Aetiological testing compared with syndromic management for sexually transmitted infections in HIV-infected pregnant women in South Africa: a non-randomised prospective cohort study

Objective To measure the frequencies of sexually transmitted infections (STIs) and adverse pregnancy outcomes among women receiving either aetiological testing or syndromic management for STIs. Design Non-randomised prospective cohort study. Setting Primary healthcare facilities in Tshwane, South Africa. Population HIV-infected pregnant women attending antenatal care services. Methods Participants were enrolled to receive aetiological testing using Xpert (R) CT/NG and Xpert (R) TV assays or standard syndromic management. Outcome data were collected at the postnatal care visit ( Main outcome measures STI prevalence at postnatal visit, and frequency of adverse pregnancy outcomes (preterm birth, low birthweight). Results We enrolled 841 women. The prevalence of any STI at baseline was 40%; Chlamydia trachomatis 30%, Neisseria gonorrhoeae 5.6%, Trichomonas vaginalis 20%. The prevalence of STIs at postnatal care was lower among those receiving aetiological testing compared with those receiving syndromic management (14% versus 23%; aRR 0.61; 95% CI 0.35-1.05). No difference was observed between study groups for frequency of preterm birth (23% versus 23%; aRR 1.2, 95% CI 0.81-1.8) and low birth weight (15% versus 13%; aRR 1.1, 95% CI 0.66-1.7). Conclusions Aetiological testing provides an effective intervention to reduce the high burden of STIs in pregnant women in South Africa; however, the optimal implementation strategy remains to be determined. Tweetable abstract Aetiological testing effectively reduces the burden of sexually transmitted infections in pregnancy