Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016
Jane Rowley a, Stephen Vander Hoorn b, Eline Korenromp c, Nicola Low d, Magnus Unemo e, Laith J Abu-Raddad f, R Matthew Chico g, Alex Smolak f, Lori Newman h, Sami Gottlieb a, Soe Soe Thwin a, Nathalie Broutet a & Melanie M Taylor a
a. Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.
b. School of Mathematics and Statistics, University of Melbourne, Melbourne, Australia.
c. Avenir Health, Geneva, Switzerland.
d. Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
e. WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University, Örebro, Sweden.
f. Department of Healthcare Policy and Research, Weill Cornell Medical College – Qatar, Doha, Qatar.
g. Department of Disease Control, London School of Hygiene & Tropical Medicine, London, England.
h. Enteric and Sexually Transmitted Infections Branch, National Institute of Allergy and Infectious Diseases, Washington DC, United States of America.
Correspondence to Melanie Taylor (email: email@example.com).
(Submitted: 10 December 2018 – Revised version received: 08 April 2019 – Accepted: 03 May 2019 – Published online: 06 June 2019.)
Bulletin of the World Health Organization 2019;97:548-562P. doi: http://dx.doi.org/10.2471/BLT.18.228486
Sexually transmitted infections are among the most common communicable conditions and affect the health and lives of people worldwide. The World Health Organization (WHO) periodically generates estimates to gauge the global burden of four of the most common curable sexually transmitted infections: chlamydia (etiological agent: Chlamydia trachomatis), gonorrhoea (Neisseria gonorrhoeae), trichomoniasis (Trichomonas vaginalis) and syphilis (Treponema pallidum).1–6 The estimates provide evidence for programme improvement, monitoring and evaluation.
These sexually transmitted infections cause acute urogenital conditions such as cervicitis, urethritis, vaginitis and genital ulceration, and some of the etiological agents also infect the rectum and pharynx. Chlamydia and gonorrhoea can cause serious short- and long-term complications, including pelvic inflammatory disease, ectopic pregnancy, infertility, chronic pelvic pain and arthritis, and they can be transmitted during pregnancy or delivery. Syphilis can cause neurological, cardiovascular and dermatological disease in adults, and stillbirth, neonatal death, premature delivery or severe disability in infants. All four infections are implicated in increasing the risk of human immunodeficiency virus (HIV) acquisition and transmission.7 Moreover, people with sexually transmitted infections often experience stigma, stereotyping, vulnerability, shame and gender-based violence.8
In May 2016, the World Health Assembly adopted the Global health sector strategy on sexually transmitted infections, 2016–2021.9 This strategy includes rapid scale-up of evidence-based interventions and services to end sexually transmitted infections as public health concerns by 2030. The strategy sets targets for reductions in gonorrhoea and syphilis incidence in adults and recommends the establishment of global baseline incidences of sexually transmitted infections by 2018. The primary objectives of this study were to estimate the 2016 global and regional prevalence and incidence of chlamydia, gonorrhoea, trichomoniasis and syphilis in adult women and men.
Chlamydia, gonorrhoea and trichomoniasis
We generated estimates for these three infections through systematic reviews using the same methods as for the 2012 estimates.6
We searched for articles published between 1 January 2009 and 29 July 2018 in PubMed® without language restrictions. We used PubMed Medical subject heading (MeSH) terms for individual country names combined with: “chlamydia”[MeSH Terms] OR “chlamydia”[All Fields], “gonorrhoea”[All Fields] OR “gonorrhea”[MeSH Terms] OR “gonorrhea”[All Fields], “trichomonas infections”[MeSH Terms] OR (“trichomonas”[All Fields] AND “infections”[All Fields]) OR “trichomonas infections”[All Fields] OR “trichomoniasis”[All Fields]). We also asked WHO regional sexually transmitted infection advisors and other leading experts in the field for additional published and unpublished data.
To be eligible, studies had to collect most specimens between 2009 and 2016 or be published in 2010 or later if specimen collection dates were not available. Other study inclusion criteria were: sample size of at least 100 individuals; general population (e.g. pregnant women, women at delivery, women attending family planning clinics, men and women selected for participation in demographic and health surveys); and use of an internationally recognized diagnostic test with demonstrated precision using urine, urethral, cervical or vaginal specimens.
To reduce bias in the estimation of general population prevalence, we excluded studies conducted among the following groups: patients seeking care for sexually transmitted infection or urogenital symptoms, women presenting at gynaecology or sexual health clinics with sexually transmitted infection related issues, studies restricted to women with abnormal Papanicolaou test results, remote or indigenous populations, recent immigrant or migrant populations, men who have sex with men and commercial sex workers.
Two investigators independently reviewed all identified studies to verify eligibility. When more than one publication reported on the same population, we retained the publication with the most detailed information. For each included study, we calculated prevalence as the number of individuals with a positive test result divided by the total number tested. We then standardized these values by applying adjustment factors for the accuracy of the laboratory diagnostic test, study location (rural versus urban) and the age of the study population. If the adjustments resulted in a negative value, we replaced the value with 0.1% when doing the meta-analysis. The methods and adjustment factors were identical to those used to generate the 2012 estimates.6
We obtained estimates for 10 geographical areas (referred to as estimation regions).6 Estimates for high-income North America (Canada and United States of America), were based on the latest published United States estimates that used data from multiple sources.10,11 For the other nine estimation regions, we calculated a summary prevalence estimate by meta-analysis if there were three or more data points.12 There were sufficient data to generate an estimate for chlamydia in women in all regions, but not for gonorrhoea or trichomoniasis. For regions with insufficient data for gonorrhoea and trichomoniasis, we assumed that prevalence was a multiple of the prevalence of chlamydia. The infection specific multiples were based on those studies that met the 2016 inclusion criteria (available from the data repository).13 For men, when there were insufficient data for meta-analysis, the prevalence of an infection was assumed to be proportional to the prevalence in women. The male-to-female ratios were infection-specific and were set at the same values as in 2012 estimates.6
To reflect the contribution of populations at higher risk of infection (e.g. men who have sex with men and commercial sex workers), who are likely to be under-represented in general population samples, we increased prevalence estimates by 10%, as in the 2012 estimates,6 for each estimation region, apart from high-income North America.
We performed the meta-analyses using a Bayesian approach with a Markov Chain Monte Carlo algorithm implemented with the software BRrugs in R package (R foundation, Vienna, Austria).14 For each infection, the software generated 10 000 samples from the posterior distribution for the expected mean prevalence in each estimation region based on the β-binomial model, and used these to calculate the 2.5 and 97.5 uncertainty percentiles.15 We calculated global and regional prevalence estimates for each infection by weighting each of the 10 000 samples from estimation regions according to population size, using United Nations population data for women and men aged 15–49 years.16 We present results by WHO region, 2016 World Bank income classification17 and 2017 sustainable development goal (SDG) region.18 All analyses were carried out using R statistical software (R foundation).
We based syphilis estimates on the WHO’s published 2016 maternal prevalence estimates.19 These estimates were generated by using Spectrum-STI, a statistical trend-fitting model in the publicly available Spectrum suite of health policy planning tools20 and country specific data from the global Spectrum-STI syphilis database (available from the corresponding author). As in the 2012 estimation,6 we assumed that the prevalence of syphilis in all women 15–49 years of age in each country was the same as in pregnant women. We then increased the estimate by 10% to reflect the contribution of populations at higher risk. The men to women prevalence ratio of syphilis was set at 1.0 and assumed to have a uniform distribution ± 33% around this value, in agreement with data from a recent global meta-analysis of syphilis.21
We generated regional and global estimates by weighting the contribution of each country by the number of women and men aged 15–49 years. Regional and global 95% uncertainty intervals (UIs) were generated using the delta method;22 uncertainties were assumed to be independent across countries.
We calculated incidence estimates for each infection by dividing prevalence by the average duration of infection for all estimation regions except high-income North America where published estimates were used.10,11 Estimates of the average duration of infection were those used in the 2012 estimation6 and assumed to have a uniform distribution of ± 33.3% around the average duration. We calculated uncertainty in incidence for a given region, sex and infection at the national level using the delta method;22 uncertainty in the prevalence estimate was multiplied by uncertainty in the estimated duration of infection. Regional and global uncertainty intervals were generated assuming uncertainties were independent across countries.
Chlamydia, gonorrhoea and trichomoniasis
Of the 7244 articles screened, 112 studies met the inclusion criteria for one or more of the three infections (Fig. 1). We identified an additional 18 studies through expert consultations and reviewing reference lists (Nguyen M et al., Hanoi Medical University, Viet Nam, personal communication, 23 March 2018; El Kettani A et al., National Institute of Hygiene, Morocco, personal communication, 2 May 2016; Galdavadze K et al., Disease Control and Public Health, Republic of Georgia; personal communication, 22 August 2017).23–150 Of these 130 studies, 111 reported data for women only (Table 1; available at: http://www.who.int/bulletin/volumes/96/8/18-228486), three reported data for men only (Table 2; available at: http://www.who.int/bulletin/volumes/96/8/18-228486) and 16 reported data for both women and men (Table 1 and Table 2). Only 34 studies in women and four studies in men provided information on all three infections. The included studies contained 100 data points in women for chlamydia, 64 for gonorrhoea and 69 for trichomoniasis. In men, there were 16 data points for chlamydia, 11 for gonorrhoea and seven for trichomoniasis (Table 3).
