{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T21:56:37Z","timestamp":1787694997565,"version":"build-2784847793"},"reference-count":30,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K01 AI116298 to ALDK24 HD054314 to GJ-SP01 HSD 064915T32 T32AI07140 to JP"],"award-info":[{"award-number":["K01 AI116298 to ALDK24 HD054314 to GJ-SP01 HSD 064915T32 T32AI07140 to JP"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007813","name":"Center for AIDS Research, University of Washington","doi-asserted-by":"publisher","award":["P30 AI27757"],"award-info":[{"award-number":["P30 AI27757"]}],"id":[{"id":"10.13039\/100007813","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2018,7,24]]},"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec>\n<jats:title>Objectives<\/jats:title>\n<jats:p>We evaluated the relationship of sexually transmitted infections (STIs) and genital infections during pregnancy and subsequent risk for infant mortality and stillbirth.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>\n    This was a nested longitudinal analysis using data from a study of peripartum HIV acquisition in Kenya. In the parent study, HIV-uninfected women were enrolled during pregnancy and followed until 9\u2005months postpartum. For this analysis, women who tested positive for HIV at any point, had a non-singleton pregnancy or a spontaneous abortion &lt;20 weeks were excluded. At enrolment, laboratory methods were used to screen for bacterial vaginosis (BV), vaginal yeast,\n<jats:italic>Chlamydia trachomatis<\/jats:italic>\n(CT),\n<jats:italic>Neisseria gonorrhoeae<\/jats:italic>\n(NG) and\n<jats:italic>Trichomonas vaginalis<\/jats:italic>\n(TV). Syphilis was diagnosed using rapid plasma reagin testing and genital ulcer disease (GUD) identified by clinical examination. Treatment of laboratory-confirmed STIs and syndromic management was provided per Kenyan national guidelines. Predictors of stillbirth and infant mortality were determined using logistic regression and Cox proportional hazards models.\n<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Overall, among 1221 women, 55% had STIs or genital infections detected: vaginal yeast (25%), BV (22%), TV (6%), CT (5%), NG (2%) and syphilis (1%). Among women with STIs\/genital infections (n=592), 34% had symptoms. Overall, 19\/1221 (2%) women experienced stillbirths. Among 1202 live births, 34 infant deaths occurred (incidence 4.0 deaths per 100 person-years, 95%\u2009CI 2.8 to 5.5). After adjustment for maternal age, education and study site, stillbirth was associated with maternal GUD (adjusted OR=9.19, 95%\u2009CI1.91 to 44.35, p=0.006). Maternal NG was associated with infant mortality (adjusted HR=3.83, 95%\u2009CI1.16 to 12.68, p=0.028); there was some evidence that maternal CT was associated with infant mortality. Stillbirth or infant mortality were not associated with other genital infections.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>STIs and genital infections were common, frequently asymptomatic and some associated with stillbirth or infant mortality. Expediting diagnosis and treatment of STIs in pregnancy may improve infant outcomes.<\/jats:p>\n<\/jats:sec>","DOI":"10.1136\/sextrans-2018-053597","type":"journal-article","created":{"date-parts":[[2018,9,18]],"date-time":"2018-09-18T14:35:31Z","timestamp":1537281331000},"page":"60-66","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":60,"title":["Sexually transmitted infections during pregnancy and subsequent risk of stillbirth and infant mortality in Kenya: a prospective study"],"prefix":"10.1136","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3967-1189","authenticated-orcid":false,"given":"Alex J","family":"Warr","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1255-7191","authenticated-orcid":false,"given":"Jillian","family":"Pintye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kinuthia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4178-7706","authenticated-orcid":false,"given":"Alison L","family":"Drake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A","family":"Unger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R Scott","family":"McClelland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Matemo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lusi","family":"Osborn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"John-Stewart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,9,18]]},"reference":[{"key":"2024092304402199000_95.1.60.1","doi-asserted-by":"publisher","DOI":"10.1136\/sti.2002.004077"},{"key":"2024092304402199000_95.1.60.2","doi-asserted-by":"publisher","DOI":"10.1038\/nature05447"},{"key":"2024092304402199000_95.1.60.3","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1097\/INF.0000000000001199","article-title":"Chlamydia trachomatis and Neisseria gonorrhoeae in HIV-infected pregnant women and adverse infant outcomes","volume":"35","author":"Adachi","year":"2016","journal-title":"Pediatr Infect Dis J"},{"key":"2024092304402199000_95.1.60.4","unstructured":"World Health Organization . Elimination of mother-to-child transmission (EMTCT) of HIV and syphilis. In: Global guidance on criteria and processes for validation. Geneva, Switzerland, 2014."},{"issue":"Suppl 1","key":"2024092304402199000_95.1.60.5","first-page":"S15","article-title":"Introduction of rapid syphilis testing in antenatal care: a systematic review of the impact on HIV and syphilis testing uptake and coverage","volume":"130","author":"Swartzendruber","year":"2015","journal-title":"Int J Gynaecol Obstet"},{"key":"2024092304402199000_95.1.60.6","doi-asserted-by":"crossref","first-page":"e300","DOI":"10.1016\/S2214-109X(16)30362-X","article-title":"First estimates of the global and regional incidence of neonatal herpes infection","volume":"5","author":"Looker","year":"2017","journal-title":"Lancet Glob Health"},{"key":"2024092304402199000_95.1.60.7","unstructured":"World Health Organization . Guidelines for the management of sexually transmitted infections. 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National guidelines for the diagnosis, treatment and prevention of Malaria in Kenya. 3rd Edition. 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Gonococcal Infections. In: Klein J , Maldonado Y , Nizet V , Remington J , Wilson C . eds. Remington and Klein\u2019s infectious diseases of the fetus and new born infant. Philadelphia: PA: Elsevier\/Saunders, 2016:504\u201311."},{"key":"2024092304402199000_95.1.60.26","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/OLQ.0000000000000592","article-title":"Adverse birth outcomes and maternal Neisseria gonorrhoeae infection: a population-based cohort study in Washington state","volume":"44","author":"Heumann","year":"2017","journal-title":"Sex Transm Dis"},{"key":"2024092304402199000_95.1.60.27","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0163365","article-title":"The performance of the vaginal discharge syndromic management in treating vaginal and cervical infection: a systematic review and meta-analysis","volume":"11","author":"Zemouri","year":"2016","journal-title":"PLoS One"},{"key":"2024092304402199000_95.1.60.28","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1111\/tmi.12742","article-title":"Evaluation of syndromic management guidelines for treatment of sexually transmitted infections in South African women","volume":"21","author":"van der Eem","year":"2016","journal-title":"Trop Med Int Health"},{"key":"2024092304402199000_95.1.60.29","doi-asserted-by":"crossref","first-page":"28","DOI":"10.4103\/0253-7184.176215","article-title":"Efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome","volume":"37","author":"Chauhan","year":"2016","journal-title":"Indian J Sex Trasmitted Dis AIDS"},{"key":"2024092304402199000_95.1.60.30","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000219"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2018-053597","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T17:56:27Z","timestamp":1727114187000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2018-053597"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,18]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,1,23]]},"published-print":{"date-parts":[[2019,2]]}},"alternative-id":["10.1136\/sextrans-2018-053597"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2018-053597","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9,18]]}}}