Should screening of genital infections be part of antenatal care in areas of high HIV prevalence? A prospective cohort study from Kigali,Rwanda, 1992-1993. The Pregnancy and HIV (EGE) Group.

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.     

Syphilis, gonorrhoea, and drug abuse among pregnant women in Jefferson County, Alabama, US, 1980-94: monitoring trends through systematically collected health services data

OBJECTIVE: To assess the association between self reported drug abuse and syphilis and gonorrhoea among pregnant women, Jefferson County, Alabama, United States, 1980-94. STUDY DESIGN: We analysed a prenatal care database and assessed the association of self reported drug use with seropositive syphilis and gonorrhoea using prevalence rates, multiple logistic regression models, and the Pearson correlation coefficient (r) for trends. RESULTS: Overall, 5.5% of the women acknowledged drug abuse, 1.4% had seropositive syphilis, and 4.8% had gonorrhoea. In a multivariate analysis, drug abuse was associated with syphilis (odds ratio 2.9, 95% confidence interval 1.6, 5.3) but not with gonorrhoea. Trends in the annual prevalence of drug abuse closely paralleled trends in the annual prevalence of syphilis, including simultaneous peaks in 1992 (drug abuse, 9.1%; syphilis, 3.2%). There was no such parallel trend between drug abuse and gonorrhoea. Annual prevalence of drug abuse correlated with the prevalence of syphilis (r = 0.89, p = 0.001) more than with the prevalence of gonorrhoea (r = 0.45, p = 0.201). CONCLUSION: Among pregnant women, an increase in drug abuse was closely associated with an epidemic of syphilis, but not of gonorrhoea. Systematically collected prenatal care data can usefully supplement surveillance of diseases and behavioural risk factors associated with them.     

Syphilis in pregnant women in Mozambique.

To establish the prevalence of syphilis in pregnant women in Mozambique and evaluate present diagnostic methods, 1468 pregnant women in eight of the country's 10 provinces were examined using the Venereal Disease Research Laboratory (VDRL) test. Positive serum samples were also analysed using the Treponema pallidum haemagglutination (TPHA) assay and one group was also analysed using the fluorescent treponemal antibody absorbed (FTA-ABS) test. The prevalence of VDRL seroreactivity was found to be between 4.5% and 14.6%, whereas the prevalence of treponemal disease as verified by TPHA or FTA-ABS tests was between 1.6% and 9.8%. It is concluded that syphilis is relatively common among pregnant women in Mozambique. The predictive value of a positive VDRL test, when adequately performed, was     

The impact of syphilis, HIV-1, and HIV-2 on pregnancy outcome in Bissau, Guinea-Bissau

BACKGROUND: Syphilis remains a major cause of fetal loss and neonatal mortality in sub-Saharan Africa. Guinea-Bissau is the epicenter of the HIV-2 epidemic, and little is known about the impact of HIV-2 on pregnancy. GOAL: To understand better the impact of maternal syphilis and HIV-2 on the outcomes of pregnancy in Bissau, Guinea-Bissau. STUDY DESIGN: Using a case-control design, maternal syphilis and HIV-2 seropositive results were examined in relation to adverse outcomes of pregnancy. From June 1997 to April 1998, women presenting to the Simao Mendes hospital of Bissau for a delivery or a spontaneous abortion were invited to participate in the study, and 1341 women were enrolled. The 743 control subjects were women who had delivered a term neonate with a birthweight greater than 2500 g that survived the first 28 days of life. The cases were classified into five groups of mothers according to the outcome of pregnancy: stillbirths (n = 185), spontaneous abortions (n = 89), premature deliveries (n = 256), small-for-gestation-age babies (n = 55), and neonatal deaths (n = 13). RESULTS: Among the control subjects, the prevalences of serologic syphilis and HIV infection were 3.9% and 7.9%, respectively. Positive syphilis serology results together with a rapid plasma reagin titer of 1:16 or more were associated with delivery of a stillborn (adjusted odds ratio [AOR], 6.05) and premature delivery (AOR, 2.98). In Bissau, the population-attributable risk fraction of syphilis was 7.2% (95% CI, 2.2-11.9%) for stillbirths and only 2.4% (95% CI, 0-5.8%) for premature deliveries. Spontaneous abortions, delivery of a small-for-gestation-age baby, and neonatal deaths were not associated with positive syphilis serology results. None of these pregnancy outcomes was significantly associated with HIV-2 infection. CONCLUSIONS: The effect of syphilis on the outcome of pregnancy in West Africa is similar to that reported from other parts of Africa. However, because the prevalence of positive syphilis serology results is relatively low, the impact of screening for syphilis on the outcome of pregnancy is likely to be relatively modest. The findings from this study confirm the absence of association between HIV-2 and an adverse pregnancy outcome.     

