletin of the World Health Organization.

[10]  King K. Holmes,et al.  Diagnostic Criteria and Microbial and Epidemiologic Associations , 1983 .

[11]  S. Hillier,et al.  Bacterial vaginosis and prematurity in Indonesia: association in early and late pregnancy. , 1993, American Journal of Obstetrics and Gynecology.

[12]  L. Kuhn,et al.  Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study. South African Vitamin A Study Group. , 1999, Lancet.

[13]  Ronald H Gray,et al.  Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomised community trial , 1999, The Lancet.

[14]  P. Piot,et al.  Maternal Human Immunodeficiency Virus‐1 Infection and Pregnancy Outcome , 1994, Obstetrics and gynecology.

[15]  M. Kolczak,et al.  The effect of dual infection with HIV and malaria on pregnancy outcome in western Kenya , 2003, AIDS.

[16]  B. Vuylsteke,et al.  Current status of syndromic management of sexually transmitted infections in developing countries , 2004, Sexually Transmitted Infections.

[17]  J. Desmyter,et al.  The association of gonorrhoea and syphilis with premature birth and low birthweight. , 1993, Genitourinary medicine.

[18]  N. Nagelkerke,et al.  Mass antimicrobial treatment in pregnancy. A randomized, placebo-controlled trial in a population with high rates of sexually transmitted diseases. , 1995, The Journal of reproductive medicine.

[19]  W. Fawzi,et al.  Transmission of HIV‐1 Through Breastfeeding Among Women in Dar es Salaam, Tanzania , 2002, Journal of acquired immune deficiency syndromes.

[20]  M. van der Pol,et al.  A review of studies assessing the costs and consequences of interventions to reduce mother-to-child HIV transmission in sub-Saharan Africa , 2003, AIDS.

[21]  C. Lacey,et al.  Preterm labour in association with Neisseria gonorrhoeae: case reports. , 1984, The British journal of venereal diseases.

[22]  J. Schwebke Update of trichomoniasis , 2002, Sexually transmitted infections.

[23]  Jennifer S. Smith,et al.  Age-specific prevalence of infection with herpes simplex virus types 2 and 1: a global review. , 2002, The Journal of infectious diseases.

[24]  F. Behets,et al.  Trichomoniasis in pregnant human immunodeficiency virus-infected and human immunodeficiency virus-uninfected congolese women: prevalence, risk factors, and association with low birth weight. , 1999, American journal of obstetrics and gynecology.

[25]  O. Müller,et al.  Sexually transmitted infections in young pregnant women in Bangui, Central African Republic , 1999, International journal of STD & AIDS.

[26]  L. Sokoll,et al.  Human immunodeficiency virus load in breast milk, mastitis, and mother-to-child transmission of human immunodeficiency virus type 1. , 1999, The Journal of infectious diseases.

[27]  W. Levine,et al.  SEXUALLY TRANSMITTED DISEASES TREATMENT GUIDELINES 2002 , 2002, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[28]  M. Beem,et al.  Respiratory-tract colonization and a distinctive pneumonia syndrome in infants infected with Chlamydia trachomatis. , 1977, The New England journal of medicine.

[29]  HIV voluntary counseling and testing: An essential component in preventing mother-to-child transmission of HIV , 2003 .

[30]  S. Vermund,et al.  Prevention of mother‐to‐child transmission of HIV in Africa: successes and challenges in scaling‐up a nevirapine‐based program in Lusaka, Zambia , 2003, AIDS.

[31]  Brett A. Collins,et al.  Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. , 2001, The New England journal of medicine.

[32]  L. Mofenson Tale of two epidemics--the continuing challenge of preventing mother-to-child transmission of human immunodeficiency virus. , 2003, The Journal of infectious diseases.

[33]  G. Burstein,et al.  Sexually transmitted diseases treatment guidelines , 2003, Current opinion in pediatrics.

[34]  N. Nagelkerke,et al.  Antimicrobial prophylaxis in pregnancy: a randomized, placebo-controlled trial with cefetamet-pivoxil in pregnant women with a poor obstetric history. , 1997, American journal of obstetrics and gynecology.

