Objective-To study the prevalence and
incidence of genital infections and their
association with HIV-1 infection among
pregnant women in Kigali, Rwanda.
Subjects and methods-HIV+ and HIV -
pregnant women were followed prospectively
during the last three months of
pregnancy. At enrolment, syphilis test
(RPR) on blood sample, Chlamydiae
trachomatis ELISA test on cervical
smear, laboratory gonococcal culture,
trichomonas and candida direct examination,
CD4 lymphocyte count were performed.
At each monthly follow-up clinic
visit until delivery, genital infections
were screened in the presence of clinical
signs and symptoms.
Results-The HIV seroprevalence rate
was 34'4% (N = 1233), 384 HIV+ women
and 381 HIV- women of same parity and
age were enrolled. Prevalence of genital
infections at enrolment was generally
higher in HIV+ women than in HIV -
women: syphilis, 6.3% versus 3.7% (p =
0.13); Neisseria gonorrhoea, 7.0% versus
2.4% (p = 0.005); Trichomonas vaginalis,
20.2% versus 10.9% (p = 0.0007);
Chlamydia trachomatis, 3.4% versus
5.5% (p = 0.21); Candida vaginalis,
22.3% versus 20-1% (p = 0.49). Until
delivery, the relative risk of acquiring
genital infections was also higher in HIV+
women than in HIV - women: 1.0 for
syphilis (95% CI: 0.5-2.2), 3.7 for
Neisseria gonorrhoea (1.0-13.3), 2.6 for
Trichomonas vaginalis (1.5-4.6) and 1.6
for Candida vaginalis (1. 1-2.4).
Conclusion-In the context of high HIV-1
seroprevalence among pregnant women,
prenatal care should include at least once
screening for genital infections by clinical
examination with speculum and a
syphilis testing in Africa.