Prevalence of STIs and evaluation of syndromic treatment approaches among pregnant women in semi-urban Haiti

Background: We measured sexually transmitted infection (STI) prevalence among pregnant women in Gressier, Haiti and evaluated the effectiveness of syndromic treatment (determining treatment based on symptoms and risk factors), an approach commonly used in resource-poor settings including Haiti.

Methods: Women seeking antenatal care at Gressier Health Center from August to October 2013 (N=200) were tested for chlamydia, gonorrhea, and trichomoniasis and responded to a risk assessment survey. We measured STI and calculated the sensitivity, specificity, and percentage that would be identified as needing treatment based on: Tool 1, STI symptoms in the past 4 weeks including vaginal discharge, pelvic pain, ulceration; Tool 2, risk behaviors including early sexual debut (less than 18 years), multiple partnerships in the past year, or having a non-monogamous partner in the past year; Tool 3, any worry about STI; combinations of Tools 1-3.

Results: Of 200 women tested, 199 had a non-indeterminate test result; of these, 29.0% had an STI (8.0% chlamydia; 3.0% gonorrhea; 20.5% trichomoniasis). Fifty-four percent reported at least one STI symptom, 50% were less than 18 years old at first sex, 1.5% reported multiple partnerships, 23.5% reported having a non-monogamous main partner, and 54.5% reported worry about STI. The sensitivity, specificity, and percentage screened for Tool 1 (symptoms) was 58.6%, 47.5%, 54.0%; Tool 2 (behaviors) was 79.3%, 51.8%, 57.5%; Tool 3 (worry) was 65.5%, 47.6%, 54.5%; Tools 1 and 2 (symptoms and behaviors) were 91.4%, 27.7%, 78.0%; Tools 1 and 3 (symptoms, worry) were 82.8%, 17.0%, 77.5%; Tools 2 and 3 (behaviors, worry) 91.4%, 68.7%, 75.5%.

Conclusions: Universal STI screening is needed among pregnant women. Treatment based on behaviors and perceived risk, versus symptoms, may improve STI control based on syndromic approaches.