High prevalence of sexually transmitted infections among pregnant women in southern Ethiopia: evidence from routine laboratory diagnosis.

BACKGROUND

Sexually transmitted infections (STIs) remain a major public health concern among pregnant women in low-resource settings, such as Ethiopia. Today, their true prevalence is underestimated due to syndromic management, which misses asymptomatic infections. Indeed, limited resources restrict a test-and-treat approach, and routine antenatal care screening is usually confined to HIV and syphilis. This study assessed the prevalence of common STIs using routinely available diagnostics to demonstrate their potential integration into routine antenatal care services.

METHODS

A cross-sectional study was conducted from July to December 2024 among 743 pregnant women at ≤16 weeks gestation. Vaginal swabs were examined for Trichomonas vaginalis using wet mount and Gram-negative diplococci suggestive of Neisseria gonorrhoeae using Gram stain. HIV and syphilis screening were performed using SD BIOLINE Duo kit. Participants' data were collected with REDCap, and complex-sample logistic regression analyzed factors associated with STIs.

RESULTS

Of 743 women, 91 (12.2%; 95% CI: 10.1-14.8) had at least one STI, of which 62.6% (57/91) were asymptomatic. Risk factors associated with STIs included being merchants (AOR 1.80; 95% CI: 1.05-3.11), no media usage (AOR 0.60; 95% CI: 0.39-0.91), low wealth index (AOR 1.51; 95% CI: 1.08-2.10) and the presence of clue cells (AOR 3.47; 95% CI: 1.29-9.35).

CONCLUSION

STIs remain prevalent and frequently asymptomatic, highlighting the inadequacy of syndromic management in antenatal care. Social, economic and biological factors predict infection, emphasizing the need for routine laboratory-based screening and targeted interventions. Future research should use molecular diagnostics to capture comprehensive STIs prevalence.