Fig. 1. Flowchart of the selection of studies for estimating the prevalence and incidence of chlamydia, gonorrhoea and trichomoniasis, 2016
Table 1. Included studies on chlamydia, gonorrhoea and trichomoniasis prevalence in women, 2009–2016
Table 2. Included studies on chlamydia, gonorrhoea and trichomoniasis prevalence in men, 2009–2016
Table 3. Number of data points that met the study inclusion criteria for the WHO 2016 prevalence estimates of chlamydia, gonorrhoea and trichomoniasis
For women, a total of 43 (21.0%) of 205 countries, territories and areas had one or more data points for chlamydia, 32 (15.6%) for gonorrhoea and 29 (14.1%) for trichomoniasis. For men, only 15 (7.3%) countries, territories and areas had one or more data points for chlamydia, 10 (4.9%) for gonorrhoea and 7 (3.4%) for trichomoniasis. For women there were sufficient data to generate summary estimates for chlamydia for the nine estimation regions, but not for gonorrhoea or trichomoniasis (Table 4).
Table 4. Approach used to generate 2016 regional estimates for chlamydia, gonorrhoea and trichomoniasis
As of 2 May 2018, the Spectrum-STI Database contained 1576 data points from surveys conducted since 1990, including 978 from January 2009 to December 2016.151 In total, 181 (88.3%) of 205 countries, territories and areas had sufficient data to generate a Spectrum STI estimate for 2016. For the remaining 24 countries, territories and areas, we used the median value of the countries with data for the relevant WHO region as the 2016 estimate.
Prevalence and incidence estimates
Table 5 shows prevalence estimates for the WHO regions for 2016. Based on prevalence data from 2009 to 2016, the estimated pooled global prevalence of chlamydia in 15–49-year-old women was 3.8% (95% UI: 3.3–4.5) and in men 2.7% (95% UI: 1.9–3.7), with regional values ranging from 1.5 to 7.0% in women and 1.2 to 4.0% in men. For gonorrhoea, the global estimate was 0.9% (95% UI: 0.7–1.1) in women and 0.7% (95% UI: 0.5–1.1) in men, with regional values in women ranging from 0.3 to 1.9% and from 0.3 to 1.6% in men. The estimates for trichomoniasis were 5.3% (95% UI: 4.0–7.2) in women and 0.6% (95% UI: 0.4–0.9) in men, with regional values ranging from 1.6 to 11.7% in women and from 0.2 to 1.3% in men. For syphilis, the global estimate in both men and women was 0.5% (95% UI: 0.4–0.6) with regional values ranging from 0.1 to 1.6%. The WHO African Region had the highest prevalence for chlamydia in men, gonorrhoea in women and men, trichomoniasis in women and syphilis in men and women. The WHO Region of the Americas had the highest prevalence of chlamydia in women and of trichomoniasis in men.
Table 5. Comparison of 2012 and 2016 WHO regional prevalence estimates of chlamydia, gonorrhoea, trichomoniasis and syphilis
These prevalence estimates correspond to the totals of 124.3 million cases of chlamydia, 30.6 million cases of gonorrhoea, 110.4 million cases of trichomoniasis and 19.9 million cases of syphilis (available from the data repository).13
Using the World Bank classification, high-income countries, territories and areas had the lowest estimated prevalence, and low-income countries, territories and areas had the highest prevalence of gonorrhoea, trichomoniasis and syphilis. For chlamydia, estimated prevalence was highest in upper-middle income countries, territories and areas (Fig. 2). The SDG grouping showed the highest prevalence of all four sexually transmitted infections in Oceania region, that is, Pacific island nations excluding Australia and New Zealand (available from the data repository).13
Fig. 2. Prevalence estimates of chlamydia, gonorrhoea, trichomoniasis and syphilis in adults, by World Bank classification, 2016
We estimated the global incidence rate for chlamydia in 2016 to be 34 cases per 1000 women (95% UI: 25–45) and 33 per 1000 men (95% UI: 21–48); for gonorrhoea 20 per 1000 women (95% UI: 14–28) and 26 per 1000 men (95% UI: 15–41); for trichomoniasis 40 per 1000 women (95% UI: 27–58) and 42 per 1000 men (95% UI: 23–69); and for syphilis 1.7 per 1000 women (95% UI: 1.4–2.0) and 1.6 per 1000 men (95% UI: 1.3–1.9; Fig. 3). The WHO Region of the Americas had the highest incidence rate for chlamydia and syphilis in both women and men, while the WHO African Region had the highest incidence rates for gonorrhoea and trichomoniasis in women and men. Incidence rates by income category and SDG regions are available from the data repository.13
Fig. 3. Incidence rate estimates for chlamydia, gonorrhoea, trichomoniasis and syphilis in adults, by WHO Region, 2016
These incidence rates translate globally into 127.2 million (95% UI: 95.1–165.9) new chlamydia cases, 86.9 million (95% UI: 58.6–123.4 million) gonorrhoea cases, 156.0 million (95% UI: 103.4–231.2 million) trichomoniasis cases and 6.3 million (95% UI: 5.5–7.1 million) syphilis cases in women and men aged 15–49 years in 2016. Together, the four infections accounted for 376.4 million new infections in 15–49-year-old people in 2016. Approximately 13.5% (50.8 million) of these infections occurred in low-income countries, territories and areas, 31.4% (118.1 million) in lower middle income, 47.1% (177.3 million) in upper-middle income and 8.0% (30.1 million) in high-income (available from the data repository).13
Comparison of estimates
Comparing the 2012 estimates with the estimates presented here shows that more data points were available in women for the 2016 estimates. The number increased from 69 to 100 for chlamydia, 50 to 64 for gonorrhoea and 44 to 69 for trichomoniasis. For men, the number of data points fell from 21 to 16 for chlamydia and from 12 to 11 for gonorrhoea, but increased from one to seven for trichomoniasis. The period of eligibility for both estimates was eight years with an overlap of four years (2009 to 2012); in women 27 data points were included in both estimates for chlamydia, 18 for gonorrhoea and 20 for trichomoniasis. In men, these overlaps were six, five and one, respectively.
Table 5 compares the 2012 and 2016 prevalence estimates for the four infections. For syphilis, two estimates are presented for 2012, the published estimate6 and the 2012 estimate generated using Spectrum STI and the latest Spectrum data set.19 For all infections in both women and men, the 2016 global prevalence estimate was within the 95% UI for 2012. At the regional level, the 95% UIs for prevalence overlapped for all four infections in both men and women, apart from gonorrhoea in men in the WHO African Region which was higher in 2016 than in 2012.
We estimated a global total of 376.4 million new curable urogenital infections with chlamydia, gonorrhoea, trichomoniasis and syphilis in 15–49-year-old women and men in 2016. This estimate corresponds to an average of just over 1 million new infections each day. The number of individuals infected, however, is smaller as repeat infections and co-infections are common.152
The estimates of prevalence and incidence in 2016 were similar to those in 2012, both globally and by region, showing that sexually transmitted infections are persistently endemic worldwide. Grouping countries, territories and areas according to SDG regions revealed that the prevalence and incidence of all four sexually transmitted infections, in both women and men, were highest in the Oceania Region. The small island states in this SDG region are part of the WHO Western Pacific Region, which is dominated by China (owing to its population size). Therefore, the levels of sexually transmitted infections and need for infection control in these island states are masked when viewing the estimates only by WHO Region. When using the World Bank classification of countries, the prevalence of gonorrhoea, trichomoniasis and syphilis were highest in low-income countries, territories and areas. The prevalence of chlamydia was highest in the upper middle-income countries, territories and areas, partly due to high estimates in some Latin American countries. Further research is needed to determine whether these estimates reflect methodological factors or differences in C. trachomatis transmission.
The 2016 estimates for chlamydia, gonorrhoea and trichomoniasis were based on a systematic review of the literature complemented by outreach to experts using the same methods as in 2012. The aim was to reduce bias and insure comprehensiveness in the search for data.19 For syphilis, the use of national estimates generated by a statistical model improves on the 2012 method by making use of historical trend data. The similarity between the published 2012 syphilis estimates and Spectrum STI generated estimates for 2012 provides reassurance about the validity of comparing the 2016 and 2012 estimates.
