Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis in prenatal care in the public health system, in a southern city of Brazil

Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis in prenatal care in the public health system, in a southern city of Brazil | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis in prenatal care in the public health system, in a southern city of Brazil Danielle Betina de Oliveira Traesel, Newton Sérgio de Carvalho, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3965454/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Sexually transmitted infections (STI) are prevalent in developing countries and are associated with unfavorable perinatal outcomes. Infections with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV) are asymptomatic in 70% of cases. The objective of this study is to determine the prevalence of CT, NG, MG and TV in pregnant women, correlating it with sociodemographic data. The sample had 148 pregnant women between 18 and 49 years old, who attended in Joinville, South Brazil, from November 2021 to March 2022. The exclusion criteria were: recent antibiotic therapy and risk for miscarriage. Data collection and endovaginal swabs were performed to research of agents through molecular biology. 148 pregnant women were studied, 16.2% (N=24) had at least one of the agents positive. C. trachomatis , M. genitalium and T. vaginalis were detected in 11 (7.43%), 13 (8.78%) and 3 (2.03%) women, respectively. N. gonorrhoeae was not detected. There were three cases of infection with more than one microorganism (2 CT + MG and 1 MG + TV). MG infection was associated with single women (p-value=0.014); trichomoniasis, with more partners in the last year (p-value=0.042). The high detection of MG in Brazilian pregnant women deserves to be highlighted. This had not yet been reported. The prevalence of CT and NG was in accordance to Brazilian studies, while TV was in common with European rates. The absence of clinical symptoms, the non-association between sexual risk behavior and the presence of STI were observed. Prenatal Care Mycoplasma genitalium Diagnostic Screening Programs Chlamydia Trachomatis Figures Figure 1 INTRODUCTION Sexually transmitted infections (STI) are diseases with impact on global health, having more than 374 million new infections estimated worldwide in 2020, considering curable genital infections such as Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and syphilis [1]. Mycoplasma genitalium (MG) has been considered an emerging pathogen among STI, with symptoms similar to CT and NG infection [2], but data in female populations is still limited [3,4]. During pregnancy, cervicitis caused by CT, NG and TV is associated with preterm birth, premature rupture of membranes, fetal death, intrauterine growth restriction and puerperal endometritis [5,6,7]. Studies have demonstrated a relationship between M. genitalium and poor sexual health, infertility, miscarriage and preterm labor [3,4,8,9], with the risk of preterm labor independent of other STI [2,10]. Adaptations in immune function and physiological changes in the endocervix that occur during pregnancy are highlighted as potential biological pathways for increased risk of genital infections [11]. Cervicitis is underdiagnosed, due to the large number of asymptomatic cases and, therefore, the syndromic approach is flawed, especially in developing countries [12]. The use of nucleic acid amplification test (NAAT) can be applied in the etiological diagnosis of symptomatic infections and testing asymptomatic people for screening programs [13], as it presents greater sensitivity and specificity in diagnosis [8] and allows the detection of the variability of possible pathogens in the same sample [14]. One study compared samples obtained from vaginal swabs, cervical swabs and urine tests, with a sensitivity of 86% for vaginal swabs, when searching for CT, NG, MG, TV and Human Papillomavirus (HPV) [5]. Universal screening for these infections seems justifiable when considering perinatal outcomes [15,16]. Regardless, there are no studies that provide evidence of a global recommendation, as well as randomized clinical studies for screening non-viral STI in developing countries [17]. Despite the impact on public health, STI caused by CT, NG, MG and TV are not part of the national list of compulsory notification [18]. For CT in pregnant women, the World Health Organization (WHO) recommends a syndromic approach; among developing countries, the literature indicates considering universal screening [7]. A current review found that 13 out of 15 studies show benefits in relation to universal screening for Chlamydia trachomatis in the pregnancy cycle, but the data is still heterogeneous [19]. Currently, screening for C. trachomatis in Brazil is recommended for pregnant women under 30 years of age at the first prenatal consultation, people with STI and people living with human immunodeficiency virus (HIV) at the time of diagnosis, as well as victims of sexual violence and prophylaxis users pre-exposure and post-exposure prophylaxis to HIV [6]. In the United States (USA), screening for C. trachomatis is recommended for all pregnant women [20]. The prevalence of C trachomatis in pregnant women varies from 2.5% [21], in developed countries, to 22.9% in Papua New Guinea [22]. Brazilian pregnant women present rates between 9.8 and 16.7% for C. Trachomatis [23] and 1% for N. gonorrhoeae [6,24]. M . genitalium in Brazil, in the female population, has detection between 0.9% [25] and 28.1% [26], being associated with black color, aged under 30 years, genital symptoms, low socioeconomic status, large number of sexual partners, 2 or more sexual partners in the last 12 months and sexual intercourse without condoms [4]. In a review of articles, 0.9% of 3472 pregnant women had MG infection, in developed countries [12]. In Brazil, there are no studies about the prevalence of MG in pregnant women. The prevalence of T. vaginalis (TV) is 3.9 to 24.6% in pregnants [22,23,27]. The presence of several pathogens is still little explored, however, studies showed co-infection of CT and MG between 1,02% and 10.1% in the pregnant period [28,29,30]. A Korean study with 126 women who had premature birth, 2.3% had pathogens that cause cervicitis [31]. Evaluating available data associating non-viral STI and gestational outcomes in Latin American and Caribbean countries, the importance of larger studies was seen, with an emphasis on NG, MG and TV, in view of low socioeconomic status and precarious access to health services [16]. Considering the possibility of assertive treatment with accurate diagnosis, demographic data capable of mapping prevalence of these STI among pregnant women can reduce maternal morbidity and prematurity. This study aims to determine the prevalence of C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis, in pregnant women from a city in southern Brazil and determine the prevalence of co-infection among the microorganisms studied. It also aims to relate socio-demographic data and health data with the presence of any of the microorganisms and compare the prevalence rates found with information already described in the medical literature. METHODOLOGY Observational, cross-sectional study, carried out in the city of Joinville, Santa Catarina, which was approved by the Ethics and Research Committee on Human Beings of the Health Sciences Sector (Clinical Hospital of Federal University of Paraná – UFPR) . We included 167 women between 18 and 49 years old, diagnosed with pregnancy, who attended the Basic Health Units of Joinville and the Darcy Vargas Maternity Hospital, in Joinville, Santa Catarina, Brazil, during the period of the study, regardless of gestational age, and were able and willing to provide genital samples for laboratory tests to investigate CT, NG, MG and TV using molecular biology techniques. Samples of vaginal content were used, which were obtained through vaginal swab collection during prenatal appointment. The exclusion criteria were: use of antibiotics in the last 3 months until the consultation; pregnant women at increased risk for miscarriage such as recurrent pregnancy loss, threatened miscarriage and previous history of cervical conization. As there was no data available on the prevalence of M. genitalium in Brazilian pregnant women, the sample calculation was based on 150 patients, a predetermined number by the National Ministry of Health for the study site in Joinville. One patient was excluded due to antibiotic use less than 3 months before collection, 6 had technical problems with the sample and 12 women did not agree to the collection of a vaginal swab, resulting in a final sample of 148 patients. Study participants were included between November 2021 and March 2022, subjected to an interview and collection of 1 vaginal swab for molecular testing. The data analyzed from the prenatal card was date of birth, gestational age, number of pregnancies (including the current one), number of children (live births), number of miscarriages, number of stillbirths, serology for HIV, syphilis and hepatitis B; the remaining questions were asked directly to the patient. The vaginal swab was carried out by a medical professional, during a gynecological examination, with material being collected from the vaginal wall and immediately inserted into a culture medium, identified with the participant's initials, study number (JOI + sample sequential number) and date of collection. The samples were stored in a freezer for up to 90 days, and were subsequently sent to the central laboratory carrying out the tests (Molecular Biology, Microbiology and Serology Laboratory, Federal University of Santa Catarina, in Florianópolis, Santa Catarina). The technology used was Aptima Combo 2, Aptima TV and Aptima MG for detection of CT/NG, TV and MG respectively. In case of a positive result for detection of any of the agents, treatment and prenatal follow-up followed the recommendations of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections [32]. The collected data was stored in an electronic database. For qualitative variables, frequency tables were considered. Graphical analyzes were also carried out to assist in the interpretation of the results [33]. Variable normality checks were performed using the Shapiro-Wilk test [34]. The association between qualitative variables was performed using Fisher's exact test [34,35]. The comparison between the qualitative variable and the quantitative variables was performed using the Mann-Whitney test [34]. Bonferroni post-hoc tests were used to determine which groups differed from each other when significance occurred in the Fisher test. The significance level adopted for these analyzes was 5%. The analyzes were performed in the computational language R, version 4.1.1 [36]. RESULTS One hundred and forty eight women between 18 and 49 years old, who were diagnosed with pregnancy, undergoing prenatal care in four health units and in the Maternity Hospital in the city of Joinville, were evaluated. Analyzing the sociodemographic profile, the prevalence of white, married women, with a monthly income between 400 and 800 dollars was verified. The median age of the participants was 29 years old, the average of education was 11 years of study and gestational age was 28 completed weeks. The median age at first sexual intercourse was 16 years old and the first pregnancy was at 21 years old. One patient had syphilis in the last 12 months and two pregnant women were living with HIV. Details