Sexually transmitted infections in pregnancy: a narrative review of the global research gaps, challenges, and opportunities.
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BORIS DOI
Date of Publication
December 2020
Publication Type
Article
Division/Institute
Author
Grant, Juliana S | |
Chico, R Matthew | |
Lee, Anne Cc | |
Medina-Marino, Andrew | |
Molina, Rose L | |
Morroni, Chelsea | |
Ramogola-Masire, Doreen | |
Stafylis, Chrysovalantis | |
Tang, Weiming | |
Vallely, Andrew J | |
Wynn, Adriane | |
Yeganeh, Nava | |
Klausner, Jeffrey D |
Series
Sexually transmitted diseases
ISSN or ISBN (if monograph)
0148-5717
Publisher
Lippincott Williams & Wilkins
Language
English
Publisher DOI
PubMed ID
32773611
Description
BACKGROUND
Sexually transmitted infections (STI), such as chlamydial, gonorrheal, and trichomonal infection, are prevalent in pregnant women in many countries and are widely reported to be associated with increased risk of poor maternal and neonatal outcomes. Syndromic STI management is frequently used in pregnant women in low- and middle-income countries, yet its low specificity and sensitivity lead to both over- and undertreatment. Etiologic screening for chlamydial, gonorrheal, and/or trichomonal infection in all pregnant women combined with targeted treatment might be an effective intervention. However, the evidence base is insufficient to support development of global recommendations. We aimed to describe key considerations and knowledge gaps regarding chlamydial, gonorrheal, and trichomonal screening during pregnancy to inform future research needed for developing guidelines for low- and middle-income countries.
METHODS
We conducted a narrative review based on PubMed and clinical trials registry searches through January 20, 2020, guidelines review, and expert opinion. We summarized our findings using the frameworks adopted by the World Health Organization for guideline development.
RESULTS
Adverse maternal-child health outcomes of potential interest are wide-ranging and variably defined. No completed randomized controlled trials on etiologic screening and targeted treatment were identified. Evidence from observational studies was limited and trials of presumptive STI treatment have shown mixed results. Subgroups that might benefit from specific recommendations were identified. Evidence on harms was limited. Cost-effectiveness was influenced by STI prevalence and availability of testing infrastructure and high-accuracy/low-cost tests. Preliminary data suggested high patient acceptability.
DISCUSSION
Preliminary data on harms, acceptability, and feasibility and the availability of emerging test technologies suggest that etiologic STI screening deserves further evaluation as a potential tool to improve maternal and neonatal health outcomes worldwide.
Sexually transmitted infections (STI), such as chlamydial, gonorrheal, and trichomonal infection, are prevalent in pregnant women in many countries and are widely reported to be associated with increased risk of poor maternal and neonatal outcomes. Syndromic STI management is frequently used in pregnant women in low- and middle-income countries, yet its low specificity and sensitivity lead to both over- and undertreatment. Etiologic screening for chlamydial, gonorrheal, and/or trichomonal infection in all pregnant women combined with targeted treatment might be an effective intervention. However, the evidence base is insufficient to support development of global recommendations. We aimed to describe key considerations and knowledge gaps regarding chlamydial, gonorrheal, and trichomonal screening during pregnancy to inform future research needed for developing guidelines for low- and middle-income countries.
METHODS
We conducted a narrative review based on PubMed and clinical trials registry searches through January 20, 2020, guidelines review, and expert opinion. We summarized our findings using the frameworks adopted by the World Health Organization for guideline development.
RESULTS
Adverse maternal-child health outcomes of potential interest are wide-ranging and variably defined. No completed randomized controlled trials on etiologic screening and targeted treatment were identified. Evidence from observational studies was limited and trials of presumptive STI treatment have shown mixed results. Subgroups that might benefit from specific recommendations were identified. Evidence on harms was limited. Cost-effectiveness was influenced by STI prevalence and availability of testing infrastructure and high-accuracy/low-cost tests. Preliminary data suggested high patient acceptability.
DISCUSSION
Preliminary data on harms, acceptability, and feasibility and the availability of emerging test technologies suggest that etiologic STI screening deserves further evaluation as a potential tool to improve maternal and neonatal health outcomes worldwide.
File(s)
| File | File Type | Format | Size | License | Publisher/Copright statement | Content | |
|---|---|---|---|---|---|---|---|
| Grant_SexTransmDis_2020.pdf | Adobe PDF | 858.44 KB | Attribution-NonCommercial-NoDerivatives (CC BY-NC-ND 4.0) | published |