Prevalence, Antimicrobial Sensitivity Patterns, and Risk Factors for Chlamydial and Gonococcal Genital Infections Among Pregnant Women at the Kenyatta National Hospital 2022

Abstract

Background: Sexually transmitted infections have been on the rise and are a major public concern. The infections include Chlamydia, Gonorrhoea, Syphilis, Trichomoniasis, Hepatitis B and Human Immunodeficiency Virus. They are common in females than in males. Sexually transmitted infections are not routinely screened in Kenya. A high index of suspicion with vaginal discharge syndromes in patients are managed using a syndromic approach due to the high cost of laboratory investigations in low resource settings. Concentration has mainly been on HIV/AIDS compared to the other STIs despite the adverse gynaecological, obstetrical and perinatal complications associated. These infections are asymptomatic and are often missed. Chlamydia and Gonorrhoea are the two leading STIs in Kenya and drug resistance has been reported particularly for Gonorrhoea. Objective: The aim of this study was to determine the prevalence of Chlamydia and Gonorrhoea among pregnant women presenting at the antenatal clinic (clinic 18) at Kenyatta National Hospital and the current drug sensitivity patterns in the year 2022. Methodology: This was a cross-sectional study at the antenatal (clinic 18) at the Kenyatta National Hospital for three months. The study population was all willing pregnant women in their first antenatal visit regardless of gestation. Ethical approval was requested from the Kenyatta National Hospital- University of Nairobi Ethics and Research Committee. The participants signed consent and each filled a questionnaire that provided information on the socio-demographic, and the risk determinants of sexually transmitted infections. A speculum examination was done on each participant and two endo cervical swabs samples collected. One for NG/CT PCR to detect Neisseria gonorrhoea and Chlamydia trachomatis DNA while the second for gram staining, culture and antimicrobial sensitivity for Neisseria gonorrhoea. The prevalence, demographic characteristics were analyzed. Results :258 patients were recruited, and 226 patients fit the inclusion criteria and 11 patients declined to continue in the study. A total of 215participants took part in the study. The prevalence of CT was 18% (39/215). The prevalence of NG was 2.3% (5/215). All the infected women reported only 1 partner in the last 6 months. The parity (p2-4) showed significant association while other factors though not statistically significant like the educational level, employment and symptomatology show various trends. There was no GC growth was obtained during the study and subsequently the antimicrobial patterns. Conclusion: CT/NG prevalence is high amongst pregnant women attending the ANC. Due the asymptomatic nature of NG/CT, it should be of utmost urgency to actively offer point of care PCR for NG/CT for all women attending ANC at Kenyatta National Hospital. Keywords: Notifiable infections, syndromic approach, gram staining, NG/CT PCR, antimicrobials NG/CT