of the sample population are shown in table 1. Continuous variation data did not present a normal distribution, being interpreted through measures of median position and interquartile range (IQR). Table 1: Description of demographic and health data of the sample population of 148 pregnant women, aged 18-49, in Joinville/SC, from November 2021 to March 2022.. Variable (n evaluated) Mean (SD) Median [IQR] Minimum maximum Age - years (148) 29.69 (7.1) 29 [25 - 34] 15 - 47 Education - years (119*) 10.22 (2.32) 11 [8 - 11] 4 - 16 Gestational age (complete weeks) (148) 27.32 (7.85) 28 [22 - 34] 7 - 39 Age at first sexual intercourse - years (142*) 16.4 (2.71) 16 [15 - 17] 12 - 30 Age at first pregnancy? - years (148) 21.4 (4.79) 21 [18 - 24.5] 14 - 37 Number of pregnancies (148) 2.67 (1.96) 2 [1 - 3] 1 - 16 Number of children (148) 1.14 (1.24) 1 [0 - 2] 0 - 6 Number of miscarriage (148) 0.44 (0,87) 0 [0 - 1] 0 - 6 Number of stillbirths (140*) 0.02 (0.15) 0 [0 - 0] 0 - 1 Number of life partners (124*) 3.06 (3.43) 2 [1 - 4] 1 - 30 Number of partners in the last year (148) 1.04 (0.36) 1 [1 - 1] 0 - 5 Note: SD: standard deviation; IQR: Interquartile range (1st and 3rd quartile). Italics : Preferred descriptive measure for interpretation according to the distribution of the variable *n evaluated smaller than the total number of patients, because some patients abstracted this information during the interview. Regarding the objectives of the study, we observed that Chlamydia trachomatis was detected in 11 pregnant women (7.43%; CI 3.2-11.6%); Mycoplasma genitalium , in 13 pregnant women (8.78%; CI 4.2- 13.4%) and Trichomonas vaginalis was present in 3 pregnant women (2.03% CI 0-4.3%). Among the microorganisms researched, Neisseria gonorrhoeae was the only one not detected in the study sample. Three cases had a present infection with more than one microorganism (2 CT + MG and 1 MG + TV). This prevalence data, as well as the confidence interval found, are described in Table 2. Of the 148 patients studied, 16.2% (N=24) had at least one of the agents positive. No patient with detected CT or MG reported symptoms of leucorrhoea, pelvic pain, genital odor, dysuria, dyspareunia, vulvar pruritus, during the questionnaire. Among the 3 patients who tested positive for TV, one reported the presence of vaginal leucorrhoea. Table 2: Prevalence and confidence interval, in percentage, of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis in 148 pregnant women, between 18-49 years old, in Joinville/SC, from November 2021 to March 2022. Detected Prevalence (%) Inferior limit (%) Upper limit (%) Chlamydia trachomatis 11 7.43 3.2 11.6 Neisseria gonorrhoeae 0 - - - Mycoplasma genitalium 13 8.78 4.2 13.4 Trichomonas vaginalis 3 2.03 0 4.3 When evaluating microorganisms, a lower rate of previous miscarriage was observed in patients with positive C. trachomatis (p-value = 0.023), without association with other pathologies or sample data. In M. genitalium infection , a higher percentage of detection was observed in single patients (p-value=0.014). Patients with T. vaginalis showed a significant association with an earlier age at first pregnancy (p-value = 0.045); women with fewer partners in the last year had a lower prevalence of TV (p-value=0.042). The relationship between microorganisms and data collected through the questionnaire are described in the supplementary tables. Comparing categories evaluated between patients with positive polymerase chain reaction (PCR) for the studied pathogens (CT, MG, TV) (N=24) and patients with negative PCR (N=122), there is no statistical difference in younger women (under 21 years old), marital status, number of pregnancies, number of partners, number of partners in the last year, age at first pregnancy and risk behavior for STI. As shown in tables 3 and 4, patients with positive CT and/or MG, pathogens related to cervicitis, showed no difference in the aforementioned criteria. The positive sample for C. trachomatis was statistically similar to the group with M. genitalium . Table 3: Comparison between age, marital status and risk behavior for sexually transmitted infections and human immunodeficiency virus (HIV), among 20 pregnant women with isolated or associated Chlamydia trachomatis and Mycoplasma genitalium . Variable Class CT (%) MG (%) CT+MG (%) P-value Patient's age 30 3 (33.33) 3 (27.27) 1 (50) Marital status Married 7 (100) 6 (75) 1 (50) 0.300 Single 0 (0) 2 (25) 1 (50) Risk behavior for STI or HIV infection No 9 (100) 11 (100) 2 (100) - Yes 0 (0) 0 (0) 0 (0) Note: Kruskal-Wallis test (5% significance level). IIQ: Interquartile range (1st and 3rd quartile). CT: Chlamydia trachomatis ; MG: Mycoplasma genitalium. Italics: Preferred descriptive measure for interpretation according to the distribution of the variable. Fisher's Exact Test (5% significance level). Table 4: Comparison between parity, number of partners and age at first pregnancy, among 20 pregnant women with isolated or associated Chlamydia trachomatis and Mycoplasma genitalium . Variable (n evaluated) Class (N rated) Mean (SD) Median [IIQ] Min - Max P-value Number of pregnancies (22) CT (9) 2.33 (1.32) 2 [2 - 2] 1 - 5 0.570 CT+MG (2) 2 (1.41) 2 [1.5 - 2.5] 1 - 3 MG (11) 2.09 (1.14) 2 [1.5 - 2] 1 - 5 Number of life partners (17*) CT (7) 3.71 (2.93) 3 [2.5 - 3.5] 1 - 10 0.418 CT+MG (2) 3.5 (0.71) 3.5 [3.25 - 3.75] 3 - 4 MG (8) 3.5 (2.56) 2.5 [2 - 4.25] 1 - 9 Number of partners in the last year (22) CT (9) 1 (0) 1 [1 - 1] 1 - 1 0.208 CT+MG (2) 1 (0) 1 [1 - 1] 1 - 1 MG (11) 0.91 (0.3) 1 [1 - 1] 0 - 1 Age at first pregnancy (22) CT (9) 20.33 (3.71) 20 [18 - 23] 16 - 26 0.886 CT+MG (2) 19.5 (2.12) 19.5 [18.75 - 20.25] 18 - 21 MG (11) 20.64 (4.25) 18 [17.5 - 24] 16 - 29 *N evaluated lower than the total number of patients, because some patients abstracted this information during the interview. CT: Chlamydia trachomatis ; MG: Mycoplasma genitalium. DISCUSSION Prenatal screening for infectious diseases, such as syphilis, hepatitis B, HIV and rubella, is already indicated in american protocols [37,38], however, microorganisms such as C. trachomatis, N. gonorrhoeae , M. genitalium and T. vaginalis have heterogeneity in how to perform screening to prevent unfavorable perinatal outcomes. The prevalence of at least one of the agents in the sample was 16.2% (N=24); C. trachomatis was 7.43%; M. genitalium, 8.7% and T. vaginalis, 2.03%, respectively. N. gonorrhoeae was not detected, and there were three cases of infection with more than one microorganism (2 CT + MG and 1 MG + TV). In the epidemiological associations, it found a lower rate of previous miscarriage in patients with positive CT (p-value = 0.023). Another significant associations brought forth were the detection of TV in patients with an earlier age at first pregnancy (p-value = 0.045), greater detection of MG in single patients (p-value=0.014); lower prevalence of TV in patients with fewer partners in the last year (p-value=0.042). This study provides Brazilian demographic data that we did not have access to until then, with emphasis on what can be considered a high prevalence of MG in pregnant women. The found prevalence of 7.43% of C. trachomatis is within the range of 6.15 to 16.7% in pregnant women in Brazil [6,15,24,39] and Botswana [40], lower than 11.2% in pregnant women in Latin America [23], 14.7% in Haiti [5] and 22.9% in Papua New Guinea [22]. When compared to developed countries such as France, with a prevalence of 2.5% [21], we have a considerably higher rate, but in European pregnant women under the age of 25, CT was found in 7.6% [21] and 18.4% [41], in France and Spain, respectively. Among women who have some risk factor for STI, we have a prevalence of 10.7% in Brazilian women under 25 years old [42], 2.1% in HIV-positive Brazilian women [43], 4% in Spanish women under 30 years old [11] and 9% in female sex workers [44], which was not found when we stratified risk groups in our sample. The non-detection of NG in the sample (n=0/148) was in line with the prevalence of 1.0% in Brazilian pregnant women [24,39] and 1,2% in Latin America [23]. Populations at risk, such as young women, sex workers and HIV positive people have a prevalence of 0.1%-1.5% [11,45], 3.3% [44] and 0.9% [46], respectively. Even in underdeveloped countries, NG detection rates during pregnancy are between 0.5 and 4.6% [5,23,40], with emphasis only on Papua New Guinea, with a rate 14.2% [22]. T. vaginalis was detected in 2.03% of the samples, lower than that found in Latin America (3.9%) [23] and Botswana (5.0%) [40]. Van Gerwen described an important variation in TV rates among pregnant women, from 3.9 to 24.6% [27]. In Brazil, the prevalence in pregnant adolescents (11-19 years old) was 4.3% [47], possibly higher than the value found in our research due to the age of the patients studied. The low rates found in our study can be attributed to the high human development index (HDI) in Joinville, in southern Brazil. The association between TV and younger age at first pregnancy and women with more sexual partners may be related to the lower use of condoms, attributed to this population [48], since they disregard barrier methods in long relationships and during the gestational period. M. genitalium was identified in 13 pregnant women, 8.78% of the sample. This work is the first to describe the prevalence of MG in pregnant women in Brazil. Current literature report a prevalence of MG in pregnant women of 0.7% in England [49], 0.8% in France [21], 0.8% in Japan [50], 1.02% in Iran [28], 5.2% in Argentina [29], 11.9% in the Solomon Islands and 12.5% in Papua New Guine [51]. MG infection rates between 0.7-8.5% [10,12], with numbers ranging from 2.4 to 10% in young pregnant women, risky sexual behavior and low socioeconomic status [10]. In pregnant women under 30 years of age, M. genitalium was found in 1.3% of Spanish women [11] and 2.4% of French women [21]. Our prevalence (8.7%) is within the wide range found in Brazilian literature, not considering pregnant women, with a prevalence between 0.9% [8,52] and up to 28% in vaginal swab analysis by polymerase chain reaction (PCR) in postmenopausal women [25]. And it is lower when considering the high-risk population (15.9%) and sex workers (10.8%) [44]. In our study, MG was found more often in single women and was not related to age groups. Furthermore, no patient with MG presented leucorrhoea, dysuria, dyspareunia, pelvic pain or any other symptoms of genital infection when questioned. It highlights the importance of universal screening during pregnancy. Antimicrobial resistance associated with M. genitalium points to formulate new ways of population screening, diagnosis and treatment protocols in the United States [53], which should also be considered in Brazil, since treatment with a single dose of azithromycin is still widely used in medical practice and has been shown to be ineffective in recent studies [54]. Co-infection by more than one microorganism studied, observed in 16% of the sample, was higher than that found in the literature, between 1,02% [28,29] and 10% [30,43], close to the rate of 13.5%, in an African country [40]. There was no direct association with already known risk factors to STI such as young age and unfavorable socioeconomic situation [30] Among the epidemiological associations, we can highlight a lower rate of previous miscarriage in patients with positive CT (p-value = 0.023), this result may have been influenced by the sample size and has no cause-effect association. When comparing populations with positive CT and