Prevalence & Risk Factors of Three Curable Sexually Transmitted Infections among Women in Nairobi, Kenya

BACKGROUND:

Sexually transmitted infections (STIs) are a major public health problem, especially in developing countries. The complications of untreated STIs in the female genital tract and their role in adverse pregnancy and perinatal outcomes have been well documented. The prevalence of STIs in Kenya among women in the general population has not been extensively studied and there is a lack of guidelines for screening of non-pregnant women. Knowledge of the prevalence of curable STIs among this population can provide a basis for integrating STI screening in family planning clinics.

METHODS:

A cross-sectional study was conducted between May and September 2013 at the family planning (FP) clinic at Kenyatta National Hospital (KNH) in Nairobi, Kenya. A total of 261 participants aged 18-49 years were enrolled; with data from 249 participants being analysed. An interviewer-administered questionnaire was used to gather socio-demographic data and assess for risk factors. Each participant was screened for Trichomonas vaginalis (TV) by wet mount microscopy; Neisseria gonorrhoeae (GC) by culture and Chlamydia trachomatis (CT) by PCR.

RESULTS:

The prevalence of CT was 13 % (33/249), TV 0.4 % (1/249) and GC 0 % (0/249). All the infected women reported having had only one sexual partner in the previous 1 year. The age group prevalence for CT was highest in the 25-29 years age group (21 %). The syndromic approach to the management of STIs showed a low specificity (vaginal discharge, 65.7 %; lower abdominal pain, 60.6 %) and positive predictive value (vaginal discharge, 14 %; lower abdominal pain, 11.5 %) for the two commonly used symptoms when compared to the gold standard of CT PCR.

CONCLUSION:

A high prevalence of CT was identified among women attending the FP Clinic at KNH. The study reinforces the need to implement regular screening for STIs among FP clinic attendants. It also reveals the need to review the usage of the syndromic approach for the management of STIs.

Characteristics of CT positive participants

Characteristics	Chlamydia infections/n	Prevalence (%)	P value
Age group
<25	1/13	8
25–29	6/28	21
30–34	6/56	11
35–39	10/67	15
40–44	8/48	17
45–49	2/37	5
Marital status
Married	29/211	14	0.59
Not married	4/38	11
Education level
Primary and below	11/67	16	0.37
Above primary	22/182	12
Occupation
Paid employment	11/83	13	0.9
Self employed	16/127	13
Unemployed	6/39	15
Coitarche
≤20 years	21/160	13	0.95
>20 years	10/78	13
Treated STIs
No	32/224	14	0.22
Yes	1/25	4

Full article at:   http://goo.gl/zLt0e0

By:  Maina AN1, Kimani J2, Anzala O3.

• 1Department of Medical Microbiology, University of Nairobi, P.O BOX 19676-00202, Nairobi, Kenya. acnmaina@yahoo.com.
• 2Kenya AIDS Control Project, University of Manitoba/Nairobi Collaborative Research Group, P.O BOX 19676-00202, Nairobi, Kenya.
• 3KAVI Institute of Clinical Research, University of Nairobi, P.O BOX 19676-00202, Nairobi, Kenya.
• BMC Res Notes. 2016 Mar 29;9(1):193. doi: 10.1186/s13104-016-1990-x. 

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HIV Risk & Behaviour among Part-Time vs Professional Female Sex Workers: Baseline Report of an Interventional Cohort in Burkina Faso

OBJECTIVE:

To readjust HIV control programmes in Africa, we assessed the factors associated with high-risk behaviours and HIV infection among young female sex workers (FSW) in Burkina Faso.

METHODS:

We carried out a cross-sectional study from September 2009 to September 2010 in Ouagadougou, the capital city. FSW were categorised as professionals and part-time sex workers (PTSW). After a face-to-face questionnaire, blood and urine samples were collected for HIV, HSV-2, genital infections and pregnancy. High-risk behaviour was defined as a recent unprotected sex with either casual clients, regular clients or regular partners.

