Prevalence of STIs, Preterm Births in Women With HIV Infection

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Researchers assessed the prevalence of sexually transmitted infections during pregnancy and factors associated with preterm birth among women with HIV infection.

Results of a longitudinal study found that there has been no change in the rate of sexually transmitted infections (STIs) diagnosed during pregnancy among women with HIV infection in the United States. These findings were published in Clinical Infectious Diseases.

Data for this study were sourced from the Surveillance Monitoring for Antiretroviral Therapy Toxicities (SMARTT) cohort, a substudy of the Pediatric HIV/AIDS Cohort Study (PHACS). Included patients (N=1785) were women with HIV infection enrolled between week 22 of gestation and 1-week postpartum. This study was conducted at 22 sites in the US and Puerto Rico between 2010 and 2019. Trends in STI diagnoses and the associated risk for preterm birth were evaluated.

Among patients included in the study, the mean age at delivery was 29.2 (IQR, 24.8-33.7) years, 70.8% were Black, 27.5% were Hispanic, 53.4% had an annual household income of less than $10,000 and 29.5% had not completed high school. In addition, most patients (66.6%) were receiving antiviral therapy at the time of conception or during the first trimester.

A total of 2146 pregnancies occurred among the study population.

During the study period, the prevalence of Chlamydia trachomatis infection was 7.7% (95% CI, 6.7%-8.9%), Neisseria gonorrhoeae infection was 2.3% (95% CI, 1.7%-3.0%), syphilis was 2.4% (95% CI, 1.8%-3.1%), and Trichomonas vaginalis was 14.5% (95% CI, 12.8%-16.3%). No changes in the prevalence of these infections among the study population was observed between 2010 and 2019.

The researchers found that the rate of C trachomatis infection was increased among patients who were younger than 25 years at delivery vs those who were 25 and older (adjusted risk ratio [aRR], 2.27). Other factors associated with C trachomatis infection during pregnancy were receipt of prenatal care in the second or third trimesters (aRR, 1.69), and an increased HIV viral load (≥400 copies/mL; aRR, 1.96). Factors associated with a diagnosis of N gonorrhoeae during pregnancy included substance use disorder (SUD; aRR, 3.94), being younger than 25 years at time of delivery (aRR, 2.86), and Hispanic ethnicity (aRR, 0.20). For syphilis diagnoses during pregnancy, significant risk factors were late receipt of prenatal care (aRR, 2.02), alcohol use disorder (aRR, 2.05), and SUD (aRR, 3.81).

Data on T vaginalis diagnoses were unavailable for 30.3% of the patients. In the dataset that included multiple imputation to account for missing data, diagnoses of T vaginilas during pregnancy were associated with being younger than 25 years at the time of delivery (aRR, 1.45), Black ethnicity (aRR, 1.54), tobacco use (aRR, 1.61), SUD (aRR, 1.71), increased HIV viral load (aRR, 1.48), and residing in the Midwest (aRR, 2.61) and South (aRR, 2.22).

A total of 291 preterm births occurred. However, the researchers noted that neither the total number of STI diagnoses nor any individual STI were associated with an increased risk for preterm birth.

This study was most limited by the lack of standardized STI testing.

According to the researchers, “these data fill critical gaps in [the] knowledge of STI patterns [among women with HIV infection during pregnancy], an important and underserved group.”

Disclosure: Multiple authors declared affiliations with industry. Please see the original reference for a full list of disclosures.


Young MR, Broadwell C, Kacanek D, et al. Sexually transmitted infections in pregnant people living with HIV: Temporal trends, demographic 1 correlates and association with preterm birth. Clin Infect Dis. 2022;ciac321. doi:10.1093/cid/ciac321