MG, there is no significant difference, which may point to a similarity in the risk factors for acquiring these STI, as Larsen already points out, in patients with cervicitis [2]. Twenty four patients (16.2% of the sample) presented a positive PCR for pathogens that cause cervicitis, a significant number compared to Korean data - 2.38%, including the same group of microorganisms [31]. This study is part of a multicenter project to screen microorganisms during pregnancy, that aims to evaluate possible implementation of these tests in the national territory. There were limitations related to the logistical difficulties between collection, storage, transportation and execution of NAAT exams, the sample size and the collection in a hospital environment, in the tertiary service, which may be associated with an increase in comorbidities in the population. Despite the relatively small number of patients evaluated, we highlight the prevalence of MG as well as the co-infection between CT and MG, which reinforces the importance of molecular biology tests in the assertive diagnosis of STI, mainly in special populations, such as pregnant women. Expanding screening for C. trachomatis during prenatal care, given its high prevalence and the possibility of co-infection with other pathogens, also proves to be an important public health measure in Brazil, confirming data from the worldwide available literature. Even in asymptomatic pregnant women, cervicitis can cause preterm birth, premature rupture of membranes, fetal death, intrauterine growth restriction and puerperal endometritis [3-9]. Regarding the microorganisms to be tested, as there was no statistical difference between the populations, the data evaluated suggest screening for C. trachomatis and M. genitalium universally, for all pregnant women. Even though the region studied has a high human development index (HDI) compared to the rest of the country, we observed a high prevalence of CT and MG, which further alerts us to regions of greater vulnerability, such as young people, low socioeconomic status and precarious access to health services. The prospects point to the need for a larger population study, evaluating risk groups for STI during the pregnant period, in order to verify the indication and feasibility of implantation, territorially, the screening of important pathogens to improve perinatal morbidity and mortality rates. Studies like this make it possible to measure data so that future strategies can have an impact on the health of developing countries like Brazil. Declarations FUNDING Aptima Combo 2, Aptima TV and Aptima MG molecular biology tests , as well as their interpretation, carried out by a laboratory linked to the Federal University of Santa Catarina, provided by the Ministry of Health of Brazil. The forms used, the statistical evaluation and the sending of samples for laboratory analysis were paid for by author Danielle Betina de Oliveira Traesel . COMPETING INTERESTS The authors have no relevant financial or non-financial interests to disclose. AUTHOR CONTRIBUTIONS All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Danielle Betina de Oliveira Traesel and Newton Sérgio de Carvalho. The first draft of the manuscript was written by Danielle Betina de Oliveira Traesel and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. DATA AVAILABILITY The datasets generated during and analysed during the current study are available in the personal repository, datasetchamydiaoOFICIAL.xlsx ETHICS APPROVAL This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics and Research Committee on Human Beings of the Health Sciences Sector (Clinical Hospital of Federal University of Paraná – UFPR) CONSENT TO PARTICIPATE Informed consent was obtained from all individual participants included in the study. References WORLD HEALTH ORGANIZATION - WHO. Global Health Sector Strategy on Sexually Transmitted Infections 2016 - 2021. 2016. [ S. l. ]: World Health Organization , 2016. LARSEN, B; HWANG, J. Mycoplasma, Ureaplasma, and adverse pregnancy outcomes: a fresh look. 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Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecções que causam cervicite. Epidemiol. Serv. Saude , Brasília, 30(Esp.1):e2020587, 2021 TANG, W; MAO, J; LI, KT, et al. Pregnancy and fertility-related adverse outcomes associated with Chlamydia trachomatis infection: a global systematic review and meta-analysis. Sex Transm Infect 2020;96:322–329. DE CARVALHO, NS; PALÚ, G; WITKIN, SS. Mycoplasma genitalium, a stealth female reproductive tract. European Journal of Clinical Microbiology and Infectious Diseases , vol. 39, no. 2, p. 229–234, 2020. https://doi.org/10.1007/s10096-019-03707-8. FRENZER, C; EGLI-GANY, D; VALLELY, LM; VALLELY, AJ, LOW, N. Adverse pregnancy and perinatal outcomes associated with Mycoplasma genitalium: systematic review and meta-analysis. Sex Transm Infect. 2022 May;98(3):222-227. doi: 10.1136/sextrans-2021-055352. Epub 2022 Mar 29. PMID: 35351816; PMCID: PMC9016252. DONDERS, GGG; RUBAN, K; BELLEN, G; PETRICEVIC, L. Mycoplasma/Ureaplasma infection in pregnancy: to screen or not to screen. J Perinat Med. 2017 Jul 26;45(5):505-515. doi: 10.1515/jpm-2016-0111. PMID: 28099135. PIÑEIRO, L; ZUBIKARAI, M; MANZANAL, A, et al. Prevalence of Chlamydia trachomatis , Mycoplasma genitalium , and Neisseria gonorrhoeae infections in a screening program for under-30-year-old pregnant women with a high participation rate in northern Spain (2016–2020). Reproductive, Female and Child Health. 2023; 2: 19- 27. doi:10.1002/rfc2.20 BAUMANN, L; CINA, M; EGLI-GANY, D; GOUTAKI, M; HALBEISEN, FS; LOHRER, GR; ALI, H; SCOTT, P; LOW, N. Prevalence of Mycoplasma genitalium in different population groups: systematic review and meta-analysis. Sex Transm Infect 2018;94:254–261. WORLD HEALTH ORGANIZATION (WHO). Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus [Internet]. Geneva: World Health Organization : 2013. [cited 2020 Jun 20]. LORINCZ, A. (Ed.). (2006). Nucleic Acid Testing for Human Disease (1st ed.). CRC Press. https://doi.org/10.1201/9781420016888 DE CARVALHO, NS; PEGORARO, MG; TAKIMURA, M; OLIVEIRA JÚNIOR, FC. Prevalência da infecção por Chlamydia trachomatis em parturientes jovens atendidas em uma maternidade pública. DST – J bras Doenças Sex Transm 2010; 22(3):141-144 - ISSN: 0103-4065 - ISSN on-line: 2177-8264 LARA-ESCANDELL, M; GAMBERINI, C; JULIANA, NCA; AL-NASIRY, S; MORRÉ, SA; AMBROSINO, E. The association between non-viral sexually transmitted infections and pregnancy outcome in Latin America and the Caribbean: A systematic review. Heliyon . 2023 Dec 13;10(1):e23338. doi: 10.1016/j.heliyon.2023.e23338. PMID: 38187347; PMCID: PMC10767377. GRANT, JS; CHICO, RM; LEE, AC; LOW, N; MEDINA-MARINO, A; MOLINA, RL; MORRONI, C; RAMOGOLA-MASIRE, D; STAFYLIS, C; TANG, W; VALLELY, AJ; WYNN, A; YEGANEH, N; KLAUSNER, JD. Sexually Transmitted Infections in Pregnancy: A Narrative Review of the Global Research Gaps, Challenges, and Opportunities. Sex Transm Dis. 2020 Dec;47(12):779-789. doi: 10.1097/OLQ.0000000000001258. PMID: 32773611; PMCID: PMC7668326. BRAZIL. Ministry of Health. MS/GM Consolidation Ordinance No. 4, of September 28, 2017. Consolidation of standards on systems and subsystems of the Unified Health System [Internet]. Official Gazette of the Union , Brasília (DF), 2017 Oct 03 [cited 2020 Jul 31];Supplement:288. Available at: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2017/prc0004_03_10_2017.html ADACHI, KN, NIELSEN-SAINES, K, KLAUSNER, JD. Chlamydia trachomatis Screening and Treatment in Pregnancy to Reduce Adverse Pregnancy and Neonatal Outcomes: A Review. Front. Public Health 9:531073; 2021. doi: 10.3389/fpubh.2021.531073 WIHLFAHRT, K; GÜNTHER, V; MENDLING, W; WESTERMANN, A; WILLER, D; GITAS, G; RUCHAY, Z; MAASS, N; ALLAHGOLI, L; ALKATOUT, I. Sexually Transmitted Diseases-An Update and Overview of Current Research. Diagnostics (Basel) . 2023 May 8;13(9):1656. doi: 10.3390/diagnostics13091656. PMID: 37175047; PMCID: PMC10178083. PEUCHANT, O; LE ROY, C; DESVEAUX, C; PARIS, A; ASSELINEAU, J; MALDONADO, C; CHËNE, G; HOROVITZ, J; DALLAY, D; DE BABEYRAC, B; BÉBÉAR, C. Screening for Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium should it be integrated into routine pregnancy care in French young pregnant women? Diagn Microbiol Infect Dis. 2015 May;82(1):14-9. doi: 10.1016/j.diagmicrobio.2015.01.014. Epub 2015 Feb 3. PMID: 25753079. VALLELY, LM; TOLIMAN, P; RYAN, C; RAI, G; WAPLING, J; TOMADO, C; HULIAFI, S; MUNNULL, G; RARAU P; PHUANUKOONNON, S; WAND, H; SIBA, P; MOLA GDL, KALDOR, JM, VALLELY, AJ. Prevalence and risk factors of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and other sexually transmissible infections among women attending antenatal clinics in three provinces in Papua New Guinea: a cross-sectional survey. Sex Health . 2016 Oct;13(5):420-427. doi: 10.1071/SH15227. PMID: 28636866. JOSEPH DAVEY, DL; SHULL, HI; BILLINGS, JD; WANG, D; ADACHI, K; KLAUSNER, JD. Prevalence of Curable Sexually Transmitted Infections in Pregnant Women in Low- and Middle-Income Countries From 2010 to 2015: A Systematic Review. Sex Transm Dis . 2016 Jul;43(7):450-8. doi: 10.1097/OLQ.0000000000000460. Erratum in: Sex Transm Dis. 2020 May;47(5):e11-e13. PMID: 27322048; PMCID: PMC5889114. PINTO, VM; SZWARCWALD, CL; BARONI, C; STRINGARI, LL; INOCÊNCIO, LA; MIRANDA, AE. Chlamydia trachomatis prevalence and risk behaviors in parturient women aged 15 to 24 in Brazil. Sex Transm Dis [Internet]. 2011 Oct [cited 2020 Sep 10];38(10):957-61. Available from: https://doi.org/10.1097/olq.0b013e31822037fc RODRIGUES MM, FERNANDES PA, HADDAD JP, PAICA MC, SOUZA C, ANDRADE TC, FERNANDES AP. Frequency of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis and Ureaplasma species in cervical samples. J Obstet Gynaecol . 2011;31(3):237-41. doi: 10.3109/01443615.2010.548880. PMID: 21417648. CAMPOS, GB; LOBÃO, TN; SELIS, NN; AMORIM, AT; MARTINS, HB; BARBOSA, MS; OLIVEIRA, TH; DOS SANTOS, DB; FIGUEIREDO, TB; MIRANDA MARQUES, L; TIMENETSKY, J. Prevalence of Mycoplasma genitalium and Mycoplasma hominis in urogenital tract of Brazilian women. BMC Infect Dis. 2015 Feb 14;15:60. doi: 10.1186/s12879-015-0792-4. PMID: 25886914; PMCID: PMC4336719. VAN GERWEN, OT; MUZNY, CA. Recent advances in the epidemiology, diagnosis, and management of Trichomonas vaginalis infection. F1000Res. 2019 Sep 20;8:F1000 Faculty Rev-1666. doi: 10.12688/f1000research.19972.1. PMID: 31583080; PMCID: PMC6758837. HASANABAD, MH; MOHAMMADZADEH, M; BAHADOR, A; FAZEL, N; RAKHSHANI, H; MAJNOONI, A. Prevalence of Chlamydia trachomatis and Mycoplasma genitalium in pregnant women of Sabzevar-Iran. Iran J Microbiol. 2011 Sep;3(3):123-8. PMID: 22347594; PMCID: PMC3279818. MAGDALENO, MA; IRURTIA, MC; CASANOVA, NB; LEONINO, P; PEREYRA, A; DI BARTOLOMEO, S; BALCONI, S; MONTENEGRO, DG. Prevalencia de la infección por Mycoplasma genitalium en mujeres embarazadas . Acta bioquím. clín. latinoam ; 54(4): 415-420, jul. 2020. SHILLING, HS; GARLAND, SM; COSTA, AM; MARCEGLIA, A; FETHERS, K; DANIELEWSKI, J; MURRAY, G; BRADSHAW, C; VODSTRCIL, L; HOCKING, JS; KALDOR, J; GUY, R; MACHALEK, DA. Chlamydia trachomatis and Mycoplasma genitalium prevalence and associated factors among women presenting to a pregnancy termination and contraception clinic, 2009-2019. Sex Transm Infect. 