[35]  S. Moses,et al.  Syphilis control in pregnancy: decentralization of screening facilities to primary care level, a demonstration project in Nairobi, Kenya , 1995, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[36]  Francis A. Plummer,et al.  Risk factors for postnatal mother–child transmission of HIV-1 , 2000, AIDS.

[37]  J. Zeh,et al.  Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. , 2003, JAMA.

[38]  L. Scott Prevention of perinatal herpes: prophylactic antiviral therapy? , 1999, Clinical obstetrics and gynecology.

[39]  Margaret-Mary G. Wilson,et al.  Sexually transmitted diseases. , 2003, Clinics in geriatric medicine.

[40]  M A Krohn,et al.  Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation , 1991, Journal of clinical microbiology.

[41]  R. Brunham,et al.  Maternal gonococcal infection as a preventable risk factor for low birth weight. , 1990, The Journal of infectious diseases.

[42]  M. Fowler,et al.  Prevention of mother-to-child HIV transmission in resource-poor countries: translating research into policy and practice. , 2000, JAMA.

[43]  S. Hillier,et al.  Cervicovaginal microflora and pregnancy outcome: Results of a double‐blind, placebo‐controlled trial of erythromycin treatment , 1991, American journal of obstetrics and gynecology.

[44]  S. Isenberg,et al.  The influence of perinatal infective factors on ophthalmia neonatorum. , 1996, Journal of pediatric ophthalmology and strabismus.

[45]  A. Meheus,et al.  Syphilis intervention in pregnancy: Zambian demonstration project. , 1990, Genitourinary medicine.

[46]  S. Hammer,et al.  Intrapartum exposure to nevirapine and subsequent maternal responses to nevirapine-based antiretroviral therapy. , 2004, The New England journal of medicine.

[47]  K. Holmes,et al.  Nonspecific vaginitis: Diagnostic criteria and microbial and epidemiologic associations , 1983 .

[48]  B. Stray-Pedersen,et al.  Reproductive tract infections among women attending primary health care facilities in Moshi, Tanzania. , 2002, East African medical journal.

[49]  J. Changalucha,et al.  Herpes simplex virus type 2 infection increases HIV incidence: a prospective study in rural Tanzania , 2002, AIDS.

[50]  E. Goetghebeur,et al.  Vaginal lavage with chlorhexidine during labour to reduce mother-to-child HIV transmission: clinical trial in Mombasa, Kenya , 2001, AIDS.

[51]  J. Feldman,et al.  Risk factors for prematurity and premature rupture of membranes: a prospective study of the vaginal flora in pregnancy. , 1984, American journal of obstetrics and gynecology.

[52]  P. Mason,et al.  Risk factors for gonococcal and chlamydial cervical infection in pregnant and non-pregnant women in Zimbabwe. , 2008, Central African Journal of Medicine.

[53]  P. Piot,et al.  Epidemiology and control of gonococcal ophthalmia neonatorum. , 1989, Bulletin of the World Health Organization.

[54]  J. French,et al.  Premature rupture of membranes and bacterial vaginosis. , 1993, American journal of obstetrics and gynecology.

[55]  J. Hauth,et al.  Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis , 1995, The New England journal of medicine.

[56]  R. Hayes,et al.  Risk scores to detect cervical infections in urban antenatal clinic attenders in Mwanza, Tanzania. , 1998, Sexually transmitted infections.

[57]  R. Corkhill,et al.  The Nairobi Birth Survey 1. the study design, the population and outline results. , 1982, Journal of obstetrics & gynaecology of Eastern and Central Africa.

[58]  R. Hayes,et al.  Is antenatal syphilis screening still cost effective in sub-Saharan Africa , 2003, Sexually transmitted infections.

[59]  S. Vansteelandt,et al.  Placental Inflammation and Perinatal Transmission of HIV‐1 , 2002, Journal of acquired immune deficiency syndromes.

[60]  W. Marai Lower genital tract infections among pregnant women: a review. , 2001, East African medical journal.

[61]  S. Moses,et al.  Rapid increase of both HIV‐1 infection and syphilis among pregnant women in Nairobi, Kenya , 1992, AIDS.