RESULTS:

We recruited 609 FSW including 188 (30.9%) professionals. Their median age was 21 years (IQR 19-23), and the prevalence of HIV was 10.3% among professionals and 6.5% among PTSW. Only 3 of 46 HIV-infected women were aware of their status. Overall, 277 (45.6%) women reported high-risk behaviours (41.2% among professionals and 47.5% among PTSW), which were driven mainly by non-systematic condom use with regular partners. In multivariable analysis, PTSW and having a primary or higher education level remained associated with high-risk behaviours. HIV infection was associated with older age with being married/cohabiting and with Trichomonas vaginalis infection, while history of HIV testing was associated with a decreased risk.

CONCLUSIONS:

This study highlights the need for targeted interventions among young FSW focusing particularly on PTSW, sexual behaviours with regular partners and regular HIV testing.

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By:  Traore IT1, Hema NM2, Sanon A1, Some F2, Ouedraogo D2, Some R2, Niessougou J2, Konate I1, Mayaud P3, Van De Perre P4, Meda N5, Nagot N4.

• 1Department of Clinical Research, Centre Muraz, Bobo-Dioulasso, Burkina Faso.
• 2Centre of International Research for Health, University of Ouagadougou, Ouagadougou, Burkina Faso.
• 3Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
• 4CHU Montpellier & INSERM U1058, Montpellier, France.
• 5Department of Public Health, Centre Muraz, Bobo-Dioulasso, Burkina Faso Department of Public Health, University of Ouagadougou, Ouagadougou, Burkina Faso. 
• Sex Transm Infect. 2016 Feb 1. pii: sextrans-2015-052038. doi: 10.1136/sextrans-2015-052038.

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Sustained High Prevalence of Viral Hepatitis and Sexually Transmissible Infections among Female Sex Workers in China: A Systematic Review and Meta-Analysis

Background

The 1980’s economic boom has been associated with a rapid expansion of China’s sex industry over the past three decades. Consequently, the spread of sexually transmitted infections (STIs) and hepatitis infections among female sex workers (FSW) has become an important public health issue in China. This study identifies prevalence and risks of hepatitis and STIs in Chinese FSWs.

Method

Four electronic databases were searched for Chinese and English language peer-reviewed studies conducted between 01/2000-12/2011 that reported prevalence of hepatitis and STIs (excluding HIV) among Chinese FSW. Following the PRISMA guidelines, meta-analysis was used to estimate pooled prevalence and 95 % confidence intervals for each infection.

Result

Three hundred and thirty nine articles (34 in English and 305 in Chinese) investigating 603,647 FSWs in 29 Chinese provinces were included in this review. Over the period 2000–2011, the seroprevalence of active hepatitis B and hepatitis C among FSW were 10.7 % (7.3–15.5 %) and 1.0 % (0.7–1.3 %), respectively. The most prevalent STI was human papillomavirus (HPV, 27.0 % [10.1–55.1 %]), followed by herpes simplex virus-2 (HSV-2, 15.8 % [11.7–20.9 %]), chlamydia (13.7 % [12.1–15.4 %]), gonorrhoea (6.1 % [5.3–7.0 %]), syphilis (5.2 % [4.8–5.7 %]), genital warts (3.3 % [2.5–4.2 %]) and Trichomonas vaginitis (2.1 % [1.5–24.2 %]). Disease burden of both hepatitis and STI among FSW were concentrated in South Central and Southwest China. In particular, chlamydia and syphilis demonstrated a significant declining trend during the studied period (P < 0.05). Compared with the general Chinese population, FSW had significantly higher prevalence of all STIs except Trichomonas vaginitis. Further, compared to the general FSW population, HIV-positive FSW had significantly higher prevalence of syphilis, chlamydia, HSV-2 and Trichomonas vaginitis.

Conclusion

Prevalence of hepatitis and STIs remained high and mostly stable among Chinese FSW over the period of 2000–2011. Targeted STI and hepatitis surveillance and interventions should be strengthened among Chinese FSWs, especially those who are HIV-positive.