2022 Mar;98(2):115-120. doi: 10.1136/sextrans-2020-054695. Epub 2021 Mar 29. PMID: 33782146. CHOI, SJ; PARK, SD; JANG, IH; UH, Y; LEE, A. The prevalence of vaginal microorganisms in pregnant women with preterm labor and preterm birth. Ann Lab Med. 2012 May;32(3):194-200. doi: 10.3343/alm.2012.32.3.194. Epub 2012 Apr 18. PMID: 22563554; PMCID: PMC3339299. BRAZIL. Ministry of Health. Secretariat of Health Surveillance. Department of Chronic Diseases and Sexually Transmitted Infections. Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections (STI) . Brasília: Ministry of Health; 2022. ISBN 978-65-5993-276-4 COSTA NETO, PL. (2002). Estatística (2ª Edição ed.) . São Paulo: Blucher SIEGEL, S; CASTELLAN JR, NJ (2006). Estatística não-paramétrica para ciência do comportamento (2ª Edição ed.). Porto Alegre: Artmed. AGRESTI, A. (2007). An introduction to categorical data analysis. (2, Ed.) New Jersey: John Wiley & Sons, Inc. TEAM, RC (2022). R: A language and environment for statistical computing. KOUMANS, EH; ROSEN, J; VAN DYKE, MK; SELL, E; PHARES, CR; TAYLOR, A; LOFT, J; SCHRAG, S; ABC and DHAP/RTI TEAMS. Prevention of mother-to-child transmission of infections during pregnancy: implementation of recommended interventions, United States, 2003-2004. Am J Obstet Gynecol. 2012 Feb;206(2):158.e1-158.e11. doi: 10.1016/j.ajog.2011.08.027. Epub 2011 Sep 8. PMID: 22030318; PMCID: PMC4707941. US Preventive Services Task Force. Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;326(10):949–956. doi:10.1001/jama.2021.14081 JALIL, EM; PINTO, VM; BENZAKEN, AS; RIBEIRO, D; OLIVEIRA, EC; GARCIA, EG; MOHERDAUI, F; BARBOSA, MJ. Prevalência da infecção por clamídia e gonococo em gestantes de seis cidades brasileiras [Prevalence of Chlamydia and Neisseria gonorrhoeae infections in pregnant women in six Brazilian cities]. Rev Bras Ginecol Obstet. 2008 Dec;30(12):614-9. Portuguese. doi: 10.1590/s0100-72032008001200005. PMID: 19219343. WYNN, A; RAMGOLA-MASIRE, D; GAOLEBALE, P; MOSHASHANE N, SICKBOY O, DUQUE S, WILLIAMS E, DOHERTY K, KLAUSNER JD, MORRONI C. Prevalence and treatment outcomes of routine Chlamydia trachomatis , Neisseria gonorrhoeae and Trichomonas vaginalis testing during antenatal care, Gaborone, Botswana. Sex Transm Infect. 2018 May;94(3):230-235. doi: 10.1136/sextrans-2017-053134. Epub 2017 Nov 2. PMID: 29097418; PMCID: PMC6117829. DORADO CRIADO, M; FABRA GARRIDO, C; MERINO SAN MARTÍN, E; GONZÁLEZ ARBOLEYA, C; GOMÉZ-ARROYO, B; GONZÁLEZ-DONAPETRY, P; BAQUERO-ARTIGAO, F; DE LA CALLE, M; QUILES-MELERO, I; CALVO, C. Is an Antenatal Screening for Chlamydia trachomatis Necessary in the Current Society? Pediatr Infect Dis J. 2021 Nov 1;40(11):1034-1036. doi: 10.1097/INF.0000000000003229. PMID: 34321448. PIAZZETA, RCPS; DE CARVALHO, NS; DE ANDRADE, RP; PIAZETTA, G; PIAZETTA, SR; CARNEIRO, R. Prevalência da infecção por Chlamydia trachomatis e Neisseria gonorrhoeae em mulheres jovens sexualmente ativas em uma cidade do Sul do Brasil. Rev Bras Ginecol Obstet . 2011; 33(11):328-33 MIRANDA AE, SILVEIRA MF, TRAVASSOS AG, TENÓRIO T, VAL ICCD, LANNOY L, et al. Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae and associated factors among women living with Human Immunodeficiency Virus in Brazil: a multicenter study. Braz J Infect Dis [Internet]. 2017Jul-Aug [cited 2020 Sep 28]; 21(4):402-7. COOREVITS, L; TRAEN, A; BINGÉ, L; VAN DORPE, J; PRAET, M; BOLENS, J; PADAIKO, E. Identifying a consensus sample type to test for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis and human papillomavirus. Clin Microbiol Infect. 2018 Dec;24(12):1328-1332. doi: 10.1016/j.cmi.2018.03.013. Epub 2018 Mar 17. PMID: 29559392. PIAZZETA, RCPS; DE CARVALHO, NS; DE ANDRADE, RP; PIAZETTA, G; PIAZETTA, SR; CARNEIRO, R. Prevalência da infecção por Chlamydia trachomatis e Neisseria gonorrhoeae em mulheres jovens sexualmente ativas em uma cidade do Sul do Brasil. Rev Bras Ginecol Obstet . 2011; 33(11):328-33 MIGCHELSEN, SJ; ENAYAT, Q; HARB, AK; DAAHIR, U; SLATER, L; ANDERSON, A; TALEBI, A; DUNN, J; BUITENDAM, E; SHAW, D; O’BRIEN, N; CHECCHI, M; FIFER, HELEN; SAUNDERS, J, SOLDAN; K, FOLKARD, K; SINKA, K; MOHAMMED, H. Sexually transmitted infections and screening for chlamydia in England, 2022. June 2023, UK Health Security Agency, London. BORBOREMA, NC. Prevalência de Trichomonas vaginalis em uma população de mulheres adolescentes, Goiânia-Goiás 2004-2005. Laboratório de Biologia, Fisiologia e Imunologia de Protozoários do DMIPP do Instituto de Patologia Tropical e Saúde Pública [dissertação de mestrado]. Goiânia (GO): Universidade Federal de Goiás; 2005 TEASDALE, CA.; ABRAMS, EJ; CHIASSON, MA; JUSTMAN, J; BLANCHARD, K; JONES, HE. Sexual Risk and Intravaginal Practice Behavior Changes During Pregnancy. Archives of Sexual Behavior , vol. 46, no. 2, p. 539–548, 2017. https://doi.org/10.1007/s10508-016-0818-z. OAKESHOTT, P; HAY, P; TAYLOR-ROBINSON, D; HAY, S; DOHN, B; KERRU, S; JENSEN, JS. Prevalence of Mycoplasma genitalium in early pregnancy and relationship between its presence and pregnancy outcome. BJOG . 2004 Dec;111(12):1464-7. doi: 10.1111/j.1471-0528.2004.00276.x. PMID: 15663138. KATAOKA, S; YAMADA, T; CHOU, K; NISHIDA, R; MORIKAWA, M; MINAMI, M; YAMADA, H; SAKURAGI, N; MINAKAMI, H. Association between preterm birth and vaginal colonization by mycoplasmas in early pregnancy. J Clin Microbiol. 2006 Jan;44(1):51-5. doi: 10.1128/JCM.44.1.51-55.2006. PMID: 16390947; PMCID: PMC1351938. SCOULLAR, MJL; BOEUF, P; PEACH, E; FIDELIS, R; TOKMUN, K; MELEPIA, P; ELIJAH, A; BRADSHAW, CS; FEHLER, G; SIBA, PM; ERSKINE, S; MOKANY, E; KENNEDY, E; UMBERS, AJ; LUCHTERS, S; ROBINSON, LJ; WONG, NC; VALLELY, AJ; BADMAN, SG; VALLELY, LM; FOWKES, FJI; MORGAN, C; POMAT, W; CRABB, BS; BEESON, JG; HEALTHY MOTHERS HEALTHY BABIES STUDY TEAM1. Mycoplasma genitalium and Other Reproductive Tract Infections in Pregnant Women, Papua New Guinea, 2015-2017. Emerg Infect Dis. 2021 Mar;27(3):894-904. doi: 10.3201/eid2703.201783. PMID: 33622474; PMCID: PMC7920647. SILVEIRA, M. F.; BRUNI, M. P.; STAUFFERT, D.; GOLPARIAN, D.; UNEMO, M. Prevalence and risk factors associated with Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium among women in Pelotas, Southern Brazil. International Journal of STD and AIDS , vol. 31, no. 5, p. 432–439, 2020. https://doi.org/10.1177/0956462419898982. KORICH, F; REDDY, NG; TRENT, M. Mycoplasma genitalium and Trichomonas vaginalis: addressing disparities and promoting public health control of two emerging sexually transmitted infections. Curr Opin Pediatr. 2020 Aug;32(4):482-488. doi: 10.1097/MOP.0000000000000909. PMID: 32520821; PMCID: PMC7919501. JENSEN, JS; CUSINI, M; GOMBERG, M; MOI, H. European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol. 2016; 30: 1650– 1656. Additional Declarations No competing interests reported. Supplementary Files ATTACHMENTS.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3965454","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":273901215,"identity":"56bd038a-b3eb-467f-8362-e1f30f5453d7","order_by":0,"name":"Danielle Betina de Oliveira 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1","display":"","copyAsset":false,"role":"figure","size":53094,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the sample population, among 167 pregnant women eligible for research on \u003cem\u003eChlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium \u003c/em\u003eand \u003cem\u003eTrichomonas vaginalis \u003c/em\u003e, according to Strobe (Equator Network).\u003c/p\u003e","description":"","filename":"figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3965454/v1/0506704765cb7b670bb4887e.jpg"},{"id":51828370,"identity":"000f7ba5-d79c-4e76-89b2-df5dbac76ab5","added_by":"auto","created_at":"2024-02-29 17:29:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":716220,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3965454/v1/894d559c-e757-4013-ad95-cece52694d98.pdf"},{"id":51445725,"identity":"c3b83ba0-8364-4b66-99c5-d040e5f820ca","added_by":"auto","created_at":"2024-02-21 18:11:21","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26865,"visible":true,"origin":"","legend":"","description":"","filename":"ATTACHMENTS.docx","url":"https://assets-eu.researchsquare.com/files/rs-3965454/v1/927fe2dfdbf054aa5f58879e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis in prenatal care in the public health system, in a southern city of Brazil","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eSexually transmitted infections (STI) are diseases with impact on global health, having more than 374 million new infections estimated worldwide in 2020, considering curable genital infections such as \u003cem\u003eChlamydia trachomatis\u003c/em\u003e (CT), \u003cem\u003eNeisseria gonorrhoeae\u0026nbsp;\u003c/em\u003e(NG), \u003cem\u003eTrichomonas vaginalis\u0026nbsp;\u003c/em\u003e(TV)\u003cem\u003e\u0026nbsp;\u003c/em\u003eand syphilis [1]. \u003cem\u003eMycoplasma\u003c/em\u003e \u003cem\u003egenitalium\u0026nbsp;\u003c/em\u003e(MG) has been considered an emerging pathogen among STI, with symptoms similar to CT and NG infection [2], but data in female populations is still limited [3,4].\u003c/p\u003e\n\u003cp\u003eDuring pregnancy, cervicitis caused by CT, NG and TV is associated with preterm birth, premature rupture of membranes, fetal death, intrauterine growth restriction and puerperal endometritis [5,6,7]. Studies have demonstrated a relationship between \u003cem\u003eM. genitalium\u0026nbsp;\u003c/em\u003eand poor sexual health, infertility, miscarriage and preterm labor [3,4,8,9], with the risk of preterm labor independent of other STI [2,10]. Adaptations in immune function and physiological changes in the endocervix that occur during pregnancy are highlighted as potential biological pathways for increased risk of genital infections [11]. Cervicitis is underdiagnosed, due to the large number of asymptomatic cases and, therefore, the syndromic approach is flawed, especially in developing countries [12]. The use of nucleic acid amplification test (NAAT) can be applied in the etiological diagnosis of symptomatic infections and testing asymptomatic people for screening programs [13], as it presents greater sensitivity and specificity in diagnosis [8] and allows the detection of the variability of possible pathogens in the same sample [14]. One study compared samples obtained from vaginal swabs, cervical swabs and urine tests, with a sensitivity of 86% for vaginal swabs, when searching for CT, NG, MG, TV and Human Papillomavirus (HPV) [5].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Universal screening for these infections seems justifiable when considering perinatal outcomes [15,16]. Regardless, there are no studies that provide evidence of a global recommendation, as well as randomized clinical studies for screening non-viral STI in developing countries [17]. Despite the impact on public health, STI caused by CT, NG, MG and TV are not part of the national list of compulsory notification [18]. For CT in pregnant women, the World Health Organization (WHO) recommends a syndromic approach; among developing countries, the literature indicates considering universal screening [7]. A current review found that 13 out of 15 studies show benefits in relation to universal screening for \u003cem\u003eChlamydia trachomatis\u003c/em\u003e in the pregnancy cycle, but the data is still heterogeneous [19]. Currently, screening for \u003cem\u003eC. trachomatis\u0026nbsp;\u003c/em\u003ein Brazil is recommended for pregnant women under 30 years of age at the first prenatal consultation, people with STI and people living with human immunodeficiency virus (HIV) at the time of diagnosis, as well as victims of sexual violence and prophylaxis users pre-exposure and post-exposure prophylaxis to HIV [6]. In the United States (USA), screening for \u003cem\u003eC. trachomatis\u0026nbsp;\u003c/em\u003eis recommended for all pregnant women [20].