Background:
Sexually transmitted infections (STIs) are common among women who use PrEP in Kenya. Consequences of STIs are exacerbated in pregnancy; when infections are detrimental to both women and their infants. Few data are available on the burden of STIs among pregnant PrEP users.
Methods:
We analyzed data from an ongoing RCT enrolling pregnant women at high risk of HIV newly initiating PrEP at 5 antenatal clinics in Western Kenya (NCT04472884). All participants were HIV-negative, ≥18 years, initiating PrEP that day within routine antenatal care, screened for syphilis per national guidelines, and had high HIV risk scores (corresponding to 8.9 HIV infections per 100 person-years). From February to September 2022, women at a subset of facilities were offered chlamydia and gonorrhea (CT/NG) testing using Xpert CT/NG® with same-day results. Women diagnosed with CT or NG were offered immediate directly observed treatment (DOT) and expedited partner therapy (EPT) as per the national guidelines.
Results:
As of September 2022, 237 HIV-negative pregnant women newly initiating PrEP were enrolled at a median gestational age of 27 weeks (IQR 25-29). The median age of women was 26 years (IQR 22-30), most women were married (73%), and 15% reported a previous pregnancy loss. Overall, 3% of women had syphilis, and 2% reported having a partner known to be living with HIV; 92% reported unknown partner(s) HIV status. Among women offered CT/NG testing, all accepted testing, and the CT prevalence was 8% while NG prevalence was 5%; one participant had syphilis and NG, but no other co-infections were detected. Among women with any STI, only 14% reported STI symptoms (e.g., abnormal vaginal discharge and/or vulvar burning/itching). Frequency of having any STI was higher among women < 20 years compared to women ≥20 years (20% vs. 4%, p=0.002). All participants with STIs accepted DOT while 88% of women with STIs accepted EPT for their partners. One month after accepting EPT, all women had dispensed EPT to male partners and all partners accepted—no social harms were reported.
Conclusions:
In our study among pregnant women at high risk for HIV and taking PrEP, STIs are relatively common, especially among younger women, and frequently asymptomatic. CT/NG testing and EPT is highly acceptable and integrating CT/NG screening for pregnant women on PrEP may be a high-yield intervention with benefits for women and their infants, and partners of women testing positive for STIs.