Below:  a. Estimated prevalence of sexually transmitted infections including Hepatitis B and C virus among female sex workers in six Chinese regions during 2000–2011. *Only infection with > 10 papers were included, so the analysis excluded HPV because there are only four papers being found. b. Level of disease burden among female workers across the six regions in China during 2000–2011 (high, moderate and low prevalence represent the top, middle and bottom one-third of prevalence ranking among the six Chinese regions). *Only infection with > 10 papers were included, so the analysis excluded HPV because there are only four papers being found

Full article at:   http://goo.gl/IEGUPh

By:  Shu Su, Eric P. F. Chow, Kathryn E. Muessig, Lei Yuan, Joseph D. Tucker, Xiaohu Zhang, Jiehui Ren, Christopher K. Fairley, Jun Jing and Lei Zhang

Affiliated with

Research Center for Public Health, School of Medicine, Tsinghua University

Melbourne Sexual Health Centre, Alfred Health

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Prevalence of Seven Sexually Transmitted Organisms by Multiplex Real-Time PCR in Fallopian Tube Specimens Collected from Saudi Women With & Without Ectopic Pregnancy

BACKGROUND:

Ectopic pregnancy (EP) is associated with maternal morbidity and occasionally mortality during the first trimester. A history of sexually transmitted infection (STI) and pelvic inflammatory disease have been implicated as major risk factors for EP. Our aim was to measure the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae, Mycoplasma genitalium (MG), Ureaplasma parvum/urealyticum, Gardnerella vaginalis, Trichomonas vaginalis and herpes simplex virus (HSV)-1&2 in Fallopian tubes collected from EP and the results were compared with those obtained from total abdominal hysterectomy (TAH) and tubal ligation.

METHODS:

This was a prospective case-control study and tubal samples were collected from 135 Saudi women recruited from 3 centres in the Western region as follow: 84 EPs, 20 TAH and 31 tubal ligations. Multiplex TaqMan PCR was performed using an IVD CE kit for the simultaneous detection of candidate pathogens following DNA extraction.

RESULTS:

Infections were detected in 31.8 % of the 135 participants either as single (11.1 %) or co-infections (20.7 %) and the frequencies were significantly higher in EP (42.85 %) compared with control (13.72 %). The rates of CT (27.4 %; P = 0.001); MG (20.2 %; P = 0.009) and HSV-1/2 (21.4 %; P = 0.01) were significantly higher in EP. No significant difference between the study groups was observed for the other pathogens (P > 0.05). Binary logistic regression also showed that infection with ≥ 2 pathogens (OR 4.9; 95 % CI: 2.2 - 11.6; P = 0.006), CT (OR 3.07; 95 % CI: 1.3 - 12.3; P = 0.002), MG (OR 2.3; 95 % CI: 1.1 - 8.6; P = 0.03) and HSV-1/2 (OR 1.7; 95 % CI: 0.75 - 5.7; P = 0.004) were associated with a significantly higher risk of developing EP.

CONCLUSIONS:

STIs are frequent in the upper genital tract of Saudi women during the reproductive age and, CT, MG and HSV-1/2 were more prevalent in EP. The observed high rates of co-infection advocate the necessity of establishing national guidelines and/or screening program utilising multiplex PCR approach for the detection of common STIs among high risk groups in the kingdom. Further studies are needed to measure the adverse reproductive outcomes associated with STIs in Saudi Arabia.

