Sexually transmitted infections (STIs) are associated with adverse birth outcomes. Current prenatal STI screening guidelines define “risk” without explicit consideration of human immunodeficiency virus (HIV) status. The study objective was to test the hypothesis that HIV status is associated with bacterial STI in pregnant women.
A team of researchers, including Drs. Jeff Szychowski and Dustin M. Long, from the department of biostatistics from University of Alabama at Birmingham School of Public Health, designed a retrospective cohort study to identify pregnant women with HIV who delivered at our facility during 2000-2014. HIV+ women were compared to HIV- women with matching by year of delivery. Logistic regression was used to model adjusted odds of prevalent and incident STI. Prevalent STI was defined as chlamydia (CT), gonorrhea (GC), syphilis, or trichomoniasis detected on an initial prenatal screening test and incident STI as a newly positive result following a negative prenatal test.
The cohort included 432 women, 210 HIV+ and 222 HIV-. Most pregnant women were screened for STI (92 percent of HIV+ women and 74 percent of HIV- women). STI rates were high and particularly elevated in HIV+ women: 29 percent vs 18 percent (p=0.02), for prevalent STI and 11 percent vs 2 percent (p<0.001) for incident STI. Risk factors for prevalent STI were as follows: HIV status, Black race, and more recent delivery. HIV status was an independent risk factor for incident STI.
The authors concluded that pregnant women who delivered in our center had high STI rates. Since HIV infection was independently associated with prevalent and incident STI, prenatal screening guidelines may need to incorporate HIV status as a high-risk group for repeat testing.Friday Letter Submission