Role of Genital Infections on pregnancy outcome with emphasis on syphilis

University dissertation from Department of Infectious Diseases and Medical Microbiology, Sölvegatan 23, 223 62 Lund

Abstract: OBJECTIVES: To elucidate the role of genital infections in last trimester pre-labour foetal death and the role and aetiology of chorioamnionitis in stillbirth in Maputo, Mozambique. To determine the role of current syphilis as a risk factor for foetal death in Maputo and the prevalence and risk factors for syphilis and HIV infection in displaced pregnant women in rural Zambezia province. To evaluate RPR predictive values in the diagnosis of syphilis during pregnancy. To evaluate an alternative screening approach among pregnant women. RESULTS: The frequency of histological chorioamnionitis was 1.4 times higher among cases compared to referents. Vasculitis was seen in 21% of the cases and 5% of the referents (OR=4.8%). Preterm birth was significantly higher among cases with chorioamnionitis compared with referents. Bacterial pathogens, particularly E.coli were recovered more frequently among cases with inflammation of the membranes or in the chorionic plate (OR=4.03 and OR=4.09). Seroreactivity in both RPR and MHA-TP occurred in 42% of cases and in 12% of controls (OR=5.3).In 32% of women with serological evidence of present or recently past syphilis (7 cases and 2 referents) placental morphological changes indicated syphilitic infection. The seroprevalence of syphilis and HIV among the displaced pregnant women was 12.2% and 2%. History of past STD, genital ulcers, vaginal discharge, genital warts and HIV infection were associated with TPHA seroreactivity; reported practice of anal sex , history of past STD and positive syphilis serology were correlated with HIV infection. Calculated RPR sensitivity, specificity and negative predictive value were 70.3%, 98.7% and 96.0%.The perinatal mortality rate was significantly higher in the control group than in the intervention group (p=0.03). CONCLUSION: Chorioamnionitis and preterm birth were strongly correlated with stillbirth. Recovery of any bacterial species from the placenta or the internal organs of stillborn was associated with stillbirth. E. coli was significantly associated with stillbirth and with chorioamnionitis among stillborns. In 12 stillborn and 3 newborn vasculitis was histologically detected, strongly supporting that infection took place when the foetus was alive. Syphilis seroprevalence was high among pregnant women, and syphilis is a risk factor for stillbirth in Maputo. Serological evidence of present or past syphilis was significantly associated with history of past STD, HIV infection, and current genital ulcers, vaginal discharge, or genital warts.

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