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe prevalence of \u003cem\u003eC trachomatis\u0026nbsp;\u003c/em\u003ein pregnant women varies from 2.5% [21], in developed countries, to 22.9% in Papua New Guinea [22]. Brazilian pregnant women present rates\u003cem\u003e\u0026nbsp;\u003c/em\u003ebetween 9.8 and 16.7% for \u003cem\u003eC. Trachomatis\u003c/em\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[23] and 1% for \u003cem\u003eN. gonorrhoeae\u0026nbsp;\u003c/em\u003e[6,24]. \u003cem\u003eM\u003c/em\u003e. \u003cem\u003egenitalium\u0026nbsp;\u003c/em\u003ein Brazil, in the female population, has detection between 0.9% [25] and 28.1% [26], being associated with black color, aged under 30 years, genital symptoms, low socioeconomic status, large number of sexual partners, 2 or more sexual partners in the last 12 months and sexual intercourse without condoms [4]. In a review of articles, 0.9% of 3472 pregnant women had MG infection, in developed countries [12]. In Brazil, there are no studies about the prevalence of MG in pregnant women. The prevalence of \u003cem\u003eT. vaginalis\u0026nbsp;\u003c/em\u003e(TV) is 3.9 to 24.6% in pregnants [22,23,27]. The presence of several pathogens is still little explored, however, studies showed co-infection of CT and MG between 1,02% and 10.1% in the pregnant period [28,29,30]. A Korean study with 126 women who had premature birth, 2.3% had pathogens that cause cervicitis [31].\u003c/p\u003e\n\u003cp\u003eEvaluating available data associating non-viral STI and gestational outcomes in Latin American and Caribbean countries, the importance of larger studies was seen, with an emphasis on NG, MG and TV, in view of low socioeconomic status and precarious access to health services [16]. Considering the possibility of assertive treatment with accurate diagnosis, demographic data capable of mapping prevalence of these STI among pregnant women can reduce maternal morbidity and prematurity. This study aims to determine the prevalence of \u003cem\u003eC. trachomatis, N. gonorrhoeae, M. genitalium\u0026nbsp;\u003c/em\u003eand \u003cem\u003eT. vaginalis,\u0026nbsp;\u003c/em\u003ein pregnant women from a city in southern Brazil and determine the prevalence of co-infection among the microorganisms studied. It also aims to relate socio-demographic data and health data with the presence of any of the microorganisms and compare the prevalence rates found with information already described in the medical literature.\u0026nbsp;\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003eObservational, cross-sectional study, carried out in the city of Joinville, Santa Catarina, which was approved by the Ethics and Research Committee on Human Beings of the Health Sciences Sector (Clinical Hospital of Federal University of Paran\u0026aacute; \u0026ndash; UFPR) .\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;We included 167 women between 18 and 49 years old, diagnosed with pregnancy, who attended the Basic Health Units of Joinville and the Darcy Vargas Maternity Hospital, in Joinville, Santa Catarina, Brazil, during the period of the study, regardless of gestational age, and were able and willing to provide genital samples for laboratory tests to investigate CT, NG, MG and TV using molecular biology techniques. Samples of vaginal content were used, which were obtained through vaginal swab collection during\u003cem\u003e\u0026nbsp;\u003c/em\u003eprenatal appointment. \u003cstrong\u003eThe exclusion criteria were: use of antibiotics in the last 3 months until the consultation; pregnant women at increased risk for miscarriage such as recurrent pregnancy loss, threatened miscarriage and previous history of cervical conization.\u003c/strong\u003e As there was no data available on the prevalence of\u003cem\u003e\u0026nbsp;M. genitalium\u003c/em\u003e in Brazilian pregnant women, the sample calculation was based on 150 patients, a predetermined number by the National Ministry of Health for the study site in Joinville. One patient was excluded due to antibiotic use less than 3 months before collection, 6 had technical problems with the sample and 12 women did not agree to the collection of a vaginal swab, resulting in a final sample of 148 patients.\u003c/p\u003e\n\u003cp\u003eStudy participants were included between November 2021 and March 2022, subjected to an interview and collection of 1 vaginal \u003cem\u003eswab\u0026nbsp;\u003c/em\u003efor molecular testing. The data analyzed from the prenatal card was date of birth, gestational age, number of pregnancies (including the current one), number of children (live births), number of miscarriages, number of stillbirths, serology for HIV, syphilis and hepatitis B; the remaining questions were asked directly to the patient. The vaginal \u003cem\u003eswab\u0026nbsp;\u003c/em\u003ewas carried out by a medical professional, during a gynecological examination, with material being collected from the vaginal wall and immediately inserted into a culture medium, identified with the participant\u0026apos;s initials, study number (JOI + sample sequential number) and date of collection. The samples were stored in a freezer for up to 90 days, and were subsequently sent to the central laboratory carrying out the tests (Molecular Biology, Microbiology and Serology Laboratory, Federal University of Santa Catarina, in Florian\u0026oacute;polis, Santa Catarina). The technology used was Aptima Combo 2, Aptima TV and Aptima MG for detection of CT/NG, TV and MG respectively. In case of a positive result for detection of any of the agents, treatment and prenatal follow-up followed the recommendations of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections [32].\u003c/p\u003e\n\u003cp\u003eThe collected data was stored in an electronic database. For qualitative variables, frequency tables were considered. Graphical analyzes were also carried out to assist in the interpretation of the results [33]. Variable normality checks were performed using the Shapiro-Wilk test [34]. The association between qualitative variables was performed using Fisher\u0026apos;s exact test [34,35]. The comparison between the qualitative variable and the quantitative variables was performed using the Mann-Whitney test [34]. Bonferroni post-hoc tests were used to determine which groups differed from each other when significance occurred in the Fisher test. The significance level adopted for these analyzes was 5%. The analyzes were performed in the computational language R, version 4.1.1 [36].\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOne hundred and forty eight women between 18 and 49 years old, who were diagnosed with pregnancy, undergoing prenatal care in four health units and in the Maternity Hospital in the city of Joinville, were evaluated. Analyzing the sociodemographic profile, the prevalence of white, married women, with a monthly income between 400 and 800 dollars was verified. The median age of the participants was 29 years old, the average of education was 11 years of study and gestational age was 28 completed weeks. The median age at first sexual intercourse was 16 years old and the first pregnancy was at 21 years old. One patient had syphilis in the last 12 months and two pregnant women were living with HIV.\u003c/p\u003e\n\u003cp\u003eDetails of the sample population are shown in table\u0026nbsp;1. Continuous variation data did not present a normal distribution, being interpreted through measures of median position and interquartile range (IQR).\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;1: Description of demographic and health data of the sample population of 148 pregnant women, aged 18-49, in Joinville/SC, from November 2021 to March 2022..\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"650\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.76923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable (n evaluated)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian [IQR]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMinimum maximum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.76923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eAge - years (148)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14%\" valign=\"top\"\u003e\n \u003cp\u003e29.69 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e29 [25 - 34]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e15 - 47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.76923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eEducation - years (119*)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14%\" valign=\"top\"\u003e\n \u003cp\u003e10.22 (2.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e11 [8 - 11]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e4 - 16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.76923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eGestational age (complete weeks) (148)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14%\" valign=\"top\"\u003e\n \u003cp\u003e27.32 (7.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e28 [22 - 34]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e7 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.76923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eAge at first sexual intercourse - years (142*)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14%\" valign=\"top\"\u003e\n \u003cp\u003e16.4 (2.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e16 [15 - 17]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e12 - 30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.76923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eAge at first pregnancy? - years (148)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14%\" valign=\"top\"\u003e\n \u003cp\u003e21.4 (4.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e21 [18 - 24.5]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e14 - 37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.76923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of pregnancies (148)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14%\" valign=\"top\"\u003e\n \u003cp\u003e2.67 (1.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e2 [1 - 3]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e1 - 16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.76923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of children (148)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14%\" valign=\"top\"\u003e\n \u003cp\u003e1.14 (1.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e1 [0 - 2]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e0 - 6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.76923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of miscarriage (148)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14%\" valign=\"top\"\u003e\n \u003cp\u003e0.44 (0,87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e0 [0 - 1]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e0 - 6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.76923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of stillbirths (140*)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14%\" valign=\"top\"\u003e\n \u003cp\u003e0.02 (0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e0 [0 - 0]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e0 - 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.76923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of life partners (124*)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14%\" valign=\"top\"\u003e\n \u003cp\u003e3.06 (3.