title: Prevalence and risk factors for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis infection in pregnant women in Papua New Guinea.
abstract: OBJECTIVE
  To determine the prevalence of, and risk factors associated with, Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis infection in pregnant women in Madang, Papua New Guinea (PNG).
  
  
  METHODS
  A cross-sectional survey was conducted among 400 pregnant women presenting to antenatal clinics. Sociodemographic and behavioural data were collected and real-time PCR diagnostic methods were used to detect the presence of chlamydia, gonorrhoea and trichomonas in self-collected vaginal swabs. The relationships between symptoms, sociodemographic and behavioural factors and infection were assessed.
  
  
  RESULTS
  The prevalence of C. trachomatis was 11.1%, N. gonorrhoeae was 9.7% and T. vaginalis was 21.3%. One-third of women (33.7%) had at least one infection. The most common symptom was abdominal pain (48.0%), but only abnormal vaginal discharge was consistently associated with infection (p<0.001). Women diagnosed with vaginal discharge syndrome were more likely to have at least one treatable infection (50.0% (47/94)  vs 26.8% (68/254), p<0.001), yet 59.1% of women with infection would have been missed by the current clinically-based syndromic diagnosis. Risk factors included having a partner at perceived risk of infection, maternal extramarital intercourse, early sexual debut, lack of formal education, urban residence and smoking. 78.8% of women reported never using condoms.
  
  
  CONCLUSIONS
  The prevalences of T. vaginalis, C. trachomatis and N. gonorrhoeae were high among pregnant women in coastal PNG. The poor performance of clinically based syndromic diagnosis suggests that alternative strategies are urgently required to improve detection and reduce the burden of sexually transmitted infections and their associated adverse pregnancy outcomes in this population.
authors.affiliation: Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea.
authors.forename: R A
authors.initials: RA
authors.lastname: Wangnapi
authors.affiliation: Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea.
authors.forename: S
authors.initials: S
authors.lastname: Soso
authors.affiliation: Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: H W
authors.initials: HW
authors.lastname: Unger
authors.affiliation: Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea.
authors.forename: C
authors.initials: C
authors.lastname: Sawera
authors.affiliation: Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea.
authors.forename: M
authors.initials: M
authors.lastname: Ome
authors.affiliation: Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Umbers
authors.affiliation: Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea.
authors.forename: N
authors.initials: N
authors.lastname: Ndrewei
authors.affiliation: Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea.
authors.forename: P
authors.initials: P
authors.lastname: Siba
authors.affiliation: Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.
authors.forename: C S N
authors.initials: CS
authors.lastname: Li Wai Suen
authors.affiliation: Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea The Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Vallely
authors.affiliation: Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea The Burnet Institute, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Wapling
authors.affiliation: Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea The Burnet Institute, Melbourne, Victoria, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Ryan
authors.affiliation: Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Mueller
authors.affiliation: Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: S J
authors.initials: SJ
authors.lastname: Rogerson
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000453:epidemiology*; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology*; D006801:Humans; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D010219:Papua New Guinea / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D015995:Prevalence; D060888:Real-Time Polymerase Chain Reaction; D012307:Risk Factors; D012725:Sexual Behavior; D014245:Trichomonas Infections / Q000453:epidemiology*; D014246:Trichomonas vaginalis / Q000302:isolation & purification*; D055815:Young Adult
keywords: CHLAMYDIA INFECTION; NEISSERIA GONORRHOEA; REPRODUCTIVE HEALTH; SEXUAL HEALTH