[62]  D. Watson-Jones,et al.  Syphilis in pregnancy in Tanzania. I. Impact of maternal syphilis on outcome of pregnancy. , 2002, The Journal of infectious diseases.

[63]  P. Kirui,et al.  Validity of the vaginal discharge algorithm among pregnant and non-pregnant women in Nairobi, Kenya , 2000, Sexually transmitted infections.

[64]  S. Salhan,et al.  Effect of treatment for Chlamydia trachomatis during pregnancy , 2003, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[65]  N O'Farrell,et al.  Increasing prevalence of genital herpes in developing countries: implications for heterosexual HIV transmission and STI control programmes. , 1999, Sexually transmitted infections.

[66]  S. Hillier,et al.  Intravaginal clindamycin treatment for bacterial vaginosis: effects on preterm delivery and low birth weight. , 1995, American journal of obstetrics and gynecology.

[67]  James B. Hill,et al.  Acyclovir Prophylaxis to Prevent Herpes Simplex Virus Recurrence at Delivery: A Systematic Review , 2003, Obstetrics and gynecology.

[68]  K. Schulz,et al.  Pregnancy loss, infant death, and suffering: legacy of syphilis and gonorrhoea in Africa. , 1987, Genitourinary medicine.

[69]  P. Hardy,et al.  PREVALENCE OF SIX SEXUALLY TRANSMITTED DISEASE AGENTS AMONG PREGNANT INNER-CITY ADOLESCENTS AND PREGNANCY OUTCOME , 1984, The Lancet.

[70]  A. Wald,et al.  Risk of human immunodeficiency virus infection in herpes simplex virus type 2-seropositive persons: a meta-analysis. , 2002, The Journal of infectious diseases.

[71]  I. Kobayashi,et al.  Can HSV latency be conquered by current antiviral therapies? , 1998, Sexually transmitted infections.

[72]  Jill Turner,et al.  WORLD HEALTH ASSEMBLY , 1989, The Lancet.

[73]  F. Plummer,et al.  Postpartum upper genital tract infections in Nairobi, Kenya: epidemiology, etiology, and risk factors. , 1987, The Journal of infectious diseases.

[74]  R. Trussell,et al.  Triehomonas vaginalis and trichomoniasis. , 1947 .

[75]  M. Nolan,et al.  A review of clinical trials to prevent mother-to-child HIV-1 transmission in Africa and inform rational intervention strategies , 2002, AIDS.

[76]  E. Alexander,et al.  Cervical Chlamydia trachomatis and mycoplasmal infections in pregnancy. Epidemiology and outcomes. , 1983, JAMA.

[77]  R. Hayes,et al.  The epidemiology of HSV-2 infection and its association with HIV infection in four urban African populations , 2001, AIDS.

[78]  R. Brunham,et al.  EPIDEMIOLOGY OF OPHTHALMIA NEONATORUM IN KENYA , 1986, The Lancet.

[79]  N. Nagelkerke,et al.  Infection with HIV as a risk factor for adverse obstetrical outcome. , 1990, AIDS.

[80]  F. Plummer,et al.  The Role of Maternal Syphilis, Gonorrhoea and HIV-1 Infections in Spontaneous Abortion , 1992, International journal of STD & AIDS.

[81]  K. Holmes,et al.  Independent associations of bacterial vaginosis and Chlamydia trachomatis infection with adverse pregnancy outcome. , 1986, JAMA.

[82]  J. Overbaugh,et al.  Correlates of mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission: association with maternal plasma HIV-1 RNA load, genital HIV-1 DNA shedding, and breast infections. , 2001, The Journal of infectious diseases.

[83]  S. Isenberg,et al.  A controlled trial of povidone-iodine as prophylaxis against ophthalmia neonatorum. , 1995, The New England journal of medicine.

[84]  H. Coovadia,et al.  Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study , 1999, The Lancet.

[85]  J. Desmyter,et al.  Apparent Failure of One Injection of Benzathine Penicillin G for Syphilis During Pregnancy in Human Immunodeficiency Virus‐Seronegative African Women , 1997, Sexually transmitted diseases.

