Prevalence, symptomology, and correlates of curable sexually transmitted infections among pregnant women in Eastern Cape, South Africa

BackgroundCurable sexually transmitted infections (STIs) contribute to adverse maternal and neonatal outcomes. Syndromic management is standard care in South Africa. We evaluated prevalence, symptomology, and correlates of curable STIs, among pregnant women in Eastern Cape, South Africa.MethodsWe conducted a cross-sectional analysis using baseline data from a randomized controlled trial of pregnant women attending their first antenatal care visit at public clinics in Buffalo City Municipality (2021-2024). Participants were tested for <i>Chlamydia (C.) trachomatis</i>, <i>Neisseria (N.) gonorrhoeae</i>, <i>Trichomonas (T.) vaginalis</i> using GeneXpert point-of-care tests and for syphilis using Alere Determine TP rapid test. Symptoms were self-reported and clinically-observed. Adjusted prevalence ratios were estimated using Poisson regression models with robust standard errors.ResultsAmong 1491 participants (median age: 28 years (IQR: 24-33); gestational age: 13 weeks (IQR: 8-18); HIV prevalence: 30%), STI prevalence was 27.6% (95% CI: 25.3-29.9): <i>C. trachomatis</i> 14.7%, <i>N. gonorrhea</i> 5%, <i>T. vaginalis</i> 10.2%, syphilis 3.4%. Women with HIV had higher STI prevalence (32.8% vs 25.3%, <i>p</i> = .003), particularly for <i>T. vaginalis</i> (17% vs 7.3%, <i>p</i> < .001); 20.1% of women with C<i>. trachomatis</i>, <i>N. gonorrhea</i>, and/or <i>T. vaginalis</i> were symptomatic, and 63% of symptomatic women tested STI-negative. Younger age, lower education, multiple sex partners and unknown HIV-serostatus of partners were associated with increased STI prevalence.ConclusionWe observed a high prevalence of STIs, particularly among women with HIV, with many asymptomatic cases; emphasizing the need for integrated point-of-care testing to ensure timely treatment, reduce antibiotic overuse, and improve maternal and neonatal outcomes.