Rapid assessment of sexually transmitted diseases in a sentinel population in Thailand: prevalence of chlamydial infection, gonorrhoea, and syphilis among pregnant women--1996

OBJECTIVE: To determine the prevalence of sexually transmitted diseases (STDs) among pregnant women in Thailand, where case reporting suggests a marked decrease in STDs following a campaign promoting condom use during commercial sex. DESIGN: Cross sectional study of women at their first visit to the study hospitals' antenatal clinics in Chiang Rai (n = 500) and Bangkok (n = 521). METHODS: First catch urine specimens were tested for Chlamydia trachomatis and Neisseria gonorrhoeae using the Amplicor CT/NG polymerase chain reaction assay. Syphilis and HIV serological testing were performed in the study hospitals' laboratories. RESULTS: The prevalence of chlamydial infection was 5.7%, gonorrhoea 0.2%, and syphilis 0.5% (all VDRL or RPR titres were < or = 1:4). The prevalence of HIV infection was 7.1% in Chiang Rai and 2.9% in Bangkok. In a multivariate logistic regression analysis, chlamydial infection was associated with younger age and with higher gestational age at first antenatal clinic visit, but was not associated with marital status, gravidity, city of enrollment, or HIV infection status. CONCLUSIONS: There was a low prevalence of gonorrhoea and syphilis among these pregnant women in Thailand. Chlamydial infection was detected at a higher prevalence, especially among younger women and women registering later for antenatal care. Testing of pregnant women using easily collected urine specimens and a sensitive nucleic acid amplification assay is a feasible method of rapidly assessing chlamydial and gonococcal prevalence.


     

Prevalence of sexually transmitted infections among antenatal women in Vanuatu, 1999-2000

BACKGROUND: The epidemiology of sexually transmitted infections (STIs) and HIV in Vanuatu is poorly defined. GOAL: The goal was to determine the prevalence of laboratory-confirmed gonorrhea, chlamydia, trichomoniasis, syphilis seroreactivity, and HIV among pregnant women in Vila, Vanuatu. STUDY DESIGN :A cross-sectional survey of 547 pregnant women attending a first-visit antenatal hospital clinic in Vila. Laboratory testing included polymerase chain reaction on tampons for chlamydia, gonorrhea, and trichomoniasis; testing of sera for syphilis with rapid plasmid reagin; and enzyme-linked immunosorbent assay for HIV. RESULTS: The prevalence of trichomoniasis was 27.5% (150); of chlamydia, 21.5% (117); of gonorrhea, 5.9% (32); and of syphilis, 13 (2.4%). No HIV cases were detected; 214 women (40%) had > or =1 STI. Young age and single marital status were both significantly associated with infection (P < 0.001). CONCLUSION: Chlamydial infection and trichomoniasis are hyperendemic among pregnant women in Vila. Young, single women are at greatest risk for infection.     

