(P269) Prevalence and predictors of Chlamydia trachomatis and Neisseria gonorrhoeae among HIV-negative pregnant women in Kenya

Background

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in pregnancy contribute to adverse perinatal outcomes. Identifying predictors of CT/NG could help optimize diagnostic testing for pregnant women in settings where syndromic management persists as standard-of-care.



Methods

We analyzed baseline data from a longitudinal study of maternal HIV acquisition. Pregnant women without HIV were enrolled at two antenatal clinics in western Kenya. CT and NG were assessed by nucleic acid amplification tests (NAAT) using endocervical samples. Logistic regression models were used to evaluate potential predictors of CT and/or NG infection. A classification and regression tree (CART) was generated to predict the joint effects of predictors. We determined diagnostic performance of syndromic algorithms using NAAT-based diagnosis as the gold standard.



Results

Overall, 1276 women had complete CT/NG assessment. Women enrolled at a median of 26 weeks gestation (IQR 22-31), median age was 22 years (IQR 19-27), and xx (78%) were married. In total, 98 (7.7%) tested positive for CT and/or NG: 70 (5.5%) for CT, 32 (2.5%) for NG, and 4 (0.3%) had both. Two-thirds (66%) of CT and/or NG cases were asymptomatic and would have been missed without NAAT diagnosis. Predictors of CT and/or NG included age < 22 years, crowded living conditions, being unmarried, and being in a relationship < 1 year (p< 0.05). CART analyses identified women < 22 years who were not married and in a relationship for < 1 year as 5.5 times more likely to have CT and/or NG compared to women without these characteristics (38.5% vs. 7.0%, prevalence ratio=5.5, 95% CI: 3.23–9.25, p >0.001.) Compared to the NAAT-based diagnosis, syndromic algorithms demonstrated low sensitivity (34% [95% CI 31-36%]), moderate specificity (76% [95% CI 74-78%]), low positive predictive value (10% [95% CI 9-12%]), and high negative predictive value (93% [95% CI 92%-95%]) for detecting CT and/or NG.


Conclusion

In this cohort of pregnant Kenyan women, CT/NG was frequently asymptomatic and common among young unmarried women in newer relationships. Syndromic management alone would have led to underdiagnosis and missed treatment opportunities. Our results suggest antenatal CT/NG testing would be beneficial for young women in new relationships.