The study has limitations. First, limited prevalence data were available, despite an eight-year time window for data inclusion. Estimates for a given infection and region are therefore extrapolated from a small number of data points and ratios were used to generate estimates for some regions. For men, the lack of data was particularly striking. For syphilis, most data were from pregnant women, which might not reflect all women aged 15–49 years, or men. Second, the source studies include people in different age groups and used a range of diagnostic tests, so adjustment factors were applied to standardize measures across studies. Third, owing to the absence of empirical studies, incidence estimates were derived from the relationship between prevalence and duration of infection, and data on the average duration of infection for each of the four infections are also limited. Finally, because only studies among the general population were used, the prevalence and incidence in areas where key populations contribute disproportionately to sexually transmitted infection epidemics may have been underestimated despite the applied correction factor. These limitations have been discussed previously in detail.6
This study has implications for sexually transmitted infection programming and research. The quantity and quality of prevalence and incidence studies for sexually transmitted infections in representative samples of the general population, for both women and men, need improvement. Identifying opportunities to integrate data collection with clinical care platforms, such as HIV, adolescent, maternal, family planning and immunization is crucial. The recently developed WHO protocol for assessing the prevalence of sexually transmitted infections in antenatal care settings153 provides a framework and consistent methods that can be adapted for women and men. Comparing data across studies requires better understanding of the performance characteristics of diagnostic tests, and implications for estimates of the average duration of infection for each infection. The processes for producing future prevalence estimates could be made timelier and more efficient through continually updated systematic reviews,154 as well as technological solutions that automate searching of databases and facilitate high quality updates of reviews.
The global estimates of prevalence and incidence of four curable sexually transmitted infections are important in the broader global context, highlighting a continuing public health challenge. Prevalence and incidence data play an important role in the design and evaluation of programmes and interventions for sexually transmitted infections and in interpreting changes in HIV epidemiology. The global threat of antimicrobial resistance, particularly the emergence of N. gonorrhoeae resistance to the few remaining antimicrobials recommended for treatment, further highlights the importance of investing in monitoring prevalence and incidence.155 Estimates of prevalence and incidence are essential for calculations of the burden of disease due to sexually transmitted infections, which are needed to advocate for funding to support sexually transmitted infection programmes. These burden estimates can also be used to promote innovation for point-of-care diagnostics, new therapeutics, vaccines and microbicides. The WHO Global Health Sector Strategy on Sexually Transmitted Infections sets a target of 90% reductions in the incidence of gonorrhoea and of syphilis, globally, between 2018 and 2030.9 Major scale-ups of prevention, testing, treatment and partner services will be required to achieve these goals. The estimates generated in this paper, despite their limitations, provide an initial baseline for monitoring progress towards these ambitious targets.
We thank the WHO regional advisors and technical experts: Monica Alonso, Maeve Brito de Mello, Massimo Ghidinelli, Joumana Hermez, Naoko Ishikawa, Linh-Vi Le, Morkor Newman, Takeshi Nishijiima, Innocent Nuwagira, Leopold Ouedraogo, Bharat Rewari, Ahmed Sabry, Sanni Saliyou, Annemarie Stengaard, Ellen Thom and Motoyuki Tsuboi. We also thank Mary Kamb, S. Guy Mahiané, Otilia Mardh, Nico Nagelkerke, Gianfranco Spiteri, Igor Toskin, Teodora Wi, Nalinka Saman Wijesooriya and Rebecca Williams.
This work was supported by the U.S. Centers for Disease Control and Prevention, the United Kingdom Department for International Development, and the World Health Organization Human Reproduction Programme. LJA and AS acknowledge support of Qatar National Research Fund (NPRP 9-040-3-008) that provided funding for collating data provided to this study.
- Gerbase AC, Rowley JT, Heymann DH, Berkley SF, Piot P. Global prevalence and incidence estimates of selected curable STDs. Sex Transm Infect. 1998 Jun;74 Suppl 1:S12–6. pmid: 10023347
- Global prevalence and incidence of selected curable sexually transmitted infections: overview and estimates. Report No.: WHO/HIV_AIDS/2001.02. Geneva: World Health Organization; 2001. Available from: http://www.who.int/hiv/pub/sti/who_hiv_aids_2001.02.pdf [cited 2018 Nov 5].
- Prevalence and incidence of selected sexually transmitted infections, Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, and Trichomonas vaginalis: methods and results used by WHO to generate 2005 estimates. Geneva: World Health Organization; 2011. Available from: http://www.who.int/reproductivehealth/publications/rtis/9789241502450/en/ [cited 2018 Nov 5].
- Global incidence and prevalence of selected sexually transmitted infections– 2008. Geneva: World Health Organization; 2012. Available from: http://www.who.int/reproductivehealth/publications/rtis/stisestimates/en/ [cited 2018 Nov 5].
- Wijesooriya NS, Rochat RW, Kamb ML, Turlapati P, Temmerman M, Broutet N, et al. Global burden of maternal and congenital syphilis in 2008 and 2012: a health systems modelling study. Lancet Glob Health. 2016 08;4(8):e525–33. http://dx.doi.org/10.1016/S2214-109X(16)30135-8 http://dx.doi.org/10.1016/S2214-109X(16)30135-8 pmid: 27443780
- Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, et al. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS One. 2015 12 8;10(12):e0143304. http://dx.doi.org/10.1371/journal.pone.0143304 pmid: 26646541
- Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, Corey L, et al. Sexually transmitted diseases. 4th ed. New York: McGraw-Hill Medical; 2008.
- Amin A. Addressing gender inequalities to improve the sexual and reproductive health and wellbeing of women living with HIV. J Int AIDS Soc. 2015 12 1;18(6) Suppl 5:20302. pmid: 26643464
- Global health sector strategy on sexually transmitted infections 2016–2021. Towards ending STIs. Report No.: WHO/RHR/16.09. Geneva: World Health Organization; 2016. Available from: https://www.who.int/reproductivehealth/publications/rtis/ghss-stis/en/ [cited 2018 Nov 5].
- Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MCB, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013 Mar;40(3):187–93. http://dx.doi.org/10.1097/OLQ.0b013e318286bb53 pmid: 23403598
- Torrone E, Papp J, Weinstock H; Centers for Disease Control and Prevention (CDC). Prevalence of Chlamydia trachomatis genital infection among persons aged 14-39 years–United States, 2007-2012. MMWR Morb Mortal Wkly Rep. 2014 Sep 26;63(38):834–8. pmid: 25254560
- Berry SM, Carlin BP, Lee JJ, Muller P. Bayesian adaptive methods for clinical trials. 1st ed. Boca Raton: CRC Press; 2010. 323 pp. http://dx.doi.org/10.1201/EBK1439825488
- Supplemental files for chlamydia, gonorrhoea, trichomoniasis and syphilis: Global prevalence and incidence estimates, 2016. London: Figshare; 2019. http://dx.doi.org/10.6084/m9.figshare.8187107 http://dx.doi.org/10.6084/m9.figshare.8187107
- Thomas A, O’Hara B, Ligges U, Sturtz S. Making BUGS open. R News. 2006;6(1):12–7.
- Young-Xu Y, Chan KA. Pooling overdispersed binomial data to estimate event rate. BMC Med Res Methodol. 2008 08 19;8(1):58. http://dx.doi.org/10.1186/1471-2288-8-58 pmid: 18713448
- World Population Prospects. 2017. New York: United Nations; 2017. Available from: https://esa.un.org/unpd/wpp/ [cited 2018 May 5].
- World Bank country and lending groups [internet]. Washington, DC: The World Bank Group; 2018. Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519 [cited 2018 May 22].
- SDG Indicators. Regional groupings used in 2017 report and statistical annex [internet]. New York: United Nations; 2019. Available from: https://unstats.un.org/sdgs/indicators/regional-groups/ [cited 2018 May 22].
- Korenromp EL, Rowley J, Alonso M, Mello MB, Wijesooriya NS, Mahiané SG, et al. Global burden of maternal and congenital syphilis and associated adverse birth outcomes-estimates for 2016 and progress since 2012. PLoS One. 2019 02 27;14(2):e0211720. http://dx.doi.org/10.1371/journal.pone.0211720 pmid: 30811406
- Spectrum [internet]. Glastonbury: Avenir Health; 2019. Available from: https://www.avenirhealth.org/software-spectrum.php [cited 2019 May 13].
