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.