Congenital syphilis in the Russian Federation: magnitude,determinants, and consequences

OBJECTIVES: Reported cases of congenital syphilis in the Russian Federation increased 26-fold from 1991-9. Our objectives were to describe the frequency, risk factors, and consequences of delivering an infant with congenital syphilis among pregnant women with active syphilis. METHODS: In a retrospective record review using consecutive sampling of logs at maternity hospitals in five geographic areas, data were abstracted for 850 women with active syphilis during pregnancy who had completed >/=20 weeks' gestation. Further information was abstracted from records in antenatal clinics, dermatovenereology clinics, and paediatric hospitals. We assessed the frequency of confirmed or probable congenital syphilis, used logistic modelling to identify independent predictors for delivering a baby with congenital syphilis, and calculated the proportion of infants with congenital syphilis who experienced late fetal death (20-27 weeks), stillbirth (>/=28 weeks), or infant death. RESULTS: A total of 64% (n=544) of 850 pregnant syphilis infected women delivered an infant with confirmed or probable congenital syphilis; 40% of the sample had no prenatal care. Among women with no prenatal care, 77% received either no treatment or inadequate treatment and 86% delivered an infant with congenital syphilis. Important independent and modifiable risk factors for delivery of an infant with congenital syphilis included receiving no prenatal care (adjusted OR 2.8, 95% CI 1.7 to 4.7) and having the first test for syphilis at >/=28 weeks' gestation (adjusted OR 4.0, 95% CI 2.6 to 6.0). Fatal outcomes were observed in 26% of infants with congenital syphilis, including late fetal death (7%), stillbirth (16%), or neonatal death (3%). CONCLUSIONS: In the Russian Federation, the frequency of congenital syphilis is high, risk factors for congenital syphilis are modifiable, and the consequences of congenital syphilis are severe.     

妊娠期梅毒的诊疗进展

梅毒螺旋体能通过胎盘引起胎儿宫内感染,造成流产、死产、早产或分娩胎传梅毒儿.死胎和新生儿死亡是最严重的妊娠不良结局.因此,围产期应常规开展妊娠期梅毒血清学的产前筛查工作.在梅毒高流行区或高危人群,尚需在孕28周和分娩时作2次血清学检查.一旦确诊,应尽早、足量、正规给予青霉素治疗,并加强新生儿随防.孕期有效的青霉素治疗,将降低围产期死亡率及胎传梅毒的发生.     

High prevalence of sexually transmitted diseases in a rural area in Mozambique.

OBJECTIVE--To assess the extent of the sexually transmitted diseases (STDs) problem in a rural area of Mozambique. METHODS--A cross sectional study among pregnant women and patients presenting with genital complaints. Laboratory confirmation was done for gonorrhoea, chlamydial infection, active syphilis, trichomoniasis and HIV infection. SETTING--A primary health care setting in Vilanculos, Inhambane province, Mozambique. RESULTS--Evidence of one or more of the above STDs was found in 51% of 201 pregnant women, 56% of 85 women and 62% of 77 men with genital complaints. Neisseria gonorrhoea or Chlamydia trachomatis were found in 16% of pregnant women, 23% of female patients and 28% of male patients; genital ulcer disease was present in 6%, 28% and 36%, of respectively pregnant women, female and male patients. The prevalence of active syphilis was about the same in the three groups of study subjects, that is 15%. HIV infection was found in 4% of the male patients; no HIV infection could be detected in the female groups. CONCLUSION--STDs were a major health problem in this rural area in Mozambique. Though HIV infection was still low, the high prevalence of STDs indicates that the potential is there for an explosive spread of the HIV/AIDS epidemic.     