- Smolak A, Rowley J, Nagelkerke N, Kassebaum NJ, Chico RM, Korenromp EL, et al. Trends and predictors of syphilis prevalence in the general population: global pooled analyses of 1103 prevalence measures including 136 million syphilis tests. Clin Infect Dis. 2018 Apr 3;66(8):1184–91. http://dx.doi.org/10.1093/cid/cix975 pmid: 29136161
- Aroian LA, Taneja VS, Cornwell LW. Mathematical forms of the distribution of the product of two normal variables. Commun Stat Theory Methods. 1978 Jan 1;7(2):165–72. http://dx.doi.org/10.1080/03610927808827610
- Wynn A, Ramogola-Masire D, Gaolebale P, Moshashane N, Sickboy O, Duque S, et al. Prevalence and treatment outcomes of routine Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis testing during antenatal care, Gaborone, Botswana. Sex Transm Infect. 2018 05;94(3):230–5. pmid: 29097418
- Eshete A, Mekonnen Z, Zeynudin A. Trichomonas vaginalis infection among pregnant women in Jimma university specialized hospital, southwest Ethiopia. ISRN Infect Dis. 2013;2013:485439. http://dx.doi.org/10.5402/2013/485439
- Mulu W, Yimer M, Zenebe Y, Abera B. Common causes of vaginal infections and antibiotic susceptibility of aerobic bacterial isolates in women of reproductive age attending at Felegehiwot Referral Hospital, Ethiopia: a cross sectional study. BMC Womens Health. 2015 05 13;15(1):42. http://dx.doi.org/10.1186/s12905-015-0197-y pmid: 25968607
- Schönfeld A, Feldt T, Tufa TB, Orth HM, Fuchs A, Mesfun MG, et al. Prevalence and impact of sexually transmitted infections in pregnant women in central Ethiopia. Int J STD AIDS. 2018 03;29(3):251–8. http://dx.doi.org/10.1177/0956462417723545 pmid: 28776463
- Völker F, Cooper P, Bader O, Uy A, Zimmermann O, Lugert R, et al. Prevalence of pregnancy-relevant infections in a rural setting of Ghana. BMC Pregnancy Childbirth. 2017 06 6;17(1):172. http://dx.doi.org/10.1186/s12884-017-1351-3 pmid: 28583150
- Jespers V, Crucitti T, Menten J, Verhelst R, Mwaura M, Mandaliya K, et al.; Vaginal Biomarkers Study Group. Prevalence and correlates of bacterial vaginosis in different sub-populations of women in sub-Saharan Africa: a cross-sectional study. PLoS One. 2014 10 7;9(10):e109670. http://dx.doi.org/10.1371/journal.pone.0109670 pmid: 25289640
- Kinuthia J, Drake AL, Matemo D, Richardson BA, Zeh C, Osborn L, et al. HIV acquisition during pregnancy and postpartum is associated with genital infections and partnership characteristics. AIDS. 2015 Sep 24;29(15):2025–33. http://dx.doi.org/10.1097/QAD.0000000000000793 pmid: 26352880
- Drake AL, Kinuthia J, Matemo D, McClelland RS, Unger J, John-Stewart G. P3.079 Prevalence and cofactors for STIs among pregnant adolescents in western Kenya. Sex Transm Infect. 2013 Jul 1;89 Suppl 1:A172. http://dx.doi.org/10.1136/sextrans-2013-051184.0539
- Masese LN, Wanje G, Kabare E, Budambula V, Mutuku F, Omoni G, et al. Screening for sexually transmitted infections in adolescent girls and young women in Mombasa, Kenya: feasibility, prevalence, and correlates. Sex Transm Dis. 2017 12;44(12):725–31. http://dx.doi.org/10.1097/OLQ.0000000000000674 pmid: 28876312
- Masha SC, Wahome E, Vaneechoutte M, Cools P, Crucitti T, Sanders EJ. High prevalence of curable sexually transmitted infections among pregnant women in a rural county hospital in Kilifi, Kenya. PLoS One. 2017 03 31;12(3):e0175166. http://dx.doi.org/10.1371/journal.pone.0175166 pmid: 28362869
- Nkhoma M, Ashorn P, Ashorn U, Dewey KG, Gondwe A, Mbotwa J, et al. Providing lipid-based nutrient supplement during pregnancy does not reduce the risk of maternal P falciparum parasitaemia and reproductive tract infections: a randomised controlled trial. BMC Pregnancy Childbirth. 2017 01 17;17(1):35. http://dx.doi.org/10.1186/s12884-016-1215-2 pmid: 28095801
- Olowe OA, Makanjuola OB, Olowe R, Adekanle DA. Prevalence of vulvovaginal candidiasis, trichomoniasis and bacterial vaginosis among pregnant women receiving antenatal care in southwestern Nigeria. Eur J Microbiol Immunol (Bp). 2014 Dec;4(4):193–7. http://dx.doi.org/10.1556/EUJMI-D-14-00027 pmid: 25544891
- Etuketu IM, Mogaji HO, Alabi OM, Adeniran AA, Oluwole AS, Ekpo UF. Prevalence and risk factors of Trichomonas vaginalis infection among pregnant women receiving antenatal care in Abeokuta, Nigeria. Afr J Infect Dis. 2015 Jan 1;9(2):51–6. http://dx.doi.org/10.4314/ajid.v9i2.7
- Muvunyi CM, Dhont N, Verhelst R, Temmerman M, Claeys G, Padalko E. Chlamydia trachomatis infection in fertile and subfertile women in Rwanda: prevalence and diagnostic significance of IgG and IgA antibodies testing. Hum Reprod. 2011 Dec;26(12):3319–26. http://dx.doi.org/10.1093/humrep/der350 pmid: 22016415
- Franceschi S, Chantal Umulisa M, Tshomo U, Gheit T, Baussano I, Tenet V, et al. Urine testing to monitor the impact of HPV vaccination in Bhutan and Rwanda. Int J Cancer. 2016 08 1;139(3):518–26. http://dx.doi.org/10.1002/ijc.30092 pmid: 26991686
- Vieira-Baptista P, Grinceviciene S, Bellen G, Sousa C, Saldanha C, Broeck DV, et al. Genital tract infections in an isolated community: 100 women of the Príncipe Island. Infect Dis Obstet Gynecol. 2017;2017:3058569. http://dx.doi.org/10.1155/2017/3058569 pmid: 29259388
- Moodley D, Moodley P, Sebitloane M, Soowamber D, McNaughton-Reyes HL, Groves AK, et al. High prevalence and incidence of asymptomatic sexually transmitted infections during pregnancy and postdelivery in KwaZulu Natal, South Africa. Sex Transm Dis. 2015 Jan;42(1):43–7. http://dx.doi.org/10.1097/OLQ.0000000000000219 pmid: 25504300
- Peters RPH, Dubbink JH, van der Eem L, Verweij SP, Bos MLA, Ouburg S, et al. Cross-sectional study of genital, rectal, and pharyngeal Chlamydia and gonorrhea in women in rural South Africa. Sex Transm Dis. 2014 Sep;41(9):564–9. http://dx.doi.org/10.1097/OLQ.0000000000000175 pmid: 25118973
- de Waaij DJ, Dubbink JH, Ouburg S, Peters RPH, Morré SA. Prevalence of Trichomonas vaginalis infection and protozoan load in South African women: a cross-sectional study. BMJ Open. 2017 10 8;7(10):e016959. http://dx.doi.org/10.1136/bmjopen-2017-016959 pmid: 28993385
- Francis SC, Mthiyane TN, Baisley K, Mchunu SL, Ferguson JB, Smit T, et al. Prevalence of sexually transmitted infections among young people in South Africa: A nested survey in a health and demographic surveillance site. PLoS Med. 2018 02 27;15(2):e1002512. http://dx.doi.org/10.1371/journal.pmed.1002512 pmid: 29485985
- Ginindza TG, Stefan CD, Tsoka-Gwegweni JM, Dlamini X, Jolly PE, Weiderpass E, et al. Prevalence and risk factors associated with sexually transmitted infections (STIs) among women of reproductive age in Swaziland. Infect Agent Cancer. 2017 05 25;12(1):29. http://dx.doi.org/10.1186/s13027-017-0140-y pmid: 28559923
- Tchelougou D, Karou DS, Kpotsra A, Balaka A, Assih M, Bamoke M, et al. [Vaginal infections in pregnant women at the regional hospital of Sokode (Togo) in 2010 and 2011]. Med Sante Trop. 2013 Jan-Mar;23(1):49–54. French. pmid: 23692693
- Donders GG, Donders F, Bellen G, Depuydt C, Eggermont N, Michiels T, et al. Screening for abnormal vaginal microflora by self-assessed vaginal pH does not enable detection of sexually transmitted infections in Ugandan women. Diagn Microbiol Infect Dis. 2016 Jun;85(2):227–30. http://dx.doi.org/10.1016/j.diagmicrobio.2015.12.018 pmid: 27112831
- Rutherford GW, Anglemyer A, Bagenda D, Muyonga M, Lindan CP, Barker JL, et al. University students and the risk of HIV and other sexually transmitted infections in Uganda: the Crane survey. Int J Adolesc Med Health. 2014;26(2):209–15. http://dx.doi.org/10.1515/ijamh-2013-0515 pmid: 24762640
- de Walque D, Dow WH, Nathan R, Abdul R, Abilahi F, Gong E, et al. Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania. BMJ Open. 2012 02 8;2(1):e000747. http://dx.doi.org/10.1136/bmjopen-2011-000747 pmid: 22318666
- Chiduo M, Theilgaard ZP, Bakari V, Mtatifikolo F, Bygbjerg I, Flanholc L, et al. Prevalence of sexually transmitted infections among women attending antenatal clinics in Tanga, north eastern Tanzania. Int J STD AIDS. 2012 May;23(5):325–9. http://dx.doi.org/10.1258/ijsa.2011.011312 pmid: 22648885
- Hokororo A, Kihunrwa A, Hoekstra P, Kalluvya SE, Changalucha JM, Fitzgerald DW, et al. High prevalence of sexually transmitted infections in pregnant adolescent girls in Tanzania: a multi-community cross-sectional study. Sex Transm Infect. 2015 Nov;91(7):473–8. http://dx.doi.org/10.1136/sextrans-2014-051952 pmid: 25834122
- Lazenby GB, Taylor PT, Badman BS, McHaki E, Korte JE, Soper DE, et al. An association between Trichomonas vaginalis and high-risk human papillomavirus in rural Tanzanian women undergoing cervical cancer screening. Clin Ther. 2014 Jan 1;36(1):38–45. http://dx.doi.org/10.1016/j.clinthera.2013.11.009 pmid: 24417784
- Maufi AJ, Mazigo HD, Kihunrwa A. Prevalence and factors associated with Trichomonas vaginalis infection among pregnant women attending public antenatal clinics in Mwanza city, North-western Tanzania. Tanzan J Health Res. 2016 Jan 1;18(2):1–7.
