Crispin Mukerebe

We quantified incident pregnancies among reproductive-aged women with and without Schistosoma haematobium infection. Among 245 women, 59 (24.1%) became pregnant during a median follow-up of 370 days. Women with S. haematobium infection had a 52% lower rate of pregnancy within the study period compared with uninfected women (hazard ratio = 0.48 [0.29–0.80], P = .005).

Schistosoma haematobium infection may impair female genital mucosal antiviral defense. We sought to determine whether women with S. haematobium infection had higher odds of high-risk human papillomavirus (HR-HPV) persistence, a prerequisite to cervical cancer. We also examined cervicovaginal dysbiosis, which has been linked to HR-HPV persistence and schistosome infection. In 96 Tanzanian women with baseline and 9- to 12-month follow-up samples, we performed HPV genotyping, schistosome antigen quantification, and 16S rRNA sequencing. Both S. haematobium (odds ratio: 4.7 [1.3–16.5], P = .017) and Gardnerella-dominant microbiome (P = .049) were associated with HR-HPV persistence, suggesting these factors may contribute to high cervical cancer rates in Africa.

Objectives: Malaria and curable sexually transmitted and reproductive tract infections (STIs/RTIs) are associated with adverse pregnancy outcomes. This study reports the prevalence and risk factors of curable STIs/RTIs, STI/RTI co-infection and STI/RTI and malaria co-infection among HIV-negative pregnant women at their first antenatal care visit in Kenya, Malawi and Tanzania.Methods: HIV-negative pregnant women of all gravidae (n=4680) were screened for syphilis with point-of-care tests and treated if positive. Separately, women provided blood samples (n=4569) for rapid plasma reagin (RPR) testing; positive cases were confirmation byTreponema pallidumparticle agglutination (TPPA). Women also provided dried blood spots for batch testing of malaria by retrospective polymerase chain reaction (PCR (n=4226) methods. A randomly selected subgroup of women provided vaginal swabs for chlamydia, gonorrhoea and trichomoniasis testing by retrospective PCR batch testing (n=1431), and bacterial vaginosis diagnosis by Nugent scoring (n=1402).Results: Malaria prevalence was 14.6% (95% CI 13.6 to 15.7), 45.9% (43.4 to 48.4) of women were positive for at least one curable STI/RTI and 6.7% (5.5 to 8.1) were co-infected with malaria and a curable STI/RTI. Prevalence of individual STIs/RTIs ranged from 28.5% (26.2 to 30.9) for bacterial vaginosis to 14.5% (12.7 to 16.4) for trichomoniasis, 13.8% (12.1 to 15.7) for chlamydia, 2.7% (1.9 to 3.6) for gonorrhoea and 1.7% (1.4 to 2.2) for RPR/TPPA-confirmed syphilis. The prevalence of STI/RTI co-infection was 10.1% (8.7 to 11.8). Paucigravidae, at highest risk of malaria, were also at greater risk of having chlamydia, gonorrhoea and bacterial vaginosis than multigravidae.Conclusions: Of women infected with malaria, 49.0% also had a curable STI/RTI and one in five women with at least one STI/RTI were co-infected with more than one STI/RTI. Current antenatal interventions that address malaria and curable STIs/RTIs remain suboptimal. New approaches to preventing and managing these infections in pregnancy are urgently needed.Trial registration number: NCT03208179.