Chlamydial and Gonococcal Cervicitis in HIV-Seropositive and HIV-Seronegative Pregnant Women in Bangkok

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Abstract
Objectives: To determine the prevalence and risk factors associated with cervicitis caused byChlamydia trachomatisandNeisseria gonorrhoeaein human immunodeficiency virus (HIV) type 1-seropositive and HIV-seronegative pregnant women in Bangkok, and the relation to perinatal HIV transmission. Methods: As part of a multicenter perinatal HIV transmission study in an antenatal population with 2% HIV seroprevalence, endocervical swabs obtained at mid-pregnancy from a consecutive sample of 222 HIV-seropositive and 219 HIV-seronegative pregnant women at two large hospitals in Bangkok were tested for the presence ofC. trachomatisandN. gonorrhoeaeby DNA hybridization probe (Gen-Probe). Clinical risk factors and DNA probe results were analyzed in relation to the women's and newborns' HIV infection status. Results: The prevalence ofC. trachomatiswas 16.2% in HIV-seropositive pregnant women and 9.1% in HIV-seronegative pregnant women (P= 0.03). The prevalence ofN. gonorrhoeaewas 2.7% in HIV-seropositive pregnant women and 1.4% in HIV-seronegative pregnant women (P= 0.5). The overall population prevalence estimate was 9.2% forC. trachomatisand 1.4% forN. gonorrhoeae.Women with gonococcal infection were more likely to be positive forC. trachomatis(RRMH = 5.2,P< 0.01). Young age (1) were associated withC. trachomatisinfection among HIV-seronegative women. For HIV-seropositive women, primigravida status also was associated withC. trachomatisinfection. The perinatal HIV transmission rates were similar for those with and withoutC. trachomatis(24.1% and 23.2%, P = 0.9) and among those with and withoutN. gonorrhoeae(20% and 23.5%, P = 1.0). Conclusions: Among pregnant women in Bangkok,C. trachomatisinfection was considerably more common thanN. gonorrhoeaeinfection and was associated with HIV infection, young age and first pregnancy (HIV-seropositive women), and multiple partners (HIV-seronegative women). Our data do not suggest an association between perinatal HIV transmission and maternalC. trachomatisorN. gonorrhoeaeinfection identified and treated during pregnancy. The high prevalence ofC. trachomatisfound using a test not readily available in Thailand emphasizes the need for improved, inexpensive ways to screen for and diagnose these sexually transmitted infections in developing countries.