- Chaponda EB, Chico RM, Bruce J, Michelo C, Vwalika B, Mharakurwa S, et al. Malarial infection and curable sexually transmitted and reproductive tract infections among pregnant women in a rural district of Zambia. Am J Trop Med Hyg. 2016 Nov 2;95(5):1069–76. http://dx.doi.org/10.4269/ajtmh.16-0370 pmid: 27672205
- Stephen S, Muchaneta-Kubara CGE, Munjoma MW, Mandozana G. Evaluation of Cortez OneStep Chlamydia Rapicard™ Insta test for the detection of Chlamydia trachomatis in pregnant women at Mbare polyclinic in Harare, Zimbabwe. Int J MCH AIDS. 2017;6(1):19–26. http://dx.doi.org/10.21106/ijma.150 pmid: 28798890
- Touzon MS, Losada M, Eliseht MC, Menghi C, Gatta C, Santa Cruz G, et al. [Evaluation of vaginal dysfunction in symptomatic and asymptomatic pregnant women by using the analysis of basic vaginal states (BVS) and its comparison with the conventional microbiological study]. Rev Argent Microbiol. 2014 Jul-Sep;46(3):182–7. Spanish. http://dx.doi.org/10.1016/S0325-7541(14)70070-7 pmid: 25444125
- Testardini P, Vaulet MLG, Entrocassi AC, Menghi C, Eliseht MC, Gatta C, et al. Optimization of trichomonas vaginalis diagnosis during pregnancy at a university hospital, Argentina. Korean J Parasitol. 2016 Apr;54(2):191–5. http://dx.doi.org/10.3347/kjp.2016.54.2.191 pmid: 27180578
- Mucci MJ, Cuestas ML, Cervetto MM, Landaburu MF, Mujica MT. A prospective observational study of vulvovagintis in pregnant women in Argentina, with special reference to candidiasis. Mycoses. 2016 Jul;59(7):429–35. http://dx.doi.org/10.1111/myc.12490 pmid: 26931504
- The Bahamas STI surveillance report. Nassau: Department of Public Health; 2018.
- Magalhães PA, Miranda CAN, Lima ÉG, Moizéis RNC, de Lima DBS, Cobucci RNO, et al. Genital tract infection with Chlamydia trachomatis in women attended at a cervical cancer screening program in northeastern from Brazil. Arch Gynecol Obstet. 2015 May;291(5):1095–102. http://dx.doi.org/10.1007/s00404-014-3514-z pmid: 25326872
- Miranda AE, Pinto VM, Gaydos CA. Trichomonas vaginalis infection among young pregnant women in Brazil. Braz J Infect Dis. 2014 Nov-Dec;18(6):669–71. http://dx.doi.org/10.1016/j.bjid.2014.07.002 pmid: 25181400
- 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. 2011 Oct;38(10):957–61. http://dx.doi.org/10.1097/OLQ.0b013e31822037fc pmid: 21934572
- Ferreira CS, Marconi C, Parada CM de LG, Duarte MTC, Gonçalves APO, Rudge MVC, et al. Bacterial vaginosis in pregnant adolescents: proinflammatory cytokine and bacterial sialidase profile. Cross-sectional study. Sao Paulo Med J. 2015 Nov-Dec;133(6):465–70. http://dx.doi.org/10.1590/1516-3180.2014.9182710 pmid: 26465813
- Piazzetta RC, de Carvalho NS, de Andrade RP, Piazzetta G, Piazzetta SR, Carneiro R. [Prevalence of Chlamydia trachomatis and Neisseria gonorrhoea infections in sexual actives young women at a southern Brazilian city]. Rev Bras Ginecol Obstet. 2011 Nov;33(11):328–33. Portuguese. pmid: 22267110
- Silveira MF, Sclowitz IKT, Entiauspe LG, Mesenburg MA, Stauffert D, Bicca GL de O, et al. Chlamydia trachomatis infection in young pregnant women in southern Brazil: a cross-sectional study. Cad Saude Publica. 2017 02 13;33(1):e00067415. http://dx.doi.org/10.1590/0102-311x00067415 pmid: 28226066
- Mesenburg MA, Stauffert D, Silveira MF. P3.331 Prevalence of Chlamydia Trachomatis infection and associated factors in Brazilian pregnant women: preliminary results of a population-based study. Sex Transm Infect. 2013 Jul 1;89 Suppl 1:A252. http://dx.doi.org/10.1136/sextrans-2013-051184.0784
- Gatti FA, Ceolan E, Greco FS, Santos PC, Klafke GB, de Oliveira GR, et al. The prevalence of trichomoniasis and associated factors among women treated at a university hospital in southern Brazil. PLoS One. 2017 03 27;12(3):e0173604. http://dx.doi.org/10.1371/journal.pone.0173604 pmid: 28346531
- Marconi C, Duarte MTC, Silva DC, Silva MG. Prevalence of and risk factors for bacterial vaginosis among women of reproductive age attending cervical screening in southeastern Brazil. Int J Gynaecol Obstet. 2015 Nov;131(2):137–41. http://dx.doi.org/10.1016/j.ijgo.2015.05.016 pmid: 26283224
- Neves D, Sabidó M, Bôtto-Menezes C, Benzaken NS, Jardim L, Ferreira C, et al. Evaluation of screening for Chlamydia trachomatis among young women in primary health care services in Manaus, Amazonas State, Brazil. Cad Saude Publica. 2016 10 20;32(10):e00101015. http://dx.doi.org/10.1590/0102-311X00101015 pmid: 27783757
- Zamboni M, Ralph C, García P, Cuello M. [The current prevalence of Chlamydia trachomatis infection among teenagers and young asymptomatic Chilean women justifies the periodic surveillance]. Rev Chilena Infectol. 2016 Dec;33(6):619–27. Spanish. http://dx.doi.org/10.4067/S0716-10182016000600003 pmid: 28146186
- Melo A, Lagos N, Montenegro S, Orellana JJ, Vásquez AM, Moreno S, et al. [Human papilloma virus and Chlamydia trachomatis by number of sexual partners and time of sexual activity on university students in the Region of La Araucanía, Chile]. Rev Chilena Infectol. 2016 Jun;33(3):287–92. Spanish. http://dx.doi.org/10.4067/S0716-10182016000300006 pmid: 27598277
- Glehn MP, Ferreira LCES, Da Silva HDF, Machado ER. Prevalence of Trichomonas vaginalis and Candida albicans among Brazilian Women of Reproductive Age. J Clin Diagn Res. 2016 Nov;10(11):LC24–7. pmid: 28050410
- Ovalle A, Martínez MA, de la Fuente F, Falcon N, Feliú F, Fuentealba F, et al. [Prevalence of sexually transmitted infections in pregnant women attending a public hospital in Chile]. Rev Chilena Infectol. 2012 Oct;29(5):517–20. Spanish. http://dx.doi.org/10.4067/S0716-10182012000600006 pmid: 23282493
- Huneeus A, Schilling A, Fernandez MI. Prevalence of Chlamydia Trachomatis, Neisseria Gonorrhoeae, and Trichomonas Vaginalis infection in Chilean adolescents and young adults. J Pediatr Adolesc Gynecol. 2018 Aug;31(4):411–5. http://dx.doi.org/10.1016/j.jpag.2018.01.003 pmid: 29409759
- Villaseca R, Ovalle A, Amaya F, Labra B, Escalona N, Lizana P, et al. [Vaginal infections in a family health clinic in the metropolitan region, Chile]. Rev Chilena Infectol. 2015 Feb;32(1):30–6. Spanish. http://dx.doi.org/10.4067/S0716-10182015000200005 pmid: 25860041
- Stella TAL, López MI, Villegas A, Agudelo C, Arrubla M, Munoz Tamayo J, et al. Determinantes de salud sexual e ITS en adolescentes rurales, escolarizados, Medellín, Colombia, 2008. Revista Salud Publica de Medellin. 2011;5:7–24. Spanish.