妊娠合并梅毒感染者发生不良妊娠结局的临床调查研究

目的:分析妊娠合并梅毒感染孕妇发生不良妊娠结局的影响因素,为妊娠合并梅毒感染孕妇临床治疗方案选择提供参考。方法:回顾性分析2009年2月至2012年8月四川省交通运输厅公路医院产科收治204例及2012年8月至2015年10月成都市西区医院产科收治120例妊娠合并梅毒患者,统计孕妇出现不良妊娠结局的情况,比较不良妊娠结局和正常妊娠结局两组患者临床资料的差异,分析妊娠合并梅毒患者发生妊娠不良结局的影响因素,将对不良妊娠结局有影响的因素再采用Logistic多因素回归分析,分析妊娠合并梅毒感染者发生不良妊娠结局的危险因素,针对危险因素探讨预防妊娠合并梅毒感染者发生不良妊娠结局的措施。结果:324例妊娠合并梅毒感染患者中有24例(7.41%)出现不良妊娠结局,对正常组300例患者和不良结局组24例患者的临床资料分析,结果显示,产次、年龄、就诊时梅毒分期、其它传染病、驱梅疗程、随访执行情况是影响妊娠合并梅毒感染患者妊娠结局的相关因素;经Logistic多因素回归分析,就诊时梅毒为中晚期、有其他传染病、完成驱梅疗程≤1、未严格执行随访计划是妊娠合并梅毒感染患者妊娠结局不良的危险因素。结论:妊娠合并梅毒感染患者的不良妊娠结局发病率较高,影响妊娠合并梅毒感染不良妊娠结局的因素较多,在加强对孕妇进行梅毒筛查的同时,应加强梅毒感染孕妇的后续治疗和管理,确保梅毒感染得到有效控制,降低梅毒感染对妊娠结局的不良影响,提高孕妇的妊娠预后。     

Sentinel surveillance of sexually transmitted infections in South Africa: a review

OBJECTIVES: To review studies of sexually transmitted infection (STI) prevalence in South Africa between 1985 and 2003 in selected sentinel populations. To examine how STI prevalence varies between populations and to identify the limitations of the existing data. METHODS: Studies of the prevalence of syphilis, chancroid, granuloma inguinale, lymphogranuloma venereum, gonorrhoea, chlamydia, trichomoniasis, bacterial vaginosis, candidiasis, and herpes simplex virus type 2 (HSV-2) were considered. Results were included if they related to women attending antenatal clinics or family planning clinics, commercial sex workers, individuals in the general population (household surveys), patients with STIs, patients with genital ulcer disease (GUD), or men with urethritis. RESULTS: High STI prevalence rates have been measured, particularly in the case of HSV-2, trichomoniasis, bacterial vaginosis and candidiasis. The aetiological profile of GUD appears to be changing, with more GUD caused by HSV-2 and less caused by chancroid. The prevalence of gonorrhoea and syphilis is highest in "high risk" groups such as sex workers and attenders of STI clinics, but chlamydia and trichomoniasis prevalence levels are not significantly higher in these groups than in women attending antenatal clinics. CONCLUSIONS: The prevalence of STIs in South Africa is high, although there is extensive variability between regions. There is a need for STI prevalence data that are more nationally representative and that can be used to monitor prevalence trends more reliably.     

Syphilis among HIV-infected mothers and their infants in Texas from 1988 to 1994

BACKGROUND: Syphilis was investigated in a group of HIV-infected women and their infants. GOAL: To assess syphilis morbidity among HIV-infected women and their infants. Among women with syphilis during pregnancy, the risks for delivering an infant with congenital syphilis were assessed. STUDY DESIGN: Through the Pediatric Spectrum of HIV Disease project, Texas infants born to HIV-infected women were identified. After the infants were matched with their mothers, it was determined which had been reported as syphilis cases. RESULTS: In this study 18% of the HIV-infected mothers were reported as syphilis cases, most during pregnancy. Half of these mothers delivered infants (n = 49) with congenital syphilis. Inadequate prenatal care was the only significant risk for delivering an infant with congenital syphilis. The congenital syphilis rate among Texas infants of HIV-infected mothers was 48.8 per 1,000 live births. CONCLUSION: The congenital syphilis rate among Texas infants born to HIV-infected mothers was almost 50 times that of the general population.     

Sexually transmitted infections and other health conditions of women entering prison in Georgia, 1998-1999

OBJECTIVES: To assess health needs of women entering the Georgia prison system, prevalence of pregnancy and sexually transmitted infections was estimated. STUDY: Results of admission screening tests of women entering the Georgia prison system in 1998 to 1999 were abstracted retrospectively from prison records. RESULTS: Of 3636 women whose data were abstracted from prison records, 4.3% were pregnant and 8.2%, 4.0%, 5.9%, and 0.7%, respectively, had positive screening tests for trichomoniasis, HIV, chlamydia, and gonorrhea; 19.5% had at least 1 of those conditions. HIV prevalence was higher among inmates who were black or had a rapid plasma reagin test for syphilis reactive at > or =1:8 dilutions (6.0%, 15.8%, respectively) than others (1.3%, 3.7%; P < 0.001). CONCLUSION: Inmates in this study had high rates of sexually transmitted infections and many were pregnant. Black inmates were at higher risk for HIV and high rapid plasma reagin titers than white inmates or other routinely tested Georgia female populations.     

