Genital infections refer to all infections affecting the female reproductive organs, namely the vagina, uterus, fallopian tubes and ovaries [1]. There are two types of genital infections: lower genital infections, which include conditions such as vulvitis, vaginitis and cervicitis, most commonly caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Candida albicans and Gardnerella vaginalis; and upper genital tract infections, which include more serious conditions such as endometritis, salpingitis and pelvic inflammatory disease, which can be caused by sexually transmitted infections. These infections can lead to serious complications, including infertility, chronic pain and an increased risk of HIV transmission [1]-[3].

According to the World Health Organisation (WHO), every day more than one million people aged between 15 and 49 contract a sexually transmitted infection (STI): chlamydia, gonorrhoea, syphilis or trichomoniasis. These infections have consequences for sexual and reproductive health through stigmatisation, infertility, cancer and pregnancy complications, and they can increase the risk of contracting HIV [2].

Genital infections during pregnancy are a significant public health issue due to their potential consequences for maternal and foetal health. These infections can lead to complications such as spontaneous abortions, prematurity, neonatal infections and adverse outcomes for the mother and newborn. Despite their significant impact, these infections during pregnancy remain underdiagnosed and undertreated in Africa due to stigma, lack of access to healthcare during pregnancy, and low awareness of these issues. These infections are common during pregnancy due to changes in the vaginal flora during pregnancy and reduced maternal immunity [1].

Worldwide, the prevalence of these infections varies from one study to another. According to the WHO, in 2020 in developed countries, the most common causes of genital infections during pregnancy were bacterial vaginosis (15 - 20%), vulvovaginal candidiasis (10 - 20%), and Chlamydia trachomatis infection (3 - 5%). In contrast, in developing countries, the prevalence of these infections was higher (bacterial vaginosis (30 - 40%), vulvovaginal candidiasis (20 - 30%), and Chlamydia trachomatis infection (10 - 15%)) [2].

Numerous African studies have highlighted a high prevalence of vulvovaginal candidiasis (57 - 68%), bacterial vaginosis (15 - 50%) and Chlamydia trachomatis infection among pregnant women [4]-[8]. Systematic screening for group B haemolytic Streptococcus at 34 weeks of pregnancy is recommended but unfortunately not carried out, exposing women to an increased risk of neonatal infection [9]. The risk factors identified for genital infections during pregnancy in several studies are multiple and include sociodemographic factors (age, marital status, level of education) and clinical factors (history of genital infections, multiple sexual partners, immunodepression, etc.) [10]-[20].

In Cameroon, few studies have been conducted on the prevalence and profile of genital infections during pregnancy [4][16][18]. A study published by Kamga et al in Kumba in 2019 highlighted a high prevalence of bacterial vaginosis among pregnant women monitored at the Kumba district hospital [16]. Given the high number of patients attending the obstetrics department of the Ebolowa Regional Hospital Centre (CHRE), a referral hospital located in an area with a high prevalence of genital infections according to Cameroon’s 2021 demographic health survey, we set ourselves the objectives of determining the prevalence and factors associated with genital infections during pregnancy in this hospital.

The study was conducted in the gynaecology department of the Ebolowa Regional Hospital. We chose this location because of the large number of women who attend consultations there. Data collection took place over a period from 15 January to 15 August 2025. This was a cross-sectional, descriptive study with an analytical component. The sampling technique was consecutive and non-probabilistic.

All patients seen for suspected genital infection in the outpatient gynaecology department of the Ebolowa Regional Hospital Centre from 15 June to 15 August 2025 included all patients seen at the gynaecology department of the Ebolowa Regional Hospital Centre who had undergone a genital infection assessment and had given their informed consent. All patients who did not wish to participate in the study were excluded.

Data collection was carried out using a structured individual questionnaire covering:

Demographic data (age, marital status, level of education, area of residence, medical history). Medical and social history (pregnancy, parity, contraceptive use, age at first sexual intercourse, number of sexual partners, history of genital infections, use of intimate gel, etc.).Results of paraclinical tests (PCV and antibiogram, Chlamydia serology, Chlamydia PCR, Mycoplasma testing, TPHA/VDRL, etc.)

Data collection was carried out daily by a trained investigator using a pre-established and tested questionnaire. During gynaecological outpatient consultations, all patients who had requested an infectious disease assessment were interviewed by the investigator, who was able to collect sociodemographic and clinical data. After this interview, the patients were then directed to the laboratory where three vaginal samples were taken, the first being processed as a wet mount and KOH test, and the other two for Gram staining and culture.

The diagnosis of candidiasis was made by applying 20% KOH and viewing the hyphae or pseudohyphae under a microscope, and this was confirmed by the culture results.

Bacterial vaginosis was confirmed by Gram staining using the Nugent score, with a value between 7 and 10 indicating a positive result.

Trichomoniasis was investigated on wet smears showing motile flagellated trichomonas. Other bacteriological tests were performed in accordance with standard laboratory procedures.

For the diagnosis of Chlamydia trachomatis, endocervical swabs were collected during a vaginal speculum examination, and the swabs analyzed with the use of some liquid-based cervical cytologic testing platforms.

Syphilis infection was screened on blood samples by using the syphilis antibody test and gonorrhoea was detected by gram stained microscopy.