- Paredes MC, Gómez YM, Torres AM, Fernández M, Tovar MB. [Prevalence of infections by Chlamydia trachomatis and Neisseria gonorrhoeae among high school students in the Sabana Central area of Cundinamarca, Colombia]. Biomedica. 2015 Jul-Sep;35(3):314–24. Spanish. http://dx.doi.org/10.7705/biomedica.v35i3.2398 pmid: 26849693
- Giraldo-Ospina B, Henao-Nieto DE, Flórez-Salazar M, Parra-Londoño F, Gómez-Giraldo EL, Mantilla-Moreno OJ. Prevalencia de sífilis en una población de gestantes de dos comunidades de un municipio de Colombia. Biosalud (Manizales). 2015 Dec 1;14(2):9–18. Spanish. http://dx.doi.org/10.17151/biosa.2015.14.2.2
- Cerón DAG, Jimeno AG, Gómez OB, Garcia TCB. Prevalencia de gonococo y clamidia en gestantes de segundo y tercer trimestre que consultant urgencias de obstetricia des Homic en un lapso de 5 meses. Bogota: Hospital Militar Central de Bogota, Universidad Militar Nueva Granada; 2014. p. 29. Spanish.
- Jobe KA, Downey RF, Hammar D, Van Slyke L, Schmidt TA. Epidemiology of sexually transmitted infections in rural southwestern Haiti: the Grand’Anse Women’s Health Study. Am J Trop Med Hyg. 2014 Nov;91(5):881–6. http://dx.doi.org/10.4269/ajtmh.13-0762 pmid: 25200263
- Scheidell JD, Beau De Rochars VM, Séraphin MN, Hobbs MM, Morris JG Jr, Célestin JP, et al. Socioeconomic vulnerability and sexually transmitted infection among pregnant Haitian women. Sex Transm Dis. 2018 Sep;45(9):626–31. pmid: 29697553
- Bristow CC, Mathelier P, Ocheretina O, Benoit D, Pape JW, Wynn A, et al. Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis screening and treatment of pregnant women in Port-au-Prince, Haiti. Int J STD AIDS. 2017 10;28(11):1130–4. http://dx.doi.org/10.1177/0956462416689755 pmid: 28134005
- Conde-Ferráez L, Martíez JRC, Ayora-Talavera G, Losa MDRG. Human papillomavirus and Chlamydia trachomatis infection in gyneco-obstetric outpatients from a mexican hospital. Indian J Med Microbiol. 2017 Jan-Mar;35(1):74–9. http://dx.doi.org/10.4103/ijmm.IJMM_15_450 pmid: 28303822
- López-Monteon A, Gómez-Figueroa FS, Ramos-Poceros G, Guzmán-Gómez D, Ramos-Ligonio A. Codetection of Trichomonas vaginalis and Candida albicans by PCR in urine samples in a low-risk population attended in a clinic first level in central Veracruz, Mexico. BioMed Res Int. 2013;2013:281892. http://dx.doi.org/10.1155/2013/281892 pmid: 24069593
- Magaña-Contreras M, Contreras-Paredes A, Chavez-Blanco A, Lizano M, De la Cruz-Hernandez Y, De la Cruz-Hernandez E. Prevalence of sexually transmitted pathogens associated with HPV infection in cervical samples in a Mexican population. J Med Virol. 2015 Dec;87(12):2098–105. http://dx.doi.org/10.1002/jmv.24278 pmid: 26010580
- Casillas-Vega N, Morfín-Otero R, García S, Llaca-Díaz J, Rodríguez-Noriega E, Camacho-Ortiz A, et al. Frequency and genotypes of Chlamydia trachomatis in patients attending the obstetrics and gynecology clinics in Jalisco, Mexico and correlation with sociodemographic, behavioral, and biological factors. BMC Womens Health. 2017 09 15;17(1):83. http://dx.doi.org/10.1186/s12905-017-0428-5 pmid: 28915869
- Cabeza J, García PJ, Segura E, García P, Escudero F, La Rosa S, et al. Feasibility of Chlamydia trachomatis screening and treatment in pregnant women in Lima, Peru: a prospective study in two large urban hospitals. Sex Transm Infect. 2015 Feb;91(1):7–10. http://dx.doi.org/10.1136/sextrans-2014-051531 pmid: 25107711
- van der Helm JJ, Bom RJ, Grünberg AW, Bruisten SM, Schim van der Loeff MF, Sabajo LO, et al. Urogenital Chlamydia trachomatis infections among ethnic groups in Paramaribo, Suriname; determinants and ethnic sexual mixing patterns. PLoS One. 2013 07 17;8(7):e68698. http://dx.doi.org/10.1371/journal.pone.0068698 pmid: 23874730
- van der Helm JJ, Sabajo LOA, Grunberg AW, Morré SA, Speksnijder AGCL, de Vries HJC. Point-of-care test for detection of urogenital chlamydia in women shows low sensitivity. A performance evaluation study in two clinics in Suriname. PLoS One. 2012;7(2):e32122. http://dx.doi.org/10.1371/journal.pone.0032122 pmid: 22393383
- Vidwan NK, Regi A, Steinhoff M, Huppert JS, Staat MA, Dodd C, et al. Low prevalence of Chlamydia trachomatis infection in non-urban pregnant women in Vellore, S. India. PLoS One. 2012;7(5):e34794. http://dx.doi.org/10.1371/journal.pone.0034794 pmid: 22567090
- Vijaya Mn D, Umashankar K, Sudha, Nagure AG, Kavitha G. Prevalence of the Trichomonas Vaginalis infection in a tertiary care hospital in rural Bangalore, southern India. J Clin Diagn Res. 2013 Jul;7(7):1401–3. pmid: 23998075
- Kojima N, Sharma N, Ravi K, Arun A, Bristow CC, Sethi S, et al. Sexually transmitted infections and adverse birth and infant outcomes among pregnant women in rural southern India. J Clin Diagn Res. 2018 July;12(7):QC09–12.
- Shah M, Deshmukh S, Patel SV, Mehta K, Marfatia Y. Validation of vaginal discharge syndrome among pregnant women attending obstetrics clinic, in the tertiary hospital of western India. Indian J Sex Transm Dis AIDS. 2014 Jul-Dec;35(2):118–23. http://dx.doi.org/10.4103/0253-7184.142406 pmid: 26396446
- Krishnan A, Sabeena S, Bhat PV, Kamath V, Hindol M, Zadeh VR, et al. Detection of genital chlamydial and gonococcal infection using urine samples: a community-based study from India. J Infect Public Health. 2018 Jan-Feb;11(1):75–9. http://dx.doi.org/10.1016/j.jiph.2017.04.006 pmid: 28506737
- Ani LS, Darmayani IS. Trichomoniasis among pregnant women in Denpasar City, Bali, Indonesia. J Glob Pharma Technol. 2017 Apr 25;9(4):61–5.
