{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:19:26Z","timestamp":1768569566202,"version":"3.49.0"},"posted":{"date-parts":[[2025,7,3]]},"group-title":"Sexual and Reproductive Health","reference-count":40,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T00:00:00Z","timestamp":1751500800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In sub-Saharan Africa, sexually transmitted and reproductive tract infections (STIs\/RTIs) are important, but underdiagnosed risk factors for adverse pregnancy outcomes. Sulfadoxine-pyrimethamine (SP), used for intermittent preventive treatment of malaria in pregnancy (IPTp), may reduce STI\/RTI burden due to its antibacterial activity. We assessed the impact of IPTp regimens on STI\/RTI prevalence at delivery and associations between these infections and adverse birth outcomes.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    We conducted a secondary analysis of a randomized controlled trial comparing monthly IPTp with SP, dihydroartemisinin-piperaquine (DP), or DP+SP among pregnant women in Uganda. Vaginal swabs collected at or near delivery were tested for\n                    <jats:italic>Chlamydia trachomatis<\/jats:italic>\n                    ,\n                    <jats:italic>Neisseria gonorrhoeae<\/jats:italic>\n                    ,\n                    <jats:italic>Trichomonas vaginalis<\/jats:italic>\n                    , and Group B\n                    <jats:italic>Streptococcus<\/jats:italic>\n                    (GBS) using GeneXpert; bacterial vaginosis was assessed using Nugent scoring. Log-binomial regression was used to compare STI\/RTI prevalence by IPTp arm, using IPTp-DP as the reference arm. Multivariable Poisson regression with robust standard errors was used to evaluate associations between infections and preterm delivery, term low birthweight (LBW), overall LBW, and small-for-gestational age.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>\n                    Among the 2265 participants assessed, IPTp-SP reduced prevalence of\n                    <jats:italic>C. trachomatis<\/jats:italic>\n                    by 80% (2.5% vs. 12.4%; RR=0.20, 95% CI: 0.12-0.33) and of GBS by 35% (7.7% vs 11.7%; RR=0.65, 95% CI: 0.43-0.99) compared to IPTp-DP.\n                    <jats:italic>C. trachomatis<\/jats:italic>\n                    was associated with increased preterm delivery risk (RR=1.86, 95% CI: 1.07-3.25) and GBS was associated with increased term LBW risk (RR=2.08, 95% CI: 1.06-4.08).\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>\n                    Monthly IPTp-SP reduced the prevalence of\n                    <jats:italic>C. trachomatis<\/jats:italic>\n                    and GBS. These infections were associated with adverse birth outcomes, highlighting the potential non-malarial benefits of IPTp-SP.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Key Messages<\/jats:title>\n                  <jats:list list-type=\"bullet\">\n                    <jats:list-item>\n                      <jats:p>In sub-Saharan Africa, management of sexually transmitted and reproductive tract infections (STIs\/RTIs) relies on syndromic management, despite its high prevalence and potential risks associated with asymptomatic infections.<\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>Prior studies suggest that sulfadoxine-pyrimethamine (SP), the standard-of-care drug used for intermittent preventive treatment of malaria in pregnancy (IPTp), may exhibit activity certain STI\/RTI pathogens, likely stemming from the sulfonamide component of the drug.<\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>\n                        Using data from a randomized trial comparing monthly IPTp regimens, we found IPTp-SP was associated with an 80% [95% CI: 67%-88%] reduction in\n                        <jats:italic>Chlamydia trachomatis<\/jats:italic>\n                        (2.5% versus 12.4%) and a 35% [95% CI: 1%-57%] reduction in Group B\n                        <jats:italic>Streptococcus<\/jats:italic>\n                        (7.7% vs. 11.7%) compared to IPTp-DP, an antimalarial with no known antibiotic activity.\n                      <\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>\n                        <jats:italic>C. trachomatis<\/jats:italic>\n                        was associated with an increased risk of preterm delivery (RR=1.86 [95% CI: 1.07-3.25]); Group B\n                        <jats:italic>Streptococcus<\/jats:italic>\n                        colonization was associated with an increased risk of term low birthweight (RR=2.08 [95% CI: 1.06-4.08]).\n                      <\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>IPTp-SP appears to offer benefits independent of malaria prevention through its effects on certain STI\/RTIs pathogens, potentially contributing to a decrease in adverse birth outcomes. These findings are relevant as replacements to SP for IPTp are being considered.<\/jats:p>\n                    <\/jats:list-item>\n                  <\/jats:list>\n                <\/jats:sec>","DOI":"10.1101\/2025.07.02.25330769","type":"posted-content","created":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T16:55:12Z","timestamp":1751561712000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine on sexually transmitted and reproductive tract infections: results from a randomised trial in Uganda"],"prefix":"10.64898","author":[{"given":"Harriet","family":"Adrama","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin J.","family":"Dela Cruz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nida","family":"Ozarslan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abel","family":"Kakuru","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bakar","family":"Odongo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0891-6964","authenticated-orcid":false,"given":"Stephanie L.","family":"Gaw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3631-3132","authenticated-orcid":false,"given":"Jade","family":"Benjamin-Chung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jimmy","family":"Kizza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam","family":"Aguti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Ategeka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Olwoch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam","family":"Nakalembe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bishop","family":"Opira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamara D.","family":"Clark","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moses R.","family":"Kamya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip J.","family":"Rosenthal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grant","family":"Dorsey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6268-0801","authenticated-orcid":false,"given":"Michelle E.","family":"Roh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2025070701051236000_2025.07.02.25330769v1.1","unstructured":"World Health Organization. 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