Low Prevalence of Chlamydia trachomatis Infection in Non-Urban Pregnant Women in Vellore, S. India

Navjyot K Vidwan,Annie Regi,Shalini Anandan,Mary Allen Staat,Jill S Huppert,Mark Steinhoff,Rida Nongrum,Caitlin Dodd,Valsan Verghese,Katharina Kranzer

doi:10.1371/journal.pone.0034794

Navjyot K Vidwan, Annie Regi + Show 8 more

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https://doi.org/10.1371/journal.pone.0034794

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Abstract

ObjectiveTo determine the prevalence and risk factors for Chlamydia trachomatis (CT) infection in pregnant women and the rate of transmission of CT to infants.MethodsPregnant women (≥28 weeks gestation) in Vellore, South India were approached for enrollment from April 2009 to January 2010. After informed consent was obtained, women completed a socio-demographic, prenatal, and sexual history questionnaire. Endocervical samples collected at delivery were examined for CT by a rapid enzyme test and nucleic acid amplification test (NAAT). Neonatal nasopharyngeal and conjunctival swabs were collected for NAAT testing.ResultsOverall, 1198 women were enrolled and 799 (67%) endocervical samples were collected at birth. Analyses were completed on 784 participants with available rapid and NAAT results. The mean age of women was 25.8 years (range 18–39 yrs) and 22% (95% CI: 19.7–24.4%) were primigravida. All women enrolled were married; one reported >one sexual partner; and six reported prior STI. We found 71 positive rapid CT tests and 1/784 (0.1%; 95% CI: 0–0.38%) true positive CT infection using NAAT.ConclusionsTo our knowledge, this is the largest study on CT prevalence amongst healthy pregnant mothers in southern India, and it documents a very low prevalence with NAAT. Many false positive results were noted using the rapid test. These data suggest that universal CT screening is not indicated in this population.

Highlights

Chlamydia trachomatis (CT) is one of the most common genital pathogens worldwide [1]
50–75% of infants born to infected mothers become infected at one or more sites including the conjunctiva, nasopharynx, vagina, and rectum leading to purulent conjunctivitis, pneumonia, and trachoma [2]
Hammerschlag recognized that the most frequent site of perinatally acquired chlamydia infection in US neonates is the nasopharynx with rates as high as 70% and that CT pneumonia can occur in 30% of infants with nasopharyngeal infection [3]

Summary

Introduction

Chlamydia trachomatis (CT) is one of the most common genital pathogens worldwide [1]. Neonates of infected women may have increased morbidity and mortality. Newborn prematurity and low birth weight is shown to be associated with maternal chlamydia infection. 50–75% of infants born to infected mothers become infected at one or more sites including the conjunctiva, nasopharynx, vagina, and rectum leading to purulent conjunctivitis, pneumonia, and trachoma [2]. Hammerschlag recognized that the most frequent site of perinatally acquired chlamydia infection in US neonates is the nasopharynx with rates as high as 70% and that CT pneumonia can occur in 30% of infants with nasopharyngeal infection [3]. Rosenman found that of US infants exposed to CT at birth, 8 to 44% had conjunctivitis, and 0 to 17% pneumonia [4]

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