title: High prevalence and incidence of asymptomatic sexually transmitted infections during pregnancy and postdelivery in KwaZulu Natal, South Africa.
abstract: BACKGROUND
  We report the prevalence and incidence of 3 treatable sexually transmitted pathogens (Neiserria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis) in women who were HIV infected or at high risk for HIV infection, in pregnancy and postpartum, respectively.
  
  
  METHODS
  Vulvovaginal specimens collected at the first antenatal visit and again at 14 weeks postpartum were tested for N. gonorrhoeae, C. trachomatis, and T. vaginalis in the laboratory. Women were routinely tested for HIV-1 with a point-of-care test.
  
  
  RESULTS
  Among 1480 women, 32.3% (95% confidence interval, 29.9-34.7) tested positive for any of the sexually transmitted infections (STIs) in pregnancy and 19.2% (95% confidence interval, 16.9-21.5) were positive when retested 14 weeks postpartum (incidence rate, 79.2 per 100 person-years). The prevalence of N. gonorrhoeae and T. vaginalis infections in pregnancy and the incidence rate of any STI at 14 weeks postpartum were significantly higher in HIV-1-infected women (P < 0.0001 amd P = 0.0079). More than 50% of N. gonorrhoeae, T. vaginalis, and C. trachomatis infections in pregnancy were asymptomatic.
  
  
  CONCLUSIONS
  The high prevalence of asymptomatic STIs in pregnancy is compelling evidence that demands the development and validation of point-of-care tests for STIs be expedited. In addition, the high incidence of STIs 3 months postpartum suggests that women in this study setting resume unprotected sexual intercourse soon after delivery.
authors.affiliation: From the *Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa; †Department of Infection, Prevention and Control, University of KwaZulu-Natal, Durban, South Africa; ‡CAPRISA, Durban, South Africa; §University of North Carolina at Chapel Hill, Chapel Hill, NC; and ¶Center on Health, Risk and Society, American University, Washington, DC.
authors.forename: Dhayendre
authors.initials: D
authors.lastname: Moodley
authors.forename: Prashini
authors.initials: P
authors.lastname: Moodley
authors.forename: Motshedisi
authors.initials: M
authors.lastname: Sebitloane
authors.forename: Deepak
authors.initials: D
authors.lastname: Soowamber
authors.forename: Heather Luz
authors.initials: HL
authors.lastname: McNaughton-Reyes
authors.forename: Allison K
authors.initials: AK
authors.lastname: Groves
authors.forename: Suzanne
authors.initials: S
authors.lastname: Maman
mesh_terms: D000328:Adult; D058345:Asymptomatic Infections / Q000453:epidemiology*; D002690:Chlamydia Infections / Q000453:epidemiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D015331:Cohort Studies; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology; D006678:HIV / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology; D015995:Prevalence; D011645:Puerperal Infection / Q000453:epidemiology; D012749:Sexually Transmitted Diseases / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology; D013019:South Africa / Q000453:epidemiology; D014247:Trichomonas Vaginitis / Q000453:epidemiology; D014246:Trichomonas vaginalis / Q000302:isolation & purification