- Banneheke H, Fernandopulle R, Prathanapan S, de Silva G, Fernando N, Wickremasinghe R. Use of culture and immunochromatographic technique for diagnosis of trichomoniasis in Sri Lanka. Ceylon Med J. 2013 Sep;58(3):122–3. http://dx.doi.org/10.4038/cmj.v58i3.6105 pmid: 24081173
- Farr A, Kiss H, Hagmann M, Holzer I, Kueronya V, Husslein PW, et al. Evaluation of the vaginal flora in pregnant women receiving opioid maintenance therapy: a matched case-control study. BMC Pregnancy Childbirth. 2016 08 5;16(1):206. http://dx.doi.org/10.1186/s12884-016-1003-z pmid: 27495167
- Ljubin-Sternak S, Meštrović T, Kolarić B, Jarža-Davila N, Marijan T, Vraneš J. Assessing the need for routine screening for Mycoplasma genitalium in the low-risk female population: a prevalence and co-infection study on women from Croatia. Int J Prev Med. 2017 07 4;8(1):51. http://dx.doi.org/10.4103/ijpvm.IJPVM_309_16 pmid: 28757928
- Peuchant O, Le Roy C, Desveaux C, Paris A, Asselineau J, Maldonado C, et al. 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. http://dx.doi.org/10.1016/j.diagmicrobio.2015.01.014 pmid: 25753079
- Ikonomidis A, Venetis C, Georgantzis D, Giaslakiotis V, Kolovos V, Efstathiou K, et al. Prevalence of Chlamydia trachomatis, Ureaplasma spp., Mycoplasma genitalium and Mycoplasma hominis among outpatients in central Greece: absence of tetracycline resistance gene tet(M) over a 4-year period study. New Microbes New Infect. 2015 11 14;9:8–10. http://dx.doi.org/10.1016/j.nmni.2015.11.005 pmid: 26862428
- O’Higgins AC, Jackson V, Lawless M, Le Blanc D, Connolly G, Drew R, et al. Screening for asymptomatic urogenital Chlamydia trachomatis infection at a large Dublin maternity hospital: results of a pilot study. Ir J Med Sci. 2017 May;186(2):393–7. http://dx.doi.org/10.1007/s11845-016-1429-3 pmid: 26969456
- Hassan SJ, Dunphy E, Navin E, Marron L, Fitzsimmons C, Loy A, et al. Screening for Chlamydia is acceptable and feasible during cervical screening in general practice. Ir Med J. 2016 Jan;109(1):326–7. pmid: 26904785
- Bianchi S, Boveri S, Igidbashian S, Amendola A, Urbinati AMV, Frati ER, et al. Chlamydia trachomatis infection and HPV/Chlamydia trachomatis co-infection among HPV-vaccinated young women at the beginning of their sexual activity. Arch Gynecol Obstet. 2016 11;294(6):1227–33. http://dx.doi.org/10.1007/s00404-016-4167-x pmid: 27501926
- Seraceni S, Campisciano G, Contini C, Comar M. HPV genotypes distribution in Chlamydia trachomatis co-infection in a large cohort of women from north-east Italy. J Med Microbiol. 2016 May;65(5):406–13. http://dx.doi.org/10.1099/jmm.0.000245 pmid: 26944507
- Panatto D, Amicizia D, Bianchi S, Frati ER, Zotti CM, Lai PL, et al. Chlamydia trachomatis prevalence and chlamydial/HPV co-infection among HPV-unvaccinated young Italian females with normal cytology. Hum Vaccin Immunother. 2015;11(1):270–6. http://dx.doi.org/10.4161/hv.36163 pmid: 25483545
- Foschi C, Nardini P, Banzola N, D’Antuono A, Compri M, Cevenini R, et al. Chlamydia trachomatis infection prevalence and serovar distribution in a high-density urban area in the north of Italy. J Med Microbiol. 2016 Jun;65(6):510–20. http://dx.doi.org/10.1099/jmm.0.000261 pmid: 27046236
- Matteelli A, Capelli M, Sulis G, Toninelli G, Carvalho ACC, Pecorelli S, et al.; on behalf of the Clamigon Study Group. Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infection in adolescents in northern Italy: an observational school-based study. BMC Public Health. 2016 02 29;16(1):200. http://dx.doi.org/10.1186/s12889-016-2839-x pmid: 26927226
- Camporiondo MP, Farchi F, Ciccozzi M, Denaro A, Gallone D, Maracchioni F, et al. Detection of HPV and co-infecting pathogens in healthy Italian women by multiplex real-time PCR. Infez Med. 2016;24(1):12–7. pmid: 27031891
- Leli C, Castronari R, Levorato L, Luciano E, Pistoni E, Perito S, et al. Molecular sensitivity threshold of wet mount and an immunochromatographic assay evaluated by quantitative real-time PCR for diagnosis of Trichomonas vaginalis infection in a low-risk population of childbearing women. Infez Med. 2016 Jun 1;24(2):112–6. pmid: 27367320
- Gravningen K, Simonsen GS, Furberg A-S, Wilsgaard T. Factors associated with Chlamydia trachomatis testing in a high school-based screening and previously in clinical practice: a cross-sectional study in Norway. BMC Infect Dis. 2013 08 1;13(1):361. http://dx.doi.org/10.1186/1471-2334-13-361 pmid: 23915415
- Silva J, Cerqueira F, Ribeiro J, Sousa H, Osório T, Medeiros R. Is Chlamydia trachomatis related to human papillomavirus infection in young women of southern European population? A self-sampling study. Arch Gynecol Obstet. 2013 Sep;288(3):627–33. http://dx.doi.org/10.1007/s00404-013-2771-6 pmid: 23494197
- Babinská I, Halánová M, Kalinová Z, Čechová L, Čisláková L, Madarasová Gecková A. Prevalence of Chlamydia trachomatis infection and its association with sexual behaviour and alcohol use in the population living in separated and segregated Roma settlements in eastern Slovakia. Int J Environ Res Public Health. 2017 12 14;14(12):E1579. http://dx.doi.org/10.3390/ijerph14121579 pmid: 29240704
- Fernández-Benítez C, Mejuto-López P, Otero-Guerra L, Margolles-Martins MJ, Suárez-Leiva P, Vazquez F; Chlamydial Primary Care Group. Prevalence of genital Chlamydia trachomatis infection among young men and women in Spain. BMC Infect Dis. 2013 08 22;13(1):388. http://dx.doi.org/10.1186/1471-2334-13-388 pmid: 23968487
- Piñeiro L, Lekuona A, Cilla G, Lasa I, Martinez-Gallardo L-P, Korta J, et al. Prevalence of Chlamydia trachomatis infection in parturient women in Gipuzkoa, Northern Spain. Springerplus. 2016 05 10;5(1):566. http://dx.doi.org/10.1186/s40064-016-2268-4 pmid: 27247863
- Field N, Clifton S, Alexander S, Ison CA, Khanom R, Saunders P, et al. Trichomonas vaginalis infection is uncommon in the British general population: implications for clinical testing and public health screening. Sex Transm Infect. 2018 05;94(3):226–9. pmid: 27686884
- Sonnenberg P, Clifton S, Beddows S, Field N, Soldan K, Tanton C, et al. Prevalence, risk factors, and uptake of interventions for sexually transmitted infections in Britain: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal). Lancet. 2013 Nov 30;382(9907):1795–806. http://dx.doi.org/10.1016/S0140-6736(13)61947-9 pmid: 24286785
- Nada AM, Al-Azhary NH, Hassan FM. Detection of Chlamydia Trachomatis in patients with unexplained infertility : a case control study. Egypt J Med Microbiol. 2015;24(2):35–8. http://dx.doi.org/10.12816/0026085
- Hassanzadeh P, Mardaneh J, Motamedifar M. Conventional agar-based culture method, and nucleic acid amplification test (NAAT) of the cppB gene for detection of Neisseria gonorrhea in pregnant women endocervical swab specimens. Iran Red Crescent Med J. 2013 Mar;15(3):207–11. http://dx.doi.org/10.5812/ircmj.3726 pmid: 23983999
- Hamid B, Braham A, Mohtaram H. Prevalence of infection with Nisseria gonorrhoeae and Chlamydia trachomatis in women visitors of gynecology and obstetrics clinics in Zanjan Province of Iran. Afr J Microbiol Res. 2011 Sep 9;5(17):2447–50.
- Nourian A, Shabani N, Fazaeli A, Mousavinasab SN. Prevalence of trichomonas vaginalis in pregnant women in Zanjan, northwest of Iran. Jundishapur J Microbiol. 2013;6(8):e7258. http://dx.doi.org/10.5812/jjm.7258
- Rasti S, Behrashi M, Mousavi GH, Moniri R. Complications of trichomoniasis on the pregnant women. Jundishapur J Microbiol. 2011;4(1):61–3.
- Dehghan Marvast L, Aflatoonian A, Talebi AR, Eley A, Pacey AA. Relationship between Chlamydia trachomatis and Mycoplasma genitalium infection and pregnancy rate and outcome in Iranian infertile couples. Andrologia. 2017 Nov;49(9):e12747. http://dx.doi.org/10.1111/and.12747 pmid: 28032361
- Ahmadi A, Khodabandehloo M, Ramazanzadeh R, Farhadifar F, Roshani D, Ghaderi E, et al. The relationship between Chlamydia trachomatis genital infection and spontaneous abortion. J Reprod Infertil. 2016 Apr-Jun;17(2):110–6. pmid: 27141466
- Arbabi M, Fakhrieh Z, Delavari M, Abdoli A. Prevalence of trichomonas vaginalis infection in Kashan city, Iran (2012-2013). Iran J Reprod Med. 2014 Jul;12(7):507–12. pmid: 25114674
- Hasanabad MH, Bahador A, Mohammadzadeh M, Haghighi F. P3.272 Prevalence of Chlamydia Trachomatis, Neisseria Gonorrhoeae and ureaplasma urealyticum in pregnant women of Sabzevar - Iran. Sex Transm Infect. 2013 Jul 1;89 Suppl 1:A233–4. http://dx.doi.org/10.1136/sextrans-2013-051184.0728
- Mousavi A, Ramezanzadeh R, Farhadifar F, Mirnejad R, Zarei O, Ganizadeh A, et al. Detection of Chlamydia Trachomatis in fertile and infertile women in Sanandaj by PCR. Iran J Public Health. 2014 Jan 1;43(2):63.
- Nateghi Rostami M, Hossein Rashidi B, Aghsaghloo F, Nazari R. Comparison of clinical performance of antigen based-enzyme immunoassay (EIA) and major outer membrane protein (MOMP)-PCR for detection of genital Chlamydia trachomatis infection. Int J Reprod Biomed (Yazd). 2016 Jun;14(6):411–20. http://dx.doi.org/10.29252/ijrm.14.6.411 pmid: 27525325
- Marashi SMA, Moulana Z, Imani Fooladi AA, Mashhadi Karim M. Comparison of genital Chlamydia trachomatis infection incidence between women with infertility and healthy women in Iran using PCR and immunofluorescence methods. Jundishapur J Microbiol. 2014 Apr;7(4):e9450. http://dx.doi.org/10.5812/jjm.9450 pmid: 25147704
- Joolayi F, Navidifar T, Mohammad Jaafari R, Amin M. Comparison of Chlamydia trachomatis infection among infertile and fertile women in Ahvaz, Iran: A case-control study. Int J Reprod Biomed (Yazd). 2017 Nov;15(11):713–8. http://dx.doi.org/10.29252/ijrm.15.11.713 pmid: 29404533
- Kamel RM. Screening for Chlamydia trachomatis infection among infertile women in Saudi Arabia. Int J Womens Health. 2013 06 6;5:277–84. http://dx.doi.org/10.2147/IJWH.S46678 pmid: 23785247
- Wen CH. Research on the association between HPV infection and other common genital infections. Zhongguo Fuyou Baojian. 2013;28(24):3985–8.
