Randomized trial of presumptive sexually transmitted disease therapy during pregnancy in Rakai, Uganda

Am J Obstet Gynecol. 2001 Nov;185(5):1209-17. doi: 10.1067/mob.2001.118158.

Abstract

Objective: The purpose of this study was to assess presumptive sexually transmitted disease treatment on pregnancy outcome and HIV transmission.

Study design: In a randomized trial in Rakai District, Uganda, 2070 pregnant women received presumptive sexually transmitted disease treatment 1 time during pregnancy at varying gestations, and 1963 control mothers received iron/folate and referral for syphilis. Maternal-infant sexually transmitted disease/HIV and infant outcomes were assessed. Intent-to-treat analyses estimated adjusted rate ratios and 95% confidence intervals.

Results: Sexually transmitted diseases were reduced: Trichomonas vaginalis (rate ratio, 0.28; 95% CI, 0.18%-0.49%), bacterial vaginosis (rate ratio, 0.78; 95% CI, 0.69-0.87), Neisseria gonorrhoeae /Chlamydia trachomatis (rate ratio, 0.43; 95% CI, 0.27-0.68), and infant ophthalmia (rate ratio, 0.37; 95% CI, 0.20-0.70). There were reduced rates of neonatal death (rate ratio, 0.83; 95% CI, 0.71-0.97), low birth weight (rate ratio, 0.68; 95% CI, 0.53-0.86), and preterm delivery (rate ratio, 0.77; 95% CI, 0.56-1.05); but there were no effects on maternal HIV acquisition or perinatal HIV transmission.

Conclusion: Reductions of maternal sexually transmitted disease improved pregnancy outcome but not maternal HIV acquisition or perinatal HIV transmission.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Azithromycin / therapeutic use*
  • Birth Weight
  • Cefixime / therapeutic use*
  • Drug Therapy, Combination
  • Endophthalmitis / prevention & control
  • Female
  • Folic Acid / therapeutic use
  • HIV Infections / therapy
  • Humans
  • Infant
  • Infant Mortality
  • Infant, Newborn
  • Infant, Newborn, Diseases / prevention & control
  • Infant, Premature
  • Iron / therapeutic use
  • Metronidazole / therapeutic use*
  • Obstetric Labor, Premature / prevention & control
  • Pregnancy
  • Pregnancy Complications, Infectious / therapy*
  • Sexually Transmitted Diseases / prevention & control
  • Sexually Transmitted Diseases / therapy*
  • Uganda

Substances

  • Metronidazole
  • Azithromycin
  • Folic Acid
  • Cefixime
  • Iron