Randomized trial of presumptive sexually transmitted disease therapy during pregnancy in Rakai, Uganda.
OBJECTIVE
The purpose of this study was to assess presumptive sexually transmitted disease treatment on pregnancy outcome and HIV transmission.


METHODS
In a randomized trial in Rakai District, Uganda, 2070 pregnant women received presumptive sexually transmitted disease treatment 1 time during pregnancy at varying gestations, and 1963 control mothers received iron/folate and referral for syphilis. Maternal-infant sexually transmitted disease/HIV and infant outcomes were assessed. Intent-to-treat analyses estimated adjusted rate ratios and 95% confidence intervals.


RESULTS
Sexually transmitted diseases were reduced: Trichomonas vaginalis (rate ratio, 0.28; 95% CI, 0.18%-0.49%), bacterial vaginosis (rate ratio, 0.78; 95% CI, 0.69-0.87), Neisseria gonorrhoeae /Chlamydia trachomatis (rate ratio, 0.43; 95% CI, 0.27-0.68), and infant ophthalmia (rate ratio, 0.37; 95% CI, 0.20-0.70). There were reduced rates of neonatal death (rate ratio, 0.83; 95% CI, 0.71-0.97), low birth weight (rate ratio, 0.68; 95% CI, 0.53-0.86), and preterm delivery (rate ratio, 0.77; 95% CI, 0.56-1.05); but there were no effects on maternal HIV acquisition or perinatal HIV transmission.


CONCLUSIONS
Reductions of maternal sexually transmitted disease improved pregnancy outcome but not maternal HIV acquisition or perinatal HIV transmission.
Gray
R H
RH
Department of Population and Family Health Sciences, The Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md 21205, USA. rgray@jhsph.edu
Wabwire-Mangen
F
F
Kigozi
G
G
Sewankambo
N K
NK
Serwadda
D
D
Moulton
L H
LH
Quinn
T C
TC
O'Brien
K L
KL
Meehan
M
M
Abramowsky
C
C
Robb
M
M
Wawer
M J
MJ
D017963:Azithromycin / Q000627:therapeutic use*; D001724:Birth Weight; D020682:Cefixime / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000517:prevention & control; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D015658:HIV Infections / Q000628:therapy; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000517:prevention & control; D007234:Infant, Premature; D007501:Iron / Q000627:therapeutic use; D008795:Metronidazole / Q000627:therapeutic use*; D007752:Obstetric Labor, Premature / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000628:therapy*; D012749:Sexually Transmitted Diseases / Q000517:prevention & control / Q000628:therapy*; D014454:Uganda
D008795:Metronidazole; D017963:Azithromycin; D005492:Folic Acid; D020682:Cefixime; D007501:Iron