Sexually Transmitted Infections in Pregnant People Living With Human Immunodeficiency Virus: Temporal Trends, Demographic Correlates, and Association With Preterm Birth

Prevalence of sexually transmitted infections was high in pregnant people living with HIV. Coinfection was not associated with risk of preterm birth. One-third of individuals were missing data on Trichomonas vaginalis, underscoring the need for interventions promoting guideline-driven screening. Background We describe trends in prevalence and identify factors associated with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), syphilis, and Trichomonas vaginalis (TV) diagnosed in pregnancy among US people living with human immunodeficiency virus (PLHIV) and evaluate associations of sexually transmitted infections (STIs) with preterm birth (PTB). Methods We included pregnant PLHIV enrolled in the Surveillance Monitoring for ART Toxicities dynamic cohort of the Pediatric HIV/AIDS Cohort Study network who delivered between 2010 and 2019. Multivariable log-binomial or Poisson generalized estimating equation models were used to estimate the association of calendar year with each STI, controlling for confounders; the association of demographic and clinical factors with each STI; and the association of each STI with PTB. Results The sample included 2241 pregnancies among 1821 PLHIV. Median age at delivery was 29.2 years; 71% of participants identified as Black or African American. STI prevalence was: CT 7.7%, NG 2.3%, syphilis 2.4%, and TV 14.5%; 30% had unknown TV status. There were no temporal changes in STI prevalence. Younger age and initial HIV viral load >= 400 copies/mL were associated with increased risk of CT, NG, and TV. Recreational substance use was a risk factor for NG, syphilis, and TV. No STI was associated with PTB. Conclusions Unlike nationwide trends, no changes in STI prevalence during the study period were observed. The large proportion with unknown TV status underscores the need for increased adherence to screening guidelines. STIs diagnosed during pregnancy in PLHIV were not associated with risk of PTB.

Automated summary

The prevalence of sexually transmitted infections is high among pregnant individuals living with HIV. Coinfection is not associated with the risk of preterm birth. One-third of the individuals have missing data on Trichomonas vaginalis, indicating the need for interventions to promote guideline-driven screening. Sexually transmitted infections diagnosed during pregnancy among people living with HIV are not associated with the risk of preterm birth.