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e2 [1 - 4]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e1 - 30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.76923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of partners in the last year (148)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14%\" valign=\"top\"\u003e\n \u003cp\u003e1.04 (0.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e1 [1 - 1]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.615384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e0 - 5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: SD: standard deviation; IQR: Interquartile range (1st and 3rd quartile). \u003cem\u003eItalics\u0026nbsp;\u003c/em\u003e: Preferred descriptive measure for interpretation according to the distribution of the variable\u0026nbsp;*n evaluated smaller than the total number of patients, because some patients abstracted this information during the interview.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding the objectives of the study, we observed that \u003cem\u003eChlamydia trachomatis\u003c/em\u003e was detected in 11 pregnant women (7.43%; CI 3.2-11.6%); \u003cem\u003eMycoplasma genitalium\u003c/em\u003e, in 13 pregnant women (8.78%; CI 4.2- 13.4%) and \u003cem\u003eTrichomonas vaginalis\u0026nbsp;\u003c/em\u003ewas present in 3 pregnant women (2.03% CI 0-4.3%). Among the microorganisms researched, \u003cem\u003eNeisseria gonorrhoeae\u0026nbsp;\u003c/em\u003ewas the only one not detected in the study sample. Three cases had a present infection with more than one microorganism (2 CT + MG and 1 MG + TV). This prevalence data, as well as the confidence interval found, are described in Table\u0026nbsp;2. Of the 148 patients studied, 16.2% (N=24) had at least one of the agents positive. No patient with detected CT or MG reported symptoms of leucorrhoea, pelvic pain, genital odor, dysuria, dyspareunia, vulvar pruritus, during the questionnaire. Among the 3 patients who tested positive for TV, one reported the presence of vaginal leucorrhoea.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2: Prevalence and confidence interval, in percentage, of \u003cem\u003eChlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium\u0026nbsp;\u003c/em\u003eand \u003cem\u003eTrichomonas vaginalis\u0026nbsp;\u003c/em\u003ein 148 pregnant women, between 18-49 years old, in Joinville/SC, from November 2021 to March 2022.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"650\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003eDetected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003ePrevalence (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003eInferior limit (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003eUpper limit (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e\u003cem\u003eChlamydia trachomatis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e7.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e\u003cem\u003eNeisseria gonorrhoeae\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e\u003cem\u003eMycoplasma genitalium\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e8.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e\u003cem\u003eTrichomonas vaginalis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eWhen evaluating microorganisms, a lower rate of previous miscarriage was observed in patients with positive \u003cem\u003eC. trachomatis\u0026nbsp;\u003c/em\u003e(p-value = 0.023), without association with other pathologies or sample data. In \u003cem\u003eM. genitalium\u003c/em\u003e infection\u003cem\u003e,\u0026nbsp;\u003c/em\u003ea higher percentage of detection was observed in single patients (p-value=0.014). Patients with \u003cem\u003eT. vaginalis\u0026nbsp;\u003c/em\u003eshowed a significant association with an earlier age at first pregnancy (p-value = 0.045); women with fewer partners in the last year had a lower prevalence of TV (p-value=0.042). The relationship between microorganisms and data collected through the questionnaire are described in the supplementary tables.\u003c/p\u003e\n\u003cp\u003eComparing categories evaluated between patients with positive polymerase chain reaction (PCR) for the studied pathogens (CT, MG, TV) (N=24) and patients with negative PCR (N=122), there is no statistical difference in younger women (under 21 years old), marital status, number of pregnancies, number of partners, number of partners in the last year, age at first pregnancy and risk behavior for STI. As shown in tables\u0026nbsp;3\u0026nbsp;and\u0026nbsp;4, patients with positive CT and/or MG, pathogens related to cervicitis, showed no difference in the aforementioned criteria. The positive sample for \u003cem\u003eC. trachomatis\u0026nbsp;\u003c/em\u003ewas statistically similar to the group with \u003cem\u003eM. genitalium\u0026nbsp;\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;3: Comparison between age, marital status and risk behavior for sexually transmitted infections and human immunodeficiency virus (HIV), among 20 pregnant women with isolated or associated \u003cem\u003eChlamydia trachomatis\u0026nbsp;\u003c/em\u003eand \u003cem\u003eMycoplasma genitalium .\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"658\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.071537290715373%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.76407914764079%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eClass\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.155251141552512%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCT (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.981735159817351%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMG (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.220700152207002%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCT+MG (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.80669710806697%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.071537290715373%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003ePatient's age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.76407914764079%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.155251141552512%\" valign=\"top\"\u003e\n \u003cp\u003e1 (11,11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.981735159817351%\" valign=\"top\"\u003e\n \u003cp\u003e1 (9.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.220700152207002%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.80669710806697%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.556962025316455%\" valign=\"top\"\u003e\n \u003cp\u003e22-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.544303797468356%\" valign=\"top\"\u003e\n \u003cp\u003e5 (55.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.582278481012658%\" valign=\"top\"\u003e\n \u003cp\u003e7 (63.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.31645569620253%\" valign=\"top\"\u003e\n \u003cp\u003e1 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.556962025316455%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.544303797468356%\" valign=\"top\"\u003e\n \u003cp\u003e3 (33.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.582278481012658%\" valign=\"top\"\u003e\n \u003cp\u003e3 (27.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.31645569620253%\" valign=\"top\"\u003e\n \u003cp\u003e1 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.071537290715373%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.76407914764079%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.155251141552512%\" valign=\"top\"\u003e\n \u003cp\u003e7 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.981735159817351%\" valign=\"top\"\u003e\n \u003cp\u003e6 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.220700152207002%\" valign=\"top\"\u003e\n \u003cp\u003e1 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.80669710806697%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.300\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.556962025316455%\" valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.544303797468356%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.582278481012658%\" valign=\"top\"\u003e\n \u003cp\u003e2 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.31645569620253%\" valign=\"top\"\u003e\n \u003cp\u003e1 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.071537290715373%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eRisk behavior for STI or HIV infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.76407914764079%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.155251141552512%\" valign=\"top\"\u003e\n \u003cp\u003e9 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.981735159817351%\" valign=\"top\"\u003e\n \u003cp\u003e11 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.220700152207002%\" valign=\"top\"\u003e\n \u003cp\u003e2 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.80669710806697%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.556962025316455%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.544303797468356%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.582278481012658%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.31645569620253%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: Kruskal-Wallis test (5% significance level). IIQ: Interquartile range (1st and 3rd quartile). CT: \u003cem\u003eChlamydia trachomatis\u0026nbsp;\u003c/em\u003e; MG: \u003cem\u003eMycoplasma genitalium.\u0026nbsp;\u003c/em\u003eItalics: Preferred descriptive measure for interpretation according to the distribution of the variable.\u0026nbsp;Fisher's Exact Test (5% significance level).\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;4: Comparison between parity, number of partners and age at first pregnancy, among 20 pregnant women with isolated or associated \u003cem\u003eChlamydia trachomatis\u0026nbsp;\u003c/em\u003eand \u003cem\u003eMycoplasma genitalium .\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"650\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.254992319508446%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable (n evaluated)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.665130568356375%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eClass (N rated)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.981566820276498%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.589861751152075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian [IIQ]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.75268817204301%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin - Max\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.755760368663594%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.254992319508446%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of pregnancies (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.665130568356375%\" valign=\"top\"\u003e\n \u003cp\u003eCT (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.981566820276498%\" valign=\"top\"\u003e\n \u003cp\u003e2.33 (1.