BACKGROUND
According to a United Nations report from 2021, five million children died before their fifth birthday and 56% of these deaths occurred in Sub-Saharan Africa.(1) The leading cause of death before five years was preterm birth complications(2). Low birth weight, primarily resulting from preterm birth or intrauterine growth restriction, is also associated with increased risk for neonatal death and morbidity. (3) Many causes of preterm birth and low birth weight are preventable.
Common, curable sexually transmitted infections (STIs) such asChlamydia (C.) trachomatis and Neisseria (N.) gonorrhoeaeare associated with preterm birth or low birth weight.(4, 5) A meta-analysis of 12 studies found that antenatal C. trachomatisinfection increased the relative risk for preterm labor by 40%. (6) A systematic review and meta-analysis found that N. gonorrhoeaeinfection increased the odds of preterm birth by 55% and low birth weight by 66%. (7)
While antenatal C. trachomatis and N. gonorrhoeaeinfections are associated with preterm birth or low birth weight, research is mixed on whether etiologic screening and treatment can reduce adverse outcomes.(8) The majority of low and middle income countries do not screen pregnant women for those infections and continue to adapt the World Health Organization (WHO)-endorsed syndromic approach for managing urogenital symptoms (e.g. vaginal discharge) caused byC. trachomatis and N. gonorrhoeae infections.(9) Syndromic management allows for same-day treatment of symptoms; however, by only addressing symptomatic infections, asymptomatic infections are untreated.(10) Thus, research is needed to evaluate whether routine screening and treatment of asymptomatic C. trachomatis andN. gonorrhoeae infections during pregnancy can reduce adverse birth outcomes.
This study evaluated the impact of C. trachomatis and N. gonorrhoeae screening and treatment on preterm or low birth weight outcomes compared with the standard-of-care, syndromic management. Research was conducted among pregnant women living in Gaborone, Botswana who were asymptomatic for C. trachomatis and/or N. gonorrhoeae infections at their first antenatal care visit.