Failure of recommended maternal therapy to prevent congenital syphilis

A pregnant women with secondary syphilis received appropriate therapy with penicillin in the last trimester of pregnancy. At delivery, her titre had fallen fourfold, and the baby had a non-reactive cord blood titre at birth. However, the treatment failed to prevent infection in the infant, and the baby had developed signs of congenital syphilis at 10 weeks of age. The definition of "adequate therapy" of pregnant women is unclear, and recent guidelines are contradictory. Therefore, literature that pertains to penicillin therapy in pregnancy is reviewed, and new guidelines for therapy proposed.     

海南省2008—2009年妊娠梅毒流行病学调查分析

目的：了解海南省孕产妇人群中梅毒的流行现状,为制定梅毒预防与控制措施提供依据.方法：对19个市县（区）人民医院、中医院、妇幼保健院就诊的孕产妇进行梅毒筛查.结果：共筛查了48 602名孕产妇,约占海南省孕产妇的22.01%.检出梅毒感染者284例,感染率为5.84‰.黎族孕产妇感染率高于汉族.孕妇的TRUST滴度越高,不良妊娠结局的危险性越大.结论：应加强对孕产妇梅毒的早期筛查和对少数民族的健康教育.     

2018年—2020年舟山市梅毒母婴阻断相关因素分析

目的分析舟山市2018年—2020年孕产妇梅毒母婴阻断情况及相关因素,为完善舟山市梅毒母婴阻断措施并消除梅毒母婴传播提供科学依据。方法从预防艾滋病、梅毒和乙肝母婴传播管理信息系统导出2018年—2020年舟山市梅毒感染孕产妇的个案资料,分析其基本特征、检测率、治疗率等。结果 2018年—2020年舟山市行梅毒检测的孕产妇共17 734例,检测率99.98%,仅产时检出率呈逐年下降趋势(P<0.05)。梅毒感染孕产妇共128例,梅毒检出率为0.72%;文化程度以初中及以下文化程度为主,占53.91%(69例);职业以家务及待业人员为主,占85.94%(110例);户籍以本地为主,占66.41%(85例);传播途径以不详(即患者自己不清楚是怎么被感染的)为主,占67.19%(86例)。不同治疗时期的梅毒感染孕产妇分娩前/孕晚期TRUST滴度比较,差异无统计学意义(P>0.05)。不同治疗时期的梅毒感染孕产妇所生新生儿TRUST滴度比较,差异无统计学意义(P>0.05)。梅毒感染孕产妇分娩前/孕晚期TRUST滴度≥1∶4时,其所生新生儿TRUST阳性率远高于TURST滴度阴...     

Part time female sex workers in a suburban community in Kenya: a vulnerable hidden population

BACKGROUND: In sub-Saharan Africa, female sex workers (FSWs) are a vulnerable high risk group for the acquisition and transmission of sexually transmitted infections (STI) and HIV. OBJECTIVES: To study parameters of sexual behaviour and knowledge of STI and HIV, to describe health seeking behaviour related to STI, and to measure the prevalence of gonorrhoea, chlamydia, syphilis, and HIV-1, to provide baseline data for targeted STI and HIV prevention interventions. METHODS: In a cross sectional survey with snowballing recruitment, between February and March 2000, 503 self identified FSWs in a suburb in Mombasa, Kenya, were interviewed with a structured questionnaire and screened for gonorrhoea, chlamydia, syphilis, and HIV-1. RESULTS: The mean number of sexual partners in the previous week was 2.8 (SD 1.6). The mean number of non-regular clients and regular clients in the previous week was 1.5 (1.0) and 1.0 (0.9) respectively. The median weekly income from sex work was $US15. A total of 337 (67%) women had an alternative income in the informal sector. 146 (29%) and 145 (45%) never used a condom with a client and non-paying partner respectively. The prevalence of gonorrhoea, chlamydia, and syphilis was 1.8%, 4.2%, and 2.0% respectively. The overall HIV-1 seroprevalence was 30.6%. CONCLUSIONS: There is a large need for intensive STI and HIV prevention interventions in part time FSW.     