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.589861751152075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e2 [2 - 2]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.75268817204301%\" valign=\"top\"\u003e\n \u003cp\u003e1 - 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.755760368663594%\" valign=\"top\"\u003e\n \u003cp\u003e0.570\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.254992319508446%\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.665130568356375%\" valign=\"top\"\u003e\n \u003cp\u003eCT+MG (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.981566820276498%\" valign=\"top\"\u003e\n \u003cp\u003e2 (1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.589861751152075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e2 [1.5 - 2.5]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.75268817204301%\" valign=\"top\"\u003e\n \u003cp\u003e1 - 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.755760368663594%\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.254992319508446%\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.665130568356375%\" valign=\"top\"\u003e\n \u003cp\u003eMG (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.981566820276498%\" valign=\"top\"\u003e\n \u003cp\u003e2.09 (1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.589861751152075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e2 [1.5 - 2]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.75268817204301%\" valign=\"top\"\u003e\n \u003cp\u003e1 - 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.755760368663594%\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.254992319508446%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of life partners (17*)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.665130568356375%\" valign=\"top\"\u003e\n \u003cp\u003eCT (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.981566820276498%\" valign=\"top\"\u003e\n \u003cp\u003e3.71 (2.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.589861751152075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e3 [2.5 - 3.5]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.75268817204301%\" valign=\"top\"\u003e\n \u003cp\u003e1 - 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.755760368663594%\" valign=\"top\"\u003e\n \u003cp\u003e0.418\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.254992319508446%\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.665130568356375%\" valign=\"top\"\u003e\n \u003cp\u003eCT+MG (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.981566820276498%\" valign=\"top\"\u003e\n \u003cp\u003e3.5 (0.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.589861751152075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e3.5 [3.25 - 3.75]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.75268817204301%\" valign=\"top\"\u003e\n \u003cp\u003e3 - 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.755760368663594%\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.254992319508446%\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.665130568356375%\" valign=\"top\"\u003e\n \u003cp\u003eMG (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.981566820276498%\" valign=\"top\"\u003e\n \u003cp\u003e3.5 (2.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.589861751152075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e2.5 [2 - 4.25]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.75268817204301%\" valign=\"top\"\u003e\n \u003cp\u003e1 - 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.755760368663594%\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.254992319508446%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of partners in the last year (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.665130568356375%\" valign=\"top\"\u003e\n \u003cp\u003eCT (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.981566820276498%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.589861751152075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e1 [1 - 1]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.75268817204301%\" valign=\"top\"\u003e\n \u003cp\u003e1 - 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.755760368663594%\" valign=\"top\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.254992319508446%\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.665130568356375%\" valign=\"top\"\u003e\n \u003cp\u003eCT+MG (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.981566820276498%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.589861751152075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e1 [1 - 1]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.75268817204301%\" valign=\"top\"\u003e\n \u003cp\u003e1 - 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.755760368663594%\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.254992319508446%\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.665130568356375%\" valign=\"top\"\u003e\n \u003cp\u003eMG (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.981566820276498%\" valign=\"top\"\u003e\n \u003cp\u003e0.91 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.589861751152075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e1 [1 - 1]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.75268817204301%\" valign=\"top\"\u003e\n \u003cp\u003e0 - 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.755760368663594%\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.254992319508446%\" valign=\"top\"\u003e\n \u003cp\u003eAge at first pregnancy (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.665130568356375%\" valign=\"top\"\u003e\n \u003cp\u003eCT (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.981566820276498%\" valign=\"top\"\u003e\n \u003cp\u003e20.33 (3.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.589861751152075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e20 [18 - 23]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.75268817204301%\" valign=\"top\"\u003e\n \u003cp\u003e16 - 26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.755760368663594%\" valign=\"top\"\u003e\n \u003cp\u003e0.886\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.254992319508446%\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.665130568356375%\" valign=\"top\"\u003e\n \u003cp\u003eCT+MG (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.981566820276498%\" valign=\"top\"\u003e\n \u003cp\u003e19.5 (2.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.589861751152075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e19.5 [18.75 - 20.25]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.75268817204301%\" valign=\"top\"\u003e\n \u003cp\u003e18 - 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.755760368663594%\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.254992319508446%\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.665130568356375%\" valign=\"top\"\u003e\n \u003cp\u003eMG (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.981566820276498%\" valign=\"top\"\u003e\n \u003cp\u003e20.64 (4.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.589861751152075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e18 [17.5 - 24]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.75268817204301%\" valign=\"top\"\u003e\n \u003cp\u003e16 - 29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.755760368663594%\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*N evaluated lower than the total number of patients, because some patients abstracted this information during the interview. CT: \u003cem\u003eChlamydia trachomatis\u0026nbsp;\u003c/em\u003e; MG: \u003cem\u003eMycoplasma genitalium.\u003c/em\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003ePrenatal screening for infectious diseases, such as syphilis, hepatitis B, HIV and rubella, is already indicated in american protocols [37,38], however, microorganisms such as\u003cem\u003e\u0026nbsp;C. trachomatis, N. gonorrhoeae , M. genitalium\u0026nbsp;\u003c/em\u003eand \u003cem\u003eT. vaginalis\u0026nbsp;\u003c/em\u003ehave heterogeneity in how to perform screening to prevent unfavorable perinatal outcomes. The prevalence of at least one of the agents in the sample was 16.2% (N=24); \u003cem\u003eC. trachomatis\u0026nbsp;\u003c/em\u003ewas 7.43%;\u003cem\u003e\u0026nbsp;M. genitalium,\u0026nbsp;\u003c/em\u003e8.7% and \u003cem\u003eT. vaginalis,\u0026nbsp;\u003c/em\u003e2.03%, respectively. \u003cem\u003eN. gonorrhoeae\u0026nbsp;\u003c/em\u003ewas not detected, and there were three cases of infection with more than one microorganism (2 CT + MG and 1 MG + TV).\u0026nbsp;In the epidemiological associations, it found a lower rate of previous miscarriage in patients with positive CT (p-value = 0.023). Another significant associations brought forth were the detection of TV in patients with an earlier age at first pregnancy (p-value = 0.045),\u0026nbsp;greater detection of MG in single patients (p-value=0.014); lower prevalence of TV in patients with fewer partners in the last year (p-value=0.042). This study provides Brazilian demographic data that we did not have access to until then, with emphasis on what can be considered a high prevalence of MG in pregnant women.\u003c/p\u003e\n\u003cp\u003eThe found prevalence of 7.43% of \u003cem\u003eC. trachomatis\u0026nbsp;\u003c/em\u003eis within the range of 6.15 to 16.7% in pregnant women in Brazil [6,15,24,39] and Botswana [40], lower than 11.2% in pregnant women in Latin America [23], 14.7% in Haiti [5] and 22.9% in Papua New Guinea [22]. When compared to developed countries such as France, with a prevalence of 2.5% [21], we have a considerably higher rate, but in European pregnant women under the age of 25, CT was found in 7.6% [21] and 18.4% [41], in France and Spain, respectively. Among women who have some risk factor for STI, we have a prevalence of 10.7% in Brazilian women under 25 years old [42], 2.1% in HIV-positive Brazilian women [43], 4% in Spanish women under 30 years old [11] and 9% in female sex workers [44], which was not found when we stratified risk groups in our sample.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The non-detection of NG in the sample (n=0/148) was in line with the prevalence of 1.0% in Brazilian pregnant women [24,39] and 1,2% in Latin America [23]. Populations at risk, such as young women, sex workers and HIV positive people have a prevalence of 0.1%-1.5% [11,45], 3.3% [44]\u0026nbsp;and 0.9% [46], respectively. Even in underdeveloped countries, NG detection rates during pregnancy are between 0.5 and 4.6% [5,23,40], with emphasis only on Papua New Guinea, with a rate 14.2% [22].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eT. vaginalis\u0026nbsp;\u003c/em\u003ewas detected in 2.03% of the samples, lower than that found in Latin America (3.9%) [23] and Botswana (5.0%) [40]. Van Gerwen described an important variation in TV rates among pregnant women, from 3.9 to 24.6% [27]. In Brazil, the prevalence in pregnant adolescents (11-19 years old) was 4.3% [47], possibly higher than the value found in our research due to the age of the patients studied. The low rates found in our study can be attributed to the high human development index (HDI) in Joinville, in southern Brazil. The association between TV and younger age at first pregnancy and women with more sexual partners may be related to the lower use of condoms, attributed to this population [48], since they disregard barrier methods in long relationships and during the gestational period.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;M. \u003cem\u003egenitalium\u0026nbsp;\u003c/em\u003ewas identified in 13 pregnant women, 8.78% of the sample. This work is the first to describe the prevalence of MG in pregnant women in Brazil. Current literature report a prevalence of MG in pregnant women of 0.7% in England [49], 0.8% in France [21], 0.8% in Japan\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[50], 1.02% in Iran\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[28], 5.2% in Argentina [29], 11.9% in the Solomon Islands and 12.5% in Papua New Guine [51]. MG infection rates between 0.7-8.5% [10,12], with numbers ranging from 2.4 to 10% in young pregnant women, risky sexual behavior and low socioeconomic status [10]. In pregnant women under 30 years of age, \u003cem\u003eM. genitalium\u0026nbsp;\u003c/em\u003ewas found in 1.3% of Spanish women [11] and 2.4% of French women [21].