The paraclinical data were then retrieved from the laboratory records by the investigator.

This study was conducted in strict compliance with patient anonymity. We also guaranteed the confidentiality of the information provided to us in the examination forms. This information has been used solely for the purposes of the study.

The collected data were checked for completeness, inserted into Microsoft Excel and exported to SPSS version 28.0 for analysis. Statistical significant association at the bivariate analysis were put in a multiple regression model to adjust for any possible confounders and results presented in the form of Tables, pie charts and graphs. Pearson’s χ² test was used to compare the prevalence of hepatitis in different groups. Our confidence interval was set at 95% for a significance threshold of p < 0.05. Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) was used as a measure of association.

A total of 315 women agreed to complete our questionnaire. However, 15 of them were excluded due to incomplete data. We therefore compiled data from 300 women, representing 86.95% of those who agreed to participate. The average age was 29.78 ± 3.25 years, ranging from 17 to 43 years. The 21 - 30 age group was the most represented, accounting for 50% (150/300) of the sample. Among the 300 women selected, there was a predominance of those with higher education (59%; 177/300), and the majority were single (75%; 225/300) (seeTable 1).

Table 1.Sociodemographic characteristics of pregnant women screened for genital tract infections at the Ebolowa Regional Health Center.

Considering their clinical characteristics, most of our patients were primigravida (40%; 120/300) seen in the first trimester of pregnancy (44.4%; 133/300). Sixty seven percent were asymptomatic. Their average number of sexual partners was 4.02 ± 1.70 with a mean age at first intercourse of 17 ± 2.0. Most declared havens had just one partner during the last 6 months (54%; 162/300), with no protection during their last intercourse (75%; 225/300). The use of condom was seldom as 71.3% of our studied population had never used or used at times a condom during sex. Patients were not proned to vaginal douching (23%; 99/300) and the introduction of objects or products per vaginally (20%; 60/300). (seeTable 2)

The overall prevalence of genital infections was 77% (231/300). Among these patients, 33% were symptomatic and 67% had no signs or symptoms of the disease discovered during paraclinical examinations. (seeTable 2)

Table 2.Clinical characteristics of pregnant women screened for genital tract infections at the Ebolowa Regional Health Center.

Detected in 30% of the 300 patients tested, bacterial vaginosis was the most common infection, followed by Candida albicans candidiasis and Chlamydia trachomatis infection (21%; 63/300). Four percent (12/300) of our patients had syphilis during pregnancy and 2% (6/300) had Neisseria gonorrhoea infection. In our study, the rate of genital co-infection was 20.5% (61/300), with Gardnerella vaginalis/Candida albicans co-infection being the most common (19%; 57/300). Other bacteria found were Group B Streptococcus and Escherichia coli (See Table 3).

Table 3. Microorganisms responsible of genital tract infections among pregnant women followed at the ERHC.

In a univariate analysis investigating factors associated with genital infections, the age group [20 - 30] years (OR: 2.3, p = 0.035), single marital status (OR: 7.6 p = 0.0001), primary education level (OR: 4.2 p = 0.0032) and history of genital infections (OR: ¬6.2 p = 0.02) significantly influenced the occurrence of these infections. Women whose score was between [0 - 2], age at first sexual intercourse between [14 - 18] years, and cumulative number of partners between [1 - 5] were the most representative among patients with genital infection during pregnancy, but these findings were not statistically significant. (See Table 4)

Multivariate analysis revealed that being a single woman (AOR = 4.5; CI [1.02 - 10.51], p = 0.005) and having a primary school education (AOR = 3.6; CI [2.30 - 8.23], p = 0.01) were independent risk factors for genital infection during pregnancy. (SeeTable 4)

Table 4.Descriptive analysis and logistic regression of risk factors associated with genital tract infections among pregnant women at the ETHC.

The study was conducted at a point in time hence rendering causal association impossible.

The study was a hospital based study which may not be generalizable to the entire population.

The single-center study design and the use of a non-probabilistic sampling method are major limits as both could affect the generalizability of the findings.

This study, conducted at the Ebolowa Regional Hospital Centre, found that genital infections in pregnant women are very common, with a fairly high prevalence and several associated factors, as described in the literature. Bacterial vaginosis was found to be the most common infection, with young women with a low level of education being the most at risk. These results highlight the importance of systematic screening for genital infections and the need for improved sex education during pregnancy. It is also crucial to intensify awareness and prevention programmes, particularly among young people. Further research into the obstetric outcomes of women with genital infections and their newborns is imperative.

This work was supported by the Ebolowa regional Health Center and the Faculty of Medicine and Pharmaceutical Sciences Sangmelima.

This study was approved by the ERHC ethic committee. Informed consent was obtained from all participants prior to data collection. The study was conducted in accordance with the declaration of Helsinki and Good Clinical Practice guidelines

Data design and acquisition: Messakop M.Y, Makemgue LS, Bilo’o L; Data analysis and interpretation: Messakop M.Y, Biloa L, Mboua N.V, Bisay S.U, Bilo’o L, Atangana E.H, Elah N.C,Ndoumba A, Aboui F;Editing of the article:Messakop M.Y,Makemgue LS, Lendem I;Critical review of intellectual content: Makemgue LS, Bengono R, Foumane P, Ekono G.M.