Table 1

Principle inclusion and exclusion criteria for the study groups

Control group		Case group
Inclusion criteria	Exclusion criteria	Inclusion criteria	Exclusion criteria
Saudi	Non-Saudi	Saudi	Non-Saudi
Patient age ≥ 18 and ≤ 42 years.	Patient age < 18 or > 42 years.	Patient age ≥ 18 and < 40 years.	Patient age < 18 or > 40 years.
Cyclic women with a history of previous intrauterine pregnancy and no history of hydrosalpinx or ectopic pregnancy	Women with abnormal menstrual cycle, history of infertility treatment, history of PID, endometriosis and previous ectopic pregnancy.	Ectopic pregnancy following spontaneous conception	Ectopic pregnancy following assisted conception, using IUD, History/symptoms of urogenital infection (e.g. vaginal discharge, dysuria, PID, etc.)
Clinical decision to undertake total abdominal hysterectomy (TAH) for benign disease not affecting the Fallopian tubes and endometrium	Vaginal or subtotal hysterectomy	Singleton pregnancy	Multiple/heterotopic pregnancy
Clinical decision to undertake tubal ligation for sterilisation	Use of IUD ≤ 1 year prior to operation	Clinical determination that the patient is haemodynamically stable	Symptoms and signs of hypovolemia

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By:   Ashshi AM1, Batwa SA2, Kutbi SY3, Malibary FA4, Batwa M5, Refaat B6.

• 1Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, Makkah, PO Box 7607, KSA. aashshi@yhaoo.com.
• 2Obstertics and Gynaecology Department, Maternity and Children Hospital, Al-Aziziyah, Jeddah, KSA. sarahbatwa@hotmail.com.
• 3Obstertics and Gynaecology Department, Maternity and Children Hospital, Al-Aziziyah, Jeddah, KSA. seham.alkutbi@yahoo.com.
• 4Obstertics and Gynaecology Department, Maternity and Children Hospital, Al-Aziziyah, Jeddah, KSA. fzmilly12345@gmail.com.
• 5Al-Thager General Hospital, Jeddah, KSA. mbatwa@hotmail.com.
• 6Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, Makkah, PO Box 7607, KSA. bassem.refaat@yahoo.co.uk. 

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Trichomoniasis: The “Neglected” Sexually Transmitted Disease

KEY POINTS

• Although Trichomonas vaginalis is the most prevalent curable sexually transmitted infection, it has been considered a “neglected” parasitic infection, due to limited knowledge of its sequelae and associated costs.
• Newly available diagnostic methods, including nucleic acid amplification tests, may improve the ability to identify trichomoniasis in the clinical setting.
• Infections usually can be cured with a single oral dose of a nitroimidazole antimicrobial (eg, metronidazole or tinidazole). Allergy and antimicrobial resistance are of concern, given the lack of effective treatment alternatives.
• Prevention approaches include condoms and treatment for all sex partners.

 PREVENTION

Approaches to preventing trichomoniasis include:

• Abstaining from sex
• Using condoms
• Ensuring that all sex partners receive adequate treatment
• Refraining from douching

STDs, including trichomoniasis, can be avoided by abstaining entirely from sex. Among sexually active individuals, however, a more realistic approach may be to use condoms consistently and correctly.⁴⁹

All sex partners of a person diagnosed with T vaginalis infection should be notified promptly and treated appropriately before resuming sexual activity. Patient-delivered partner therapy has been found to be as effective as standard notification, and is an option in states where this strategy is permissible.^50,51

Douching is not effective in reducing trichomoniasis; on the contrary, this practice may be a risk factor for T vaginalis and other sexually transmitted infections.^2,52

Although T vaginalis infection is quite common, and usually curable with a widely available and fairly inexpensive medication, a lack of public awareness makes trichomoniasis a “neglected” STD. Disparities in the prevalence of infection by sex, age, race/ethnicity, and setting should be recognized. The emergence of antimicrobial resistance and lack of alternative treatments is of concern. Additional data regarding the severity and costs of infection, as well as evidence that treatment of T vaginalis can prevent associated conditions, could lead to wider recognition of this infection in the future.

CONTROVERSIES

Neither trichomoniasis nor T vaginalis infection is a nationally notifiable condition in the United States.⁵³Furthermore, neither the infection nor the disease is currently reportable to the health department of any state. Although the frequency, communicability, and associated health disparities have been clearly identified, consistent data are still lacking regarding severity of infection, preventability of associated adverse events, and costs. Finally, there has been little interest in this infection among members of the general public.⁵³

Below:  Trichomonas vaginalis parasites

Full article at:   http://goo.gl/L5w2rM

By:   Elissa Meites, MD, MPH

Elissa Meites, Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, MS E-02, Atlanta, GA 30333, USA;

Elissa Meites: vog.cdc@setieme

  

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Sexually transmitted infections in children as a marker of child sexual abuse and direction of future research

PURPOSE OF REVIEW:

This review considers recent evidence on sexually transmitted infections (STIs) as a marker of child sexual abuse (CSA), when diagnosed after the neonatal period. It also aims to identify if there are specific areas where additional research is required.