[86]  O. Jírovec,et al.  Trichomonas vaginalis and trichomoniasis. , 1968, Advances in parasitology.

[87]  D. Watson-Jones,et al.  Syphilis in pregnancy in Tanzania. II. The effectiveness of antenatal syphilis screening and single-dose benzathine penicillin treatment for the prevention of adverse pregnancy outcomes. , 2002, The Journal of infectious diseases.

[88]  John L Sullivan,et al.  A multicenter randomized controlled trial of nevirapine versus a combination of zidovudine and lamivudine to reduce intrapartum and early postpartum mother-to-child transmission of human immunodeficiency virus type 1. , 2003, The Journal of infectious diseases.

[89]  Dorothy Bray,et al.  Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial , 1999, The Lancet.

[90]  C. Prober,et al.  Identification of Women at Unsuspected Risk of Primary Infection with Herpes Simplex Virus Type 2 during Pregnancy , 1992 .

[91]  R L Ashley,et al.  The acquisition of herpes simplex virus during pregnancy. , 1997, The New England journal of medicine.

[92]  D. Mabey,et al.  Chlamydial and gonococcal ophthalmia neonatorum in The Gambia. , 1987, Annals of tropical paediatrics.

[93]  A. Cunningham,et al.  Neonatal herpes prevention: a minor public health problem in some communities. , 2000, Sexually transmitted infections.

[94]  K. Mandaliya,et al.  Vulnerability of women in an African setting: lessons for mother-to-child HIV transmission prevention programmes. , 2002, AIDS.

[95]  D. Wilkinson,et al.  Impact on perinatal mortality of missed opportunities to treat maternal syphilis in rural South Africa: baseline results from a clinic randomized controlled trial , 2000, Tropical medicine & international health : TM & IH.

[96]  J. Kaldor,et al.  Prevalence of Sexually Transmitted Infections Among Antenatal Women in Vanuatu, 1999–2000 , 2003, Sexually transmitted diseases.

[97]  Ingraham Nr The value of penicillin alone in the prevention and treatment of congenital syphilis. , 1950 .

[98]  J. McFee,et al.  Prevention of premature birth by screening and treatment for common genital tract infections: results of a prospective controlled evaluation. , 1995, American journal of obstetrics and gynecology.

[99]  R. Hayes,et al.  Antibody to herpes simplex virus type 2 as a marker of sexual risk behavior in rural Tanzania. , 1999, The Journal of infectious diseases.

[100]  C. Connolly,et al.  Epidemiology of syphilis in pregnancy in rural South Africa: opportunities for control , 1997, Tropical medicine & international health : TM & IH.

[101]  D. Wolday,et al.  Risk factors associated with failure of syndromic treatment of sexually transmitted diseases among women seeking primary care in Addis Ababa , 2004, Sexually Transmitted Infections.

[102]  K. Holmes,et al.  Relationships of Vaginal Lactobacillus species, Cervical Chlamydia trachomatis, and Bacterial Vaginosis to Preterm Birth , 1988, Obstetrics and gynecology.

[103]  F. Dabis,et al.  Chorioamnionitis and pregnancy outcome in HIV-infected African women. Pregnancy and HIV Study Group. , 1998, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[104]  Mary Frances Cotch,et al.  Association between Bacterial Vaginosis and Preterm Delivery of a Low-Birth-Weight Infant , 1995 .

[105]  J. Downing,et al.  The incidence of prenatal syphilis at the Boston City Hospital. , 1952, The New England journal of medicine.

[106]  M. Ogundele,et al.  HIV transmission through breastfeeding: problems and prevention , 2003, Annals of Tropical Paediatrics.

[107]  P. Piot,et al.  Prophylaxis of gonococcal and chlamydial ophthalmia neonatorum. A comparison of silver nitrate and tetracycline , 1988, The New England journal of medicine.

[108]  M. Krohn,et al.  Trichomonas vaginalis Associated With Low Birth Weight and Preterm Delivery , 1997, Sexually transmitted diseases.