Screening for Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium should it be integrated into routine pregnancy care in French young pregnant women?

Highlights

• High prevalence of C. trachomatis infection in pregnant women aged <25 years.

• Most of C. trachomatis infections are asymptomatic.

• Risk factors: being single, age <25 years, or having multiple partners in lifetime.

• C. trachomatis screening should be proposed to pregnant French women 18–24 years.

Abstract

Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium screening during pregnancy is not performed routinely in France. We conducted the first prospective study in 1004 women attending for routine antenatal care to determine the prevalence and risk factors for these bacterial infections. The overall prevalence of C. trachomatis, N. gonorrhoeae, and M. genitalium infections was 2.5%, 0%, and 0.8%, respectively. In patients aged 18–24 years, the prevalence increased to 7.9% for C. trachomatis and to 2.4% for M. genitalium. C. trachomatis infection was associated with age ≤24 years or being single or having more than 5 sexual partners in a lifetime. M. genitalium infection was more frequent in patients aged ≤24 years or who had a history of abortion or their first sexual intercourse after 20 years of age. The high prevalence of C. trachomatis in pregnant women aged ≤24 years, mostly asymptomatic, suggests that systematic screening could be beneficial.

Introduction

Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium are responsible for sexually transmitted infections (STIs). C. trachomatis remains the most frequently reported disease in Europe and United States (Bébéar and de Barbeyrac, 2009). Most infections are asymptomatic and mostly affect women. In France, where chlamydial infection is not a notifiable disease, screening studies showed large differences according to the population tested. In 2006, in the general population, C. trachomatis prevalence in people aged 18–44 was estimated at 1.4% for men and 1.6% for women, with highest rates reported in subjects aged 18–29: 2.5% for men and 3.2% for women (Goulet et al., 2010). In centers with STI screening, C. trachomatis prevalence rose up to 15% (Bébéar and de Barbeyrac, 2009). As reported in other countries, notification rates for N. gonorrhoeae have progressively increased during this last decade in France, among both men and women (La Ruche et al., 2013). Concerning M. genitalium, the prevalence of the infection ranged from 1% to 4% in men and 1% to 6.4% in women in the general population (Cazanave et al., 2012). In population at high risk for STI, it varied between 4% and 38% (Cazanave et al., 2012). Similar to infection with C. trachomatis and N. gonorrhoeae, women with M. genitalium are often asymptomatic.

C. trachomatis and N. gonorrhoeae infections during pregnancy have been associated with a number of adverse pregnancy outcomes, including preterm labor, preterm premature rupture of membranes, and uterine infections after delivery. In addition, pregnant women can transmit these infections to their infants during delivery. Newborn prematurity and low birth weight are known to be associated with maternal chlamydial infection. Among infants born to mothers with active, untreated chlamydial infections, 30–50% develop clinical conjunctivitis, and pneumonia occurs in 10–20% of the cases (Bébéar and de Barbeyrac, 2009). Prenatal screening and treatment of pregnant women are the most effective strategy for preventing neonatal chlamydial and gonococcal infections. The role of M. genitalium in maternal infections and its impact on the outcome pregnancy have only been little evaluated. Existing evidence is sparse and conflicting regarding a causal role for M. genitalium in adverse pregnancy outcomes. M. genitalium infection during pregnancy does not seem to be associated with neonatal infections, but this conclusion is based on very limited data (Cazanave et al., 2012).

Diagnosis and treatment of these infections are important to improve obstetrical outcomes. The prevalence of these STIs is unknown among women attending an antenatal clinic in France. Additionally, although it is mandatory to seek syphilis, other bacterial STI screening during pregnancy is frequently based on a syndromic approach; however, because the majority of women with a cervical infection are asymptomatic, most infections are missed using this approach.

We determined the prevalence of C. trachomatis, N. gonorrhoeae, and M. genitalium infections and the risk factors for these infections among women attending an antenatal clinic in France. It is the first study performed in France that permits to identify pregnant women at higher risk for these STIs and for whom the screening test will be most relevant.