\u003c/p\u003e\n\u003cp\u003eOur prevalence (8.7%) is within the wide range found in Brazilian literature, not considering pregnant women, with a prevalence between 0.9% [8,52] and up to 28% in vaginal swab analysis by polymerase chain reaction (PCR) in postmenopausal women [25]. And it is lower when considering the high-risk population (15.9%) and sex workers (10.8%) [44].\u003c/p\u003e\n\u003cp\u003eIn our study, MG was found more often in single women and was not related to age groups. Furthermore, no patient with MG presented leucorrhoea, dysuria, dyspareunia, pelvic pain or any other symptoms of genital infection when questioned. It highlights the importance of universal screening during pregnancy. Antimicrobial resistance associated with \u003cem\u003eM. genitalium\u0026nbsp;\u003c/em\u003epoints to formulate new ways of population screening, diagnosis and treatment protocols in the United States [53], which should also be considered in Brazil, since treatment with a single dose of azithromycin is still widely used in medical practice and has been shown to be ineffective in recent studies [54].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Co-infection by more than one microorganism studied, observed in 16% of the sample, was higher than that found in the literature, between 1,02% [28,29]\u003csup\u003e\u0026nbsp;\u003c/sup\u003e and 10% [30,43], close to the rate of 13.5%, in an African country [40]. There was no direct association with already known risk factors to STI such as young age and unfavorable socioeconomic situation [30]\u0026nbsp;Among the epidemiological associations, we can highlight a lower rate of previous miscarriage in patients with positive CT (p-value = 0.023), this result may have been influenced by the sample size and has no cause-effect association. When comparing populations with positive CT and MG, there is no significant difference, which may point to a similarity in the risk factors for acquiring these STI, as Larsen already points out, in patients with cervicitis [2]. Twenty four patients (16.2% of the sample) presented a positive PCR for pathogens that cause cervicitis, a significant number compared to Korean data - 2.38%, including the same group of microorganisms [31].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This study is part of a multicenter project to screen microorganisms during pregnancy, that aims to evaluate possible implementation of these tests in the national territory. There were limitations related to the logistical difficulties between collection, storage, transportation and execution of NAAT exams, the sample size and the collection in a hospital environment, in the tertiary service, which may be associated with an increase in comorbidities in the population. Despite the relatively small number of patients evaluated, we highlight the prevalence of MG as well as the co-infection between CT and MG, which reinforces the importance of molecular biology tests in the assertive diagnosis of STI, mainly in special populations, such as pregnant women.\u003c/p\u003e\n\u003cp\u003eExpanding screening for \u003cem\u003eC. trachomatis\u0026nbsp;\u003c/em\u003eduring prenatal care, given its high prevalence and the possibility of co-infection with other pathogens, also proves to be an important public health measure in Brazil, confirming data from the worldwide available literature. Even in asymptomatic pregnant women, cervicitis can cause preterm birth, premature rupture of membranes, fetal death, intrauterine growth restriction and puerperal endometritis [3-9]. Regarding the microorganisms to be tested, as there was no statistical difference between the populations, the data evaluated suggest screening for \u003cem\u003eC. trachomatis\u0026nbsp;\u003c/em\u003eand \u003cem\u003eM. genitalium\u0026nbsp;\u003c/em\u003euniversally, for all pregnant women. Even though the region studied has a high human development index (HDI) compared to the rest of the country, we observed a high prevalence of CT and MG, which further alerts us to regions of greater vulnerability, such as young people,\u0026nbsp;low socioeconomic status and precarious access to health services.\u003c/p\u003e\n\u003cp\u003eThe prospects point to the need for a larger population study, evaluating risk groups for STI during the pregnant period, in order to verify the indication and feasibility of implantation, territorially, the screening of important pathogens to improve perinatal morbidity and mortality rates. Studies like this make it possible to measure data so that future strategies can have an impact on the health of developing countries like Brazil.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFUNDING\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAptima Combo 2, Aptima TV and Aptima MG molecular biology tests , as well as their interpretation, carried out by a laboratory linked to the Federal University of Santa Catarina, provided by the Ministry of Health of Brazil. The forms used, the statistical evaluation and the sending of samples for laboratory analysis were paid for by author Danielle Betina de\u0026nbsp;Oliveira Traesel .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOMPETING INTERESTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by\u0026nbsp;Danielle Betina de Oliveira Traesel\u0026nbsp;and\u0026nbsp;Newton S\u0026eacute;rgio de Carvalho. The first draft of the manuscript was written by\u0026nbsp;Danielle Betina de Oliveira Traesel\u0026nbsp;and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDATA AVAILABILITY\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and analysed during the current study are available in the personal repository, datasetchamydiaoOFICIAL.xlsx\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICS APPROVAL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the\u0026nbsp;\u0026nbsp;Ethics and Research Committee on Human Beings of the Health Sciences Sector (Clinical Hospital of Federal University of Paran\u0026aacute; \u0026ndash; UFPR)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONSENT TO PARTICIPATE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWORLD HEALTH ORGANIZATION - WHO. Global Health Sector Strategy on Sexually Transmitted Infections 2016 - 2021. 2016. [\u003cem\u003eS. l.\u003c/em\u003e]: \u003cstrong\u003eWorld Health Organization\u003c/strong\u003e, 2016.\u003c/li\u003e\n\u003cli\u003eLARSEN, B; HWANG, J. Mycoplasma, Ureaplasma, and adverse pregnancy outcomes: a fresh look. \u003cstrong\u003eInfect Dis Obstet Gynecol\u003c/strong\u003e. 2010;2010:521921. doi: 10.1155/2010/521921. Epub 2010 Jul 12. 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Identifying a consensus sample type to test for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis and human papillomavirus. \u003cstrong\u003eClin Microbiol Infect.\u003c/strong\u003e 2018 Dec;24(12):1328-1332. doi: 10.1016/j.cmi.2018.03.013. Epub 2018 Mar 17. PMID: 29559392. \u003c/li\u003e\n\u003cli\u003ePIAZZETA, RCPS; DE CARVALHO, NS; DE ANDRADE, RP; PIAZETTA, G; PIAZETTA, SR; CARNEIRO, R. 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PMID: 33622474; PMCID: PMC7920647.\u003c/li\u003e\n\u003cli\u003eSILVEIRA, M. F.; BRUNI, M. P.; STAUFFERT, D.; GOLPARIAN, D.; UNEMO, M. Prevalence and risk factors associated with Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium among women in Pelotas, Southern Brazil. \u003cstrong\u003eInternational Journal of STD and AIDS\u003c/strong\u003e, vol. 31, no. 5, p. 432\u0026ndash;439, 2020. https://doi.org/10.1177/0956462419898982. \u003c/li\u003e\n\u003cli\u003eKORICH, F; REDDY, NG; TRENT, M. Mycoplasma genitalium and Trichomonas vaginalis: addressing disparities and promoting public health control of two emerging sexually transmitted infections. \u003cstrong\u003eCurr Opin Pediatr.\u003c/strong\u003e 2020 Aug;32(4):482-488. doi: 10.1097/MOP.0000000000000909. PMID: 32520821; PMCID: PMC7919501. \u003c/li\u003e\n\u003cli\u003eJENSEN, JS; CUSINI, M; GOMBERG, M; MOI, H. European guideline on Mycoplasma genitalium infections. \u003cstrong\u003eJ Eur Acad Dermatol Venereol.\u003c/strong\u003e 2016; 30: 1650\u0026ndash; 1656.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Prenatal Care, Mycoplasma genitalium, Diagnostic Screening Programs, Chlamydia Trachomatis","lastPublishedDoi":"10.21203/rs.3.rs-3965454/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3965454/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSexually transmitted infections (STI) are prevalent in developing countries and are associated with unfavorable perinatal outcomes. Infections with \u003cem\u003eChlamydia trachomatis \u003c/em\u003e(CT), \u003cem\u003eNeisseria gonorrhoeae \u003c/em\u003e(NG), \u003cem\u003eMycoplasma genitalium \u003c/em\u003e(MG) and \u003cem\u003eTrichomonas vaginalis \u003c/em\u003e(TV) are asymptomatic in 70% of cases. The objective of this study is to determine the prevalence of CT, NG, MG and TV in pregnant women, correlating it with sociodemographic data.\u003c/p\u003e\n\u003cp\u003eThe sample had 148 pregnant women between 18 and 49 years old, who attended in Joinville, South Brazil, from November 2021 to March 2022. The exclusion criteria were: recent antibiotic therapy and risk for miscarriage. Data collection and endovaginal swabs were performed\u003cem\u003e \u003c/em\u003eto research of agents through molecular biology.\u003c/p\u003e\n\u003cp\u003e148 pregnant women were studied, 16.2% (N=24) had at least one of the agents positive. \u003cem\u003eC. trachomatis \u003c/em\u003e, \u003cem\u003eM. genitalium \u003c/em\u003eand \u003cem\u003eT. vaginalis \u003c/em\u003ewere detected in 11 (7.43%), 13 (8.78%) and 3 (2.03%) women, respectively. \u003cem\u003eN. gonorrhoeae \u003c/em\u003ewas not detected. There were three cases of infection with more than one microorganism (2 CT + MG and 1 MG + TV). MG infection was associated with single women (p-value=0.014); trichomoniasis, with more partners in the last year (p-value=0.042).\u003c/p\u003e\n\u003cp\u003eThe high detection of MG in Brazilian pregnant women deserves to be highlighted. This had not yet been reported. The prevalence of CT and NG was in accordance to Brazilian studies, while TV was in common with European rates. The absence of clinical symptoms, the non-association between sexual risk behavior and the presence of STI were observed.\u003c/p\u003e","manuscriptTitle":"Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis in prenatal care in the public health system, in a southern city of Brazil","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-21 18:11:16","doi":"10.21203/rs.3.rs-3965454/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e5d67422-68b1-46c1-87b0-30c39fde5b58","owner":[],"postedDate":"February 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-29T17:21:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-21 18:11:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3965454","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3965454","identity":"rs-3965454","version":["v1"]},"buildId":"omnImTCwR2MFx8CMYfrG7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}