Comparison of STD prevalences in the Mwanza,Rakai, and Masaka trial populations: the role of selection bias and diagnostic errors

OBJECTIVES: To assess bias in estimates of STD prevalence in population based surveys resulting from diagnostic error and selection bias. To evaluate the effects of such biases on STD prevalence estimates from three community randomised trials of STD treatment for HIV prevention in Masaka and Rakai, Uganda and Mwanza, Tanzania. METHODS: Age and sex stratified prevalences of gonorrhoea, chlamydia, syphilis, HSV-2 infection, and trichomoniasis observed at baseline in the three trials were adjusted for sensitivity and specificity of diagnostic tests and for sample selection criteria. RESULTS: STD prevalences were underestimated in all three populations because of diagnostic errors and selection bias. After adjustment, gonorrhoea prevalence was higher in men and women in Mwanza (2.8% and 2.3%) compared to Rakai (1.1% and 1.9%) and Masaka (0.9% and 1.8%). Chlamydia prevalence was higher in women in Mwanza (13.0%) compared to Rakai (3.2%) and Masaka (1.6%) but similar in men (2.3% in Mwanza, 2.7% in Rakai, and 2.2% in Masaka). Prevalence of trichomoniasis was higher in women in Mwanza compared to women in Rakai (41.9% versus 30.8%). Herpes simplex virus type 2 (HSV-2) seroprevalence and prevalence of serological syphilis (TPHA+/RPR+) were similar in the three populations but the prevalence of high titre syphilis (TPHA+/RPR >/=1:8) in men and women was higher in Mwanza (5.6% and 6.3%) than in Rakai (2.3% and 1.4%) and Masaka (1.2% and 0.7%). CONCLUSIONS: Limited sensitivity of diagnostic and screening tests led to underestimation of STD prevalence in all three trials but especially in Mwanza. Adjusted prevalences of curable STD were higher in Mwanza than in Rakai and Masaka.     

Sexually transmitted diseases and risk behaviors among pregnant women attending inner city public sexually transmitted diseases clinics in Baltimore, MD, 1996-2002

OBJECTIVE: To determine the prevalence of sexually transmitted diseases (STDs) and characterize behavioral correlates among pregnant women attending inner city public STD clinics. STUDY DESIGN: A retrospective study of 2303 pregnant women frequency matched by clinic and year of visit to 2303 nonpregnant women seeking services during years 1996 to 2002 at public STD clinics in Baltimore, MD. RESULTS: On average, 329 pregnant women attended Baltimore City STD clinics each year during 1996 to 2002. Forty-six and a half percent of pregnant women knew they were pregnant when they presented to the STD clinic. Although pregnant women were younger (23.3 vs. 28.3 years of age, P <0.01) and more likely to have sought STD clinical services in the past (55.4% vs. 51.5%, P <0.01), they were less likely to report high-risk sexual behaviors such as new (4.6% vs. 7.0%, P <0.01) or multiple sex partners (11.6% vs. 13.9%, P <0.01) than nonpregnant women. However, prevalence of gonorrhea (4.8% pregnant vs. 4.2%), chlamydia (9.9% vs. 7.7%), trichomoniasis (12.4% vs. 12.0%), and early syphilis (1.5% vs. 1.2%) was high, and both groups were equally as likely to have any STD. CONCLUSION: The prevalence of STDs was similar for pregnant and nonpregnant women attending the inner city public STD clinics, despite differences in risk factors for STDs. Understanding the impact of STDs on perinatal outcomes among this population and developing targeted interventions to reduce STD-related maternal and infant morbidity are critical public health issues.