RECENT FINDINGS:

An evidence-based systematic review using strict inclusion criteria shows that CSA is a major cause of STIs in children. In children 12 years and below, 36-83% of Neisseria gonorrhoeae and 75-94% of Chlamydia trachomatis infections are due to CSA; for children 14 years and younger, 31-58% of anogenital warts are due to CSA. In child genital sampling, genital human papillomavirus (HPV) types were more common in those considered abused (13.7%) than nonabused (1.3%). HPV typing of genital warts in children were all of genital type 6. Subsequent research, into N. gonorrhoeae, C. trachomatis, Trichomonas vaginalis and syphilis in children including ophthalmic infection, found that 13 of 15 cases were confirmed/likely due to CSA. Recent data indicate that bacterial vaginosis and Mycoplasma genitalium are related to sexual activity in adults but did not assess children.

SUMMARY:

STIs in children under 13-14 years may indicate CSA. Genital HPV types are associated with CSA. Research is required of sufficient standard to contribute to the evidence base.

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By:   Rogstad KE1, Wilkinson D, Robinson A.

• 1aDepartment of Genitourinary Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield School of Medicine Sheffield bDepartment of Genitourinary Medicine, Jefferiss Wing Centre for Sexual Health, St Mary's Hospital, Imperial College Healthcare NHS Trust cDepartment of Genitourinary/HIV Medicine, CNWL NHS Foundation, Trust and UCL, London, UK. 

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Correlates of Trichomonas vaginalis among Middle Age and Older Adults Who Use Drugs

BACKGROUND:

Recent studies have reported high rates of Trichomonas vaginalis among middle age and older adults. Though trichomoniasis risk factors in this age cohort remain largely unknown, illicit drug use has been associated with increased incidence of sexually transmitted infections (STIs). The number of mid-older adults using illicit drugs has increased significantly in recent years suggesting the need to understand the relationship between drug use and STIs in this age cohort.

OBJECTIVES:

This study examined the relationship between drug use, sexual-risk behaviors, and biologically confirmed T. vaginalis in a sample of mid-older and younger adults who reported recent drug use.

METHODS:

The cross-sectional design examined the relationship between past 6-month drug use, sexual risk-behaviors, and PCR-confirmed T. vaginalis in 264 adults age 18-64 who were recruited from Baltimore, Maryland. These relationships were also explored in the age-stratified sample among those 18-44 years ("younger") and individuals 45+ years ("mid-older").

RESULTS:

Trichomoniasis prevalence did not differ significantly between younger (18.8%) and mid-older (19.1%) adults. Mid-older adults that tested positive for T. vaginalis were more likely to have used marijuana and crack in the past 6 months. Among younger adults, there were no associations between trichomoniasis and past 6-month drug use and sexual-risk behavior.

CONCLUSIONS/IMPORTANCE:

Age- and drug-related immune decline is hypothesized to contribute to increase susceptibility to T. vaginalis in mid-older adults. Broad screening for trichomoniasis, particularly among older adults who are often not regarded as at risk for STIs, is needed to control this often asymptomatic infection.

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By:  Hearn LE1, Whitehead NE1, Dunne EM1, Latimer WW2.

• 1 Clinical and Health Psychology , University of Florida , Gainesville , Florida , USA.
• 2 School of Health Sciences , Human Services and Nursing, Lehman College , CUNY , Bronx, New York , USA.

