title: Chlamydia trachomatis and Neisseria gonorrhoeae in HIV-infected Pregnant Women and Adverse Infant Outcomes.
abstract: BACKGROUND
  Sexually transmitted infections (STIs) in pregnancy such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) may lead to adverse infant outcomes.
  
  
  METHODS
  Individual urine specimens from HIV-infected pregnant women diagnosed with HIV during labor were collected at the time of infant birth and tested by polymerase chain reaction for CT and NG. Infant HIV infection was determined at 3 months with morbidity/mortality assessed through 6 months.
  
  
  RESULTS
  Of 1373 maternal urine samples, 277 (20.2%) were positive for CT and/or NG; 249 (18.1%) for CT, 63 (4.6%) for NG and 35 (2.5%) for both CT and NG. HIV infection was diagnosed in 117 (8.5%) infants. Highest rates of adverse outcomes (sepsis, pneumonia, congenital syphilis, septic arthritis, conjunctivitis, low birth weight, preterm delivery and death) were noted in infants of women with CT and NG (23/35, 65.7%) compared with NG (16/28, 57.1%), CT (84/214, 39.3%) and no STI (405/1096, 37%, P = 0.001). Death (11.4% vs. 3%, P = 0.02), low birth weight (42.9% vs. 16.9%, P = 0.001) and preterm delivery (28.6% vs. 10.2%, P = 0.008) were higher among infants of CT and NG-coinfected women. Infants who had any adverse outcome and were born to women with CT and/or NG were 3.5 times more likely to be HIV infected after controlling for maternal syphilis (odds ratio: 3.5, 95% confidence interval: 1.4-8.3). By adjusted multivariate logistic regression, infants born to mothers with any CT and/or NG were 1.35 times more likely to have an adverse outcome (odds ratio, 1.35; 95% confidence interval, 1.03-1.76).
  
  
  CONCLUSIONS
  STIs in HIV-infected pregnant women are associated with adverse outcomes in HIV-exposed infected and uninfected infants.
authors.affiliation: From the *David Geffen UCLA School of Medicine, Los Angeles, California; †UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, California; ‡Westat, Rockville, Maryland; §Fundacao Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil; ¶Office of the Global AIDS Coordinator, US Department of State, Washington DC; ‖Cepheid, Sunnyvale, California; **Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; ††Hospital Geral de Nova Iguaçu, DST/AIDS, Nova Iguaçu, Rio de Janeiro, Brazil; ‡‡Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil; §§SAMRC and Perinatal HIV Research Unit, University of Witwatersrand, Cape Town, South Africa; ¶¶Department of Obstetrics and Gynecology, Stellenbosch University/Tygerberg Hospital, Cape Town, South Africa; ‖‖Serviço de Infectologia, Hospital Conceicao, Porto Alegre, Rio Grande do Sul, Brazil; ***Hospital Femina, Porto Alegre, Rio Grande do Sul, Brazil; †††Irmandade da Santa Casa de Misericordia de Porto Alegre, Rio Grande do Sul, Brazil; ‡‡‡Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; §§§Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; ¶¶¶Foundation for Maternal and Infant Health (FUNDASAMIN), Buenos Aires, Argentina; and ‖‖‖Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Kristina
authors.initials: K
authors.lastname: Adachi
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
authors.forename: Jiahong
authors.initials: J
authors.lastname: Xu
authors.forename: Bonnie
authors.initials: B
authors.lastname: Ank
authors.forename: Claire C
authors.initials: CC
authors.lastname: Bristow
authors.forename: Mariza G
authors.initials: MG
authors.lastname: Morgado
authors.forename: D Heather
authors.initials: DH
authors.lastname: Watts
authors.forename: Fred
authors.initials: F
authors.lastname: Weir
authors.forename: David
authors.initials: D
authors.lastname: Persing
authors.forename: Lynne M
authors.initials: LM
authors.lastname: Mofenson
authors.forename: Valdilea G
authors.initials: VG
authors.lastname: Veloso
authors.forename: Jose Henrique
authors.initials: JH
authors.lastname: Pilotto
authors.forename: Esau
authors.initials: E
authors.lastname: Joao
authors.forename: Glenda
authors.initials: G
authors.lastname: Gray
authors.forename: Gerhard
authors.initials: G
authors.lastname: Theron
authors.forename: Breno
authors.initials: B
authors.lastname: Santos
authors.forename: Rosana
authors.initials: R
authors.lastname: Fonseca
authors.forename: Regis
authors.initials: R
authors.lastname: Kreitchmann
authors.forename: Jorge
authors.initials: J
authors.lastname: Pinto
authors.forename: Marisa M
authors.initials: MM
authors.lastname: Mussi-Pinhata
authors.forename: Mariana
authors.initials: M
authors.lastname: Ceriotto
authors.forename: Daisy Maria
authors.initials: DM
authors.lastname: Machado
authors.forename: Yvonne J
authors.initials: YJ
authors.lastname: Bryson
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.forename: Francisco I
authors.initials: FI
authors.lastname: Bastos
authors.forename: George
authors.initials: G
authors.lastname: Siberry
authors.forename: Karin
authors.initials: K
authors.lastname: Nielsen-Saines
mesh_terms: D002690:Chlamydia Infections / Q000150:complications / Q000453:epidemiology*; D002692:Chlamydia trachomatis; D015331:Cohort Studies; D005260:Female; D006069:Gonorrhea / Q000150:complications / Q000453:epidemiology*; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D009344:Neisseria gonorrhoeae; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic; D014556:Urine / Q000382:microbiology