Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) are associated with adverse pregnancy outcomes. Sexually transmitted infection (STI) testing followed by pathogen-directed treatment would optimize treatment compared with syndromic management. We aimed to determine STI treatment outcomes among pregnant women in South Africa.
Methods
Pregnant women at 4 healthcare clinics in East London, South Africa were included in an implementation-effectiveness study. Eligibility criteria included <27 gestational weeks and attendance at their first antenatal care visit. Nurse-collected vaginal specimens were tested on-site using the GeneXpert CT/NG and TV molecular assays. In one study arm, women with positive STI result(s) received pathogen-directed treatment, partner notification slips, and a test-of-cure (TOC) visit was scheduled at 21days post-treatment; visits were allowed up to 35 days. At TOC, sexual behaviour and partner treatment data were collected, and CT, NG, and TV STI testing were repeated; cure was defined as a negative result on repeat testing.
Results
We tested 361 eligible women in one study arm between March 2021 and November 2022. Of these, 93 (26%) tested positive for any STI and 86 (93%) received treatment within study arm timeline (51 for CT, 15 for NG, and 34 for TV); 70/93 (75%) were asymptomatic and 28/93 (30%) were HIV-positive. TOC visit was attended by 55/86 (64%, 95% confidence interval, CI 53-74) women within the appropriate window of time; 9/55 (16%, CI 8-29) had a positive repeat STI test (4/32 (13%) for CT, 5/22 (23%) for TV, and 0/11 (0%) for NG) (Table 1). Most women (98%; 54/55) reported disclosure of their STI to their partner however only 45% (25/55) reported that their partner received treatment. Of the 9 women with repeat positive testing at TOC, only 1/9 (11%, CI 0.6-49) reported that her partner received treatment compared with 24/46 (52%, CI 37-67) of cured participants (Fisher Exact p=0.03).
Conclusion
Primarily asymptomatic STIs were common among this cohort of pregnant women in South Africa. However, the potential benefits of STI testing and treatment in pregnancy may be limited by re-infection from untreated partners. Improving partner treatment should be prioritised.