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Prevalent Bacterial Vaginosis Infection - A Risk Factor for Incident Sexually Transmitted Infections in Women in Durban, South Africa

The association between bacterial vaginosis (BV) and incident sexually transmitted infections (STIs) in a cohort of high-risk women from Durban, South Africa was investigated in this study. 

We undertook a secondary analysis of the Methods for Improving Reproductive Health in Africa trial that assessed effectiveness of the latex diaphragm and lubricant gel on HIV prevention among women. During study visits, urine specimens were collected for testing for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. The presence of BV was based on vaginal pH and wet mount test assessments. The association between BV and the risk for incident STIs was determined using Cox proportional hazards model. Prevalence of BV was 31% in a cohort of 435 women tested at baseline. Among these women, BV was significantly associated with incident Trichomonas vaginalis (14.6 per 100 PY, p = 0.03) and Chlamydia trachomatis infections (15.8 per 100 PY, p = 0.04). BV remained a significant predictor for Trichomonas vaginalis infections even after adjusting for potential confounders such as age and marital status (HR: 1.60, 95% CI: 1.00, 2.57, p = 0.04). 

Our study showed an association between baseline BV infections and incident Trichomonas vaginalis and Chlamydia trachomatis infections. Women with BV infections should be counselled on the use of condoms and the risk of new STIs.

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By: Abbai NS1, Reddy T2, Ramjee G3.

• 1HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa Nathlee.abbai@mrc.ac.za.
• 2Biostatistics Unit, South African Medical Research Council, Durban, South Africa.
• 3HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.  

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Alcohol Use Problems and Sexual Risk among Young Adult African American Mothers

Studies have documented high levels of alcohol use and sexual risk among young mothers. We examined parenting satisfaction and self-efficacy in relation to alcohol use problems and sexual risk among 346 young African American women enrolled in an HIV prevention trial, 41 % (n = 141) of whom were mothers. 

Among mothers, greater parenting satisfaction was associated with a reduced likelihood of problematic alcohol use, having multiple sex partners, and testing positive for Trichomonas vaginalis. Relative to non-parenting women, mothers reported lower condom use. 

Compared to non-parenting women, mothers with the highest parenting satisfaction reported fewer alcohol use problems; mothers with the lowest parenting satisfaction reported lower condom use and were more likely to have multiple partners and test positive for T. vaginalis. 

Parenting self-efficacy was not associated with the outcomes examined. Future research investigating relationships between parenting satisfaction, alcohol use and sexual risk may be useful for improving multiple maternal health outcomes.

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By: Swartzendruber A1,2, Sales JM3,4, Rose ES3, DiClemente RJ3,4,5.

• 1Department of Behavioral Sciences & Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA, 30322, USA. alswart@emory.edu.
• 2Centers for AIDS Research, Emory University, Atlanta, GA, USA. alswart@emory.edu.
• 3Department of Behavioral Sciences & Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA, 30322, USA.
• 4Centers for AIDS Research, Emory University, Atlanta, GA, USA.
• 5Division of Infectious Diseases, Epidemiology, and Immunology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.  

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Genital Infections & Risk of Premature Rupture of Membranes in Mulago Hospital, Uganda: A Case Control Study

Inflammatory mediators that weaken and cause membrane rupture are released during the course of genital infections among pregnant women. We set out to determine the association of common genital infections (Trichomonas vaginalis, syphilis, Neisseria gonorrhea, Chlamydia trachomatis, Group B Streptococcus, Bacterial vaginosis, Herpes Simplex Virus Type 2 and candidiasis) and premature rupture of membranes in Mulago hospital, Uganda.

We conducted an unmatched case-control study among women who were in the third trimester of pregnancy at New Mulago hospital, Uganda. The cases had PROM and the controls had intact membranes during latent phase of labour in the labour ward. We used interviewer-administered questionnaires to collect data on socio-demographic characteristics, obstetric and medical history. Laboratory tests were conducted to identify T. vaginalis, syphilis, N. gonorrhea, C. trachomatis, Group B Streptococcus, Bacterial vaginosis, Herpes Simplex Virus Type 2 (HSV-2) and candidiasis. Logistic regression models were used to estimate the odds ratios (OR) and 95 % CI of the association between genital infections and PROM.

