Background: Sexually transmitted diseases are associated with adverse consequences in pregnancy and its outcome. However, early detections and effective treatments would prevent the associated complications. Objectives: The main aims of this study are to determine the prevalence of common sexually transmitted diseases and to assess the socio-demographic profile of the women. Subjects and Methods: Samples were collected from 560 pregnant women at the first antenatal visit in the hospital after they were counseled and informed consent obtained. Pre-tested questionnaires were used to assess their socio-economic and demographic characteristics. The samples were subjected to the relevant laboratory tests and analysis. Results: Out of the 562 pregnant women examined, 250 (44.5%) were infected with various etiologic agents. Genital candidasis was the highest infection encountered in 119 (21.1%) women followed by Bacterial vaginosis in 38 (6.8%) and Chalamydiae in 35 (6.2%). Others infections included Hepatitis 8 (1.4%); Trichomonasis 29 (5.2%); Human immunodeficiency virus infection 12 (2.1%), Syphilis 7 (1.2%) and 2 Gonococcal infections respectively. The mean parity of the women with infection was 3 ± 1.4 and majority was asymptomatic (57.1%). The prevalence rate of infection was inversely associated with increasing maternal age and advanced formal educational status. The mean gestational age was 19 weeks ± 4.2 and appeared highest with earlier gestational age. Conclusion: There is high prevalence of sexually transmitted diseases among our pregnant women with most of them being asymptomatic. Screening for and prophylactic treatment of the common treatable infection at booking may reduce the incidence of adverse maternal and perinatal outcome associated with these infections.
More than 25 infectious organisms are transmitted primarily through sexual contacts but the common ones includes bacterial vaginosis, herpes simplex, Chlamydia, trichomoniasis, gonococcal, Hepatitis B virus, HIV and syphilitic infections [1,2]. This age long infectious diseases have been recognized as major public and reproductive health challenges worldwide. The impact of this group of infections on the scarce resources of most individuals, family and developing nations are enormous and often under estimated [
STDs in non pregnant women have tremendous adverse consequences on the health and economic life the patients that can lead to pains, organs damage, serious disabilities such as blindness, deafness, insanity, paralysis and even mortality [5,6]. These consequences are more severe in pregnant women and therefore, early detection and treatment avert these problems. The impact of these infections on the obstetric outcome and management are well known [1,2,5]. STDs have been associated with conditions such as spontaneous miscarriages, stillbirth, prematurity, low birth weight, preterm labour, premature rupture of fetal membranes and postpartum endometritis. Other long term morbidities such as cervical cancers, chronic hepatitis, and chronic pelvic infection are also observed in women with these infections in pregnancy [
STDs can be transmitted from a pregnant mother to the baby, during antepartum, intrapartum and postpartum periods. For example, some STDs like syphilis can cross the placenta and infect the baby in-utero [
It is estimated that the number of pregnant women with STDS is increasing by about 250 million a year in the developed countries [
This is a cross sectional observational study conducted over 7 month period from 1st June to 31st December, 2010.
The sample size was estimated by previous study done in the region to be 545 for the population with a confidence interval of 95% and precision of ±5% but samples were collected from 562 women.
The study location was General Hospital Ikot Ekpene Akwa Ibom State in Nigeria. Ikot Ekpene is a rural community in Akwa Ibom State which is located in the Niger Delta region of Nigeria. It has population of 1.3 million people who are mainly subsistent farmers, petty traders, civil servants and housewives. The General Hospital is the only secondary level health care referral center in the area. The antenatal clinic is conducted twice every week (one booking and one follow up clinic). The hospital has an estimated 500 antenatal women per month and an annual delivery of 1200 women.
After obtaining the relevant ethical approval from the authority, the study was carried out in the registration first antenatal clinic visit. The women were adequately counseled and then recruited into the study after unwritten consent was obtained. Those who refused to participate in the study were excluded but were assured of receiving normal and adequate services in the clinic. Other excluded were those on antibiotic and steroid therapies as well as diabetic mellitus patients. Pre-tested semistructured questionnaires developed during a pilot study were administered to the women to obtained relevant demographic and reproductive information such as age, social status, parity, menstrual history.