- Lu Q, Yuan C, Xie C, Ai E. Analysis on the detection results in 11254 cases of urogenital Chlamydia trachomatis infection by fluorescent PCR. Chinese J AIDS STDs. 2013;19(10):760–6.
- Xia H, Li X, Li X, Liang H, Xu H. The clinical management and outcome of term premature rupture of membrane in East China: results from a retrospective multicenter study. Int J Clin Exp Med. 2015 04 15;8(4):6212–7. pmid: 26131227
- Zhang LX, Sun Y, Zhao H, Zhu N, Sun X-D, Jin X, et al. A Bayesian stepwise discriminant model for predicting risk factors of preterm premature rupture of membranes: a case-control study. Chin Med J (Engl). 2017 Oct 20;130(20):2416–22. http://dx.doi.org/10.4103/0366-6999.216396 pmid: 29052561
- Zhang D, Li T, Chen L, Zhang X, Zhao G, Liu Z. Epidemiological investigation of the relationship between common lower genital tract infections and high-risk human papillomavirus infections among women in Beijing, China. PLoS One. 2017 05 22;12(5):e0178033. http://dx.doi.org/10.1371/journal.pone.0178033 pmid: 28531212
- Imai H, Nakao H, Shinohara H, Watarai M, Matsumoto N, Yamagishi T, et al. Prevalence, potential predictors, and genotype-specific prevalence of human papillomavirus infection among sexually active students in Japan. PLoS One. 2015 07 15;10(7):e0132462. http://dx.doi.org/10.1371/journal.pone.0132462 pmid: 26176861
- Suzuki S, Tanaka M, Matsuda H, Tsukahara Y, Kuribayashi Y, Sekizawa A, et al. Current status of the screening of Chlamydia trachomatis infection among Japanese pregnant women. J Clin Med Res. 2015 Jul;7(7):582–4. http://dx.doi.org/10.14740/jocmr2137w pmid: 26015828
- Annual Reports of HIV, AIDS. Ulaanbaatar: Mongolia National Center for Communicable Disease; 2017.
- Corsenac P, Noël M, Rouchon B, Hoy D, Roth A. Prevalence and sociodemographic risk factors of chlamydia, gonorrhoea and syphilis: a national multicentre STI survey in New Caledonia, 2012. BMJ Open. 2015 09 9;5(9):e007691. http://dx.doi.org/10.1136/bmjopen-2015-007691 pmid: 26353867
- Unger HW, Ome-Kaius M, Wangnapi RA, Umbers AJ, Hanieh S, Suen CSNLW, et al. Sulphadoxine-pyrimethamine plus azithromycin for the prevention of low birthweight in Papua New Guinea: a randomised controlled trial. BMC Med. 2015 01 16;13(1):9. http://dx.doi.org/10.1186/s12916-014-0258-3 pmid: 25591391
- Wangnapi RA, Soso S, Unger HW, Sawera C, Ome M, Umbers AJ, et al. Prevalence and risk factors for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis infection in pregnant women in Papua New Guinea. Sex Transm Infect. 2015 May;91(3):194–200. http://dx.doi.org/10.1136/sextrans-2014-051670 pmid: 25313204
- Vallely LM, Toliman P, Ryan C, Rai G, Wapling J, Gabuzzi J, et al. Performance of syndromic management for the detection and treatment of genital Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis among women attending antenatal, well woman and sexual health clinics in Papua New Guinea: a cross-sectional study. BMJ Open. 2017 12 29;7(12):e018630. http://dx.doi.org/10.1136/bmjopen-2017-018630 pmid: 29288183
- Badman SG, Vallely LM, Toliman P, Kariwiga G, Lote B, Pomat W, et al. A novel point-of-care testing strategy for sexually transmitted infections among pregnant women in high-burden settings: results of a feasibility study in Papua New Guinea. BMC Infect Dis. 2016 06 6;16(1):250. http://dx.doi.org/10.1186/s12879-016-1573-4 pmid: 27268218
- Hahn H-S, Lee K-H, Koo Y-J, Kim S-G, Rhee JE, Kim MY, et al. Distribution and perinatal transmission of bacterial vaginal infections in pregnant women without vaginal symptoms. Scand J Infect Dis. 2014 May;46(5):348–53. http://dx.doi.org/10.3109/00365548.2014.880183 pmid: 24552584
- Choe HS, Lee DS, Lee S-J, Lee CB, Lee WC, Cho Y-H. Prevalence of sexually transmitted infections and sexual behavior of young adults and middle-aged people presenting to health examination centers in Korea. J Infect Chemother. 2012 Apr;18(2):207–12. http://dx.doi.org/10.1007/s10156-011-0319-x pmid: 21989518
- Kim SJ, Lee DS, Lee SJ. The prevalence and clinical significance of urethritis and cervicitis in asymptomatic people by use of multiplex polymerase chain reaction. Korean J Urol. 2011 Oct;52(10):703–8. http://dx.doi.org/10.4111/kju.2011.52.10.703 pmid: 22087366
- Kim Y, Kim J, Lee KA. Prevalence of sexually transmitted infections among healthy Korean women: implications of multiplex PCR pathogen detection on antibiotic therapy. J Infect Chemother. 2014 Jan;20(1):74–6. http://dx.doi.org/10.1016/j.jiac.2013.08.005 pmid: 24462432
- Marks M, Kako H, Butcher R, Lauri B, Puiahi E, Pitakaka R, et al. Prevalence of sexually transmitted infections in female clinic attendees in Honiara, Solomon Islands. BMJ Open. 2015 04 28;5(4):e007276. http://dx.doi.org/10.1136/bmjopen-2014-007276 pmid: 25922103
- Ton Nu PA, Nguyen VQH, Cao NT, Dessì D, Rappelli P, Fiori PL. Prevalence of Trichomonas vaginalis infection in symptomatic and asymptomatic women in Central Vietnam. J Infect Dev Ctries. 2015 07 4;9(6):655–60. http://dx.doi.org/10.3855/jidc.7190 pmid: 26142677
- Jatapai A, Sirivongrangson P, Lokpichat S, Chuenchitra T, Nelson KE, Rangsin R. Prevalence and risk factors for Chlamydia trachomatis infection among young Thai men in 2008-2009. Sex Transm Dis. 2013 Mar;40(3):241–6. http://dx.doi.org/10.1097/OLQ.0b013e31827e8de4 pmid: 23407469
- Sviben M, Missoni EM, Meštrović T, Vojnović G, Galinović GM. Epidemiology and laboratory characteristics of Trichomonas vaginalis infection in Croatian men with and without urethritis syndrome: a case-control study. Sex Transm Infect. 2015 Aug;91(5):360–4. http://dx.doi.org/10.1136/sextrans-2014-051771 pmid: 25568091
- Yeganeh O, Jeddi-Tehrani M, Yaghmaie F, Kamali K, Heidari-Vala H, Zeraati H, et al. A survey on the prevalence of Chlamydia trachomatis and Mycoplasma genitalium infections in symptomatic and asymptomatic men referring to urology clinic of Labbafinejad hospital, Tehran, Iran. Iran Red Crescent Med J. 2013 Apr;15(4):340–4. http://dx.doi.org/10.5812/ircmj.8600 pmid: 24083010
- Korenromp EL, Mahiané SG, Nagelkerke N, Taylor MM, Williams R, Chico RM, et al. Syphilis prevalence trends in adult women in 132 countries - estimations using the Spectrum Sexually Transmitted Infections model. Sci Rep. 2018 07 31;8(1):11503. http://dx.doi.org/10.1038/s41598-018-29805-9 pmid: 30065272
- Sexually transmitted infections (STIs). Geneva: World Health Organization; 2019. Available from: https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis) [cited 2019 May 24].
- Standard protocol to assess the prevalence of gonorrhea and chlamydia among pregnant women in antenatal care clinics. Geneva: World Health Organization; 2018. Available from: https://www.who.int/reproductivehealth/publications/rtis/gonorrhoea-chlamydia-among-pregnant-women/en/ [cited 2018 Nov 30].
- Thomas J, Noel-Storr A, Marshall I, Wallace B, McDonald S, Mavergames C, et al.; Living Systematic Review Network. Living systematic reviews: 2. Combining human and machine effort. J Clin Epidemiol. 2017 Nov;91:31–7. http://dx.doi.org/10.1016/j.jclinepi.2017.08.011 pmid: 28912003
- Wi T, Lahra MM, Ndowa F, Bala M, Dillon JR, Ramon-Pardo P, et al. Antimicrobial resistance in Neisseria gonorrhoeae: Global surveillance and a call for international collaborative action. PLoS Med. 2017 07 7;14(7):e1002344. http://dx.doi.org/10.1371/journal.pmed.1002344 pmid: 28686231