There was an association between PROM and abnormal vaginal discharge, presence of candidiasis and T. vaginalis. However, there was no association between PROM and presence of C. trachomatis and HSV-2 serostatus. Few or no patients with Bacterial vaginosis, Neisseria gonorrhoea, Group B streptococcus or syphilis were identified among the cases and controls. Co-infection of Trichomoniasis and candidiasis was not associated with PROM. Co infection with T. vaginalis and C. trachomatis was associated with PROM.

Trichomonas vaginalis alone, T. vaginalis with C. trachomatis co-infection and abnormal per vaginal discharge were found as risk factors for PROM. There was no association of HSV-2 serostatus, syphilis, N. gonorrhea, C. trachomatis, Group B Streptococcus and Bacterial vaginosis with PROM. Candidiasis seemed to have a protective effect on PROM.

Table 3

Genital infections and risk for PROM in Mulago Hospital

Variable	Unadjusted odds ratio (95 % CI)	Adjusted odds ratio (95 %) in model 1	Adjusted odds ratio (95 %) in model 2a	Adjusted odds ratio (95 %) in model 3b
Abnormal vaginal discharge
Yes	2.02 (1.10–3.70)	2.30 (1.18–4.47)	2.30 (1.18–4.40)	2.30 (1.18–4.46)
No
HIV status
Positive	0.99 (0.42–2.34)	1.38 (0.51–3.75)	1.30 (0.51–3.72)	1.38 (0.51–3.75)
Negative
Trichomonas vaginalis
Positive	2.98 (1.18–7.56)	4.22 (1.51–11.80)	3.70 (0.92–14.90)
Negative
Chlamydia trachomatis
Positive	2.05 (0.37–11.49)	1.91 (0.30–12.22)	1.92 (0.30–12.20)
Negative
Candida
Positive	0.27 (0.14–0.52)	0.22 (0.10–0.46)	0.16 (0.02–1.22)	0.22 (1.51–11.83)
Negative
HSV-2
Positive	1.15 (0.63–2.09)	0.95 (0.48–1.88)	0.94 (0.48–1.87)	0.95 (0.48–1.88)
Negative
Trichomonas and candida	0.49 (0.27–0.90)		1.34 (0.16–11.10)	1.34 (0.16–11.10)
Trichomonas and Chlamydia	3.09 (1.21–7.84)			4.22 (1.51–11.83)

In this table we have three models after multivariable analysis. Model 1 included abnormal vaginal discharge, HIV status Trichomonas vaginalis, Chlamydia trachomatis, candidiasis and HSV-2 serostatus. The italicized odds ratios were either independent risk factors for PROM (abnormal vaginal discharge and Trichomonas) or protective factors (candidiasis). Model 2 is included to assess whether co-infection with Trichomoniasis and candidiasis was a risk factor for premature rupture of membranes and found that this interaction was not a risk factor for PROM at multivariable analysis. Model 3 is included to assess whether co-infection with Trichomonas vaginalis and Chlamydia trachomatis was associated with PROM and it is shown that this interaction is a risk factor for PROM

aThe model 2 assesses interactions between Trichomonas vaginalis and candidiasis

bThe model 3 assesses interaction between Trichomonas vaginalis and Chlamydia trachomatis

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By: Nakubulwa S1, Kaye DK2, Bwanga F3, Tumwesigye NM4, Mirembe FM5.

• 1Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, P O Box 7072, Kampala, Uganda. sarahug@gmail.com.
• 2Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, P O Box 7072, Kampala, Uganda. dankkaye@yahoo.com.
• 3Department of Microbiology, Makerere University College of Health Sciences, P O Box 7072, Kampala, Uganda. fxb18@case.edu.
• 4School of Public Health, Makerere University College of Health Sciences, P O Box 7072, Kampala, Uganda. naz@musph.ac.ug.
• 5Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, P O Box 7072, Kampala, Uganda. flomir2002@yahoo.com.  

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