Normal antenatal history and thorough physical examination were then conducted to detect clinical signs of infections.
Representative samples were the collected and process in standard manner as follows.
With sterile gloves the vaginal fornices and the cervix were adequately exposed with sterile bivalve speculum. Separate swabs were then taken from the posterior fornix and the endocervix with sterile swab sticks. The sample from the vagina was smeared on 2 separate glass slides. Normal saline and potassium hydroxide was put on each of the slides respectively. The sample from the cervix was put in Stuart transport medium (STM) [Oxoid Ltd, UK] and transported to laboratory immediately for processing. Venous blood samples were also aseptically collected from the participants in sterile container for processing. HIV testing was unlinked, anonymous, therefore informed consent and counseling was not necessary [13-15].
All samples were processed by the same group of staff under the direct supervision by one of authors to ensure that compliance to standard procedure and remove observer errors.
Wet mounts of all swab samples were made in sterile normal saline on clean slides and examined under the low power (10×) and high power (40×) magnifications for typical yeast cells with hyphae or pseudohyphae and Trichomonas vaginalis. Gram stain was carried out on both ECS and HVS and examined with 100× objective under oil immersion for Gram negative diplococci and clue cells. Endocervical swab specimens were inoculated into blood agar and Thayer Martin agar (prepared as described by [
Yeast isolates were screened for germ tube production in serum broth. Candida albicans were identified on the basis of the following features: thick-walled oval yeast cells with pseudomycelium and germ tube formation in human serum at 37˚C. Germ tube negative species were regarded simply as yeast species.
Gardnerella vaginalis was identified by a combination of wet preparation appearance, Gram staining reaction and the pH of the discharge. The wet preparation showed abundance of “clue cells” [squamous epithelial cells whose surfaces were smothered with masses of micro-organisms], the pH of the saline preparation was found to vary between 5.0 - 5.6 [i.e. higher than normal pH of 3.0 - 4.5] when measured with a pH indicator paper (BDH, UK) and in a Gram stain of positive cases, the normal lactobacilli flora was almost or completely replaced with masses of Gram variable organisms. The specimens that were positive for pathogens were cultured and antibacterial sensitivity determined.
Separated serum from blood samples were dispensed into two 3 ml volumes sterile plastic containers and used within 2 days for screening tests of HIV, syphilis, Hepatitis B surface Antigen and Chlamydia. Others were frozen for confirmatory tests.
HIV antibody assay was carried out with Determine HIV 1 & 2 rapid test strips (Abbott laboratories-USA) and HIV 1 & 2 Stat-Pat assay (Chembio diagnosticsUSA) methods according to the standard national HIV screening in Nigeria [17,18]. These tests are qualitative membrane-based immuno assay techniques. All seropositive samples were further confirmed and differentiated into HIV 1 & 2 using immumo comb HIV 1 & 2 Biospots (Organics, Israel).
Syphilis antibodies were estimated by using syphilis ultra-rapid test strips (Clinotech Diagnostics—Canada). All reactive syphilis samples (containing Treponema Pallidum antibodies) were further tested and confirmed with TPHA (Teco Diagnostics—USA). Hepatitis B surface antigen test was done using Hepatitis B surface antigen test strips (AconR laboratories—USA). Chlamydia antibodies was tested using immunocomb Chlamydia Bivalent IgG test kit (Orgenics Medical Group—France), a semi quantitative and differential indirect solid phase enzyme immuno assay.
All the patients with infections were treated appropriately using national standard protocol. HIV seropositive women were referred for enrolment in the hospital prevention of maternal to child transmission programs and treated accordingly.
The data collected was analyzed using SPSS Version 11 computer soft ware and result presented with frequency table. Test of significance between variables were done and significance put at P = <0.05.
Out of 562 pregnant antenatal women tested, 250 (44.5%) were infected with various etiologic agents. The prevalence of pathogens detected among women is presented in
The results of the confirmatory test for Treponema pallidum performed on all strip reactive samples shows the sero-prevalence of the infection among the pregnant women. Only serum samples that gave agglutination at dilution titers of 160 and above were considered significantly positive [