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Urogenital Schistosomiasis and Sexually Transmitted Coinfections among Pregnant Women in a Schistosome-Endemic Region of the Democratic Republic of Congo

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  • 1 Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California;
  • | 2 Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo;
  • | 3 National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo;
  • | 4 Department of Medicine, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California

Schistosomiasis afflicts an estimated 10 million pregnant women in Africa annually. With mounting evidence of adverse impacts to reproductive health resulting from urogenital schistosomiasis, including increased transmission of HIV, further research on prenatal disease epidemiology is warranted, with implications for maternal and fetal health. Between October 2016 and March 2017, we conducted a cross-sectional study examining the prevalence of urogenital schistosomiasis and its association with sexually transmitted infections (STIs) other than HIV among pregnant women visiting antenatal clinics in Kisantu health zone, Democratic Republic of Congo. An extensive sociodemographic and clinical survey was administered to consenting participants, with urine samples and vaginal swabs collected to deduce active schistosomiasis and STIs, respectively. In total, 17.4% of expectant mothers were infected with Schistosoma haematobium, 3.1% with Chlamydia trachomatis (CT), 1.4% with Neisseria gonorrhoeae (NG), and 14.6% with Trichomonas vaginalis (TV). Women infected with urogenital schistosomiasis were at significantly increased odds of harboring a CT, NG, or TV infection (adjusted odds ratio = 3.0, 95% CI: 1.5, 6.0), but reports of clinical symptoms were low, ranging from 17.2% of schistosomiasis to 30.8% of TV cases. Laboratory confirmation of schistosomiasis and STIs provided objective evidence of disease in a cohort with low symptomology where syndromic management may not suffice. Shedding light on local risk factors and associated coinfections of urogenital schistosomiasis can identify unique intervention opportunities for prenatal care in trematode-endemic regions and aid in reducing adverse pregnancy outcomes.

Author Notes

Address correspondence to Adva Gadoth, Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, 650 Charles E. Young D. South, Los Angeles, CA 90095-1772. E-mail: advag@ucla.edu

Financial support: This study was funded by a seed grant from the UCLA Center for AIDS Research (ref. 5P30 AI028697), a grant from the National Center for Advancing Translational Sciences at the National Institutes of Health (NIH-NCATS; ref. UL1TR000124), and the Faucett Catalyst Fund.

Authors’ addresses: Adva Gadoth, Nicole A. Hoff, Hayley R. Ashbaugh, Reena H. Doshi, Marjan Javanbakht, Pamina Gorbach, and Anne W. Rimoin, Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, E-mails: advag@ucla.edu, nhoff84@ucla.edu, hashbaugh@ucla.edu, reenahdoshi@gmail.com, javan@g.ucla.edu, pgorbach@ucla.edu, and arimoin@ucla.edu. Gisèle Mvumbi and Kamy Musene, Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo, E-mails: mvumbig@gmail.com and kamymusene@yahoo.fr. Patrick Mukadi, National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo, E-mail: patrickmukadi@gmail.com. Emile Okitolonda-Wemakoy, Center for HIV/AIDS Strategic Information, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, E-mail: okitow@yahoo.fr. Jeffrey D. Klausner, Department of Medicine, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, E-mail: jdklausner@mednet.ucla.edu.

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