Search

Abstract Objective To assess a screening program for sexually transmitted infections (STIs) in under‐30‐year‐old pregnant women, focusing on Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium infections, which though often asymptomatic, may significantly affect women's health and can be vertically transmitted. Design Prospective, descriptive, observational study. Setting Gipuzkoa (Basque Country, Spain). Population Under‐30‐year‐old pregnant women. Methods Between 2016 and 2020, cervical samples were taken at first prenatal appointments from 3051 women. STIs were detected by multiplex nucleic acid amplification. Main Outcome Measures Prevalence of infections by age and geographical origin groups, and screening coverage. Results The coverage rate was 86% between 2017 and 2020. At least one STI was detected in 5.2% of the under‐30‐year‐olds screened (95% confidence interval [CI]: 4.5%, 6.1%): C. trachomatis in 4%, M. genitalium in 1.3% and N. gonorrhoeae in 0.1%. C. trachomatis and M. genitalium prevalence rates were higher among younger women (7.2% and 2.8%, respectively in under‐25‐year‐olds), while C. trachomatis prevalence in 25‐ to 30‐year‐olds was 2.5%. C. trachomatis was more common among Latin American women (9.7% [95% CI: 7.4%, 12.3%] vs. 2.5% [95% CI: 2.0%, 3.2%] in other women). Additionally, analysing samples from 708 pregnant over‐30‐year‐old women with STI risk factors, 1.6% had at least one of the STIs studied. Notably, 20% of all cases had STI‐related symptoms or complications during pregnancy. Conclusions The high coverage achieved, and prevalence, clinical and epidemiological results support the view that the implementation of a screening program across Spain for C. trachomatis in under‐30‐year‐old pregnant women would be both feasible and appropriate. Tweetable abstract High Chlamydia trachomatis infection prevalence (4%) and coverage (>80%) in local program support pregnancy screening across Spain.

The management of Mycoplasma genitalium sexually transmitted infection (STI) is hindered by increasing resistance to the recommended antibiotics, macrolides and quinolones, worldwide. In Gipuzkoa (Basque Country, Spain), macrolide and quinolone resistance rates in 2014–2018 were reported as n = 1019) and quinolones (n = 958) was studied, analysing mutations in 23S rRNA and parC/gyrA genes, respectively. The rate of macrolide resistance increased from 17.3% in 2014–2018 to 32.1% in 2019–2021, as much in the more prevalent A2058/2059G mutations (16.6–27.8%) as in the emergent A2058T mutations (0.5–4.1%) but with differences in the odds ratios and the relative risk increase between A2058T and A2058/2059G mutations. MG191 adhesin and MG309 lipoprotein of the 27 emergent strains detected with A2058T mutations were amplified, sequenced, and typed using phylogenetic and variable number tandem repeat analysis, respectively. Genetic clonal spread was ruled out, but most of the A2058T cases were men who had sex with men (24/27) with a history of STI and antibiotic treatments (19/27). No changes were observed in quinolone resistance trends, but the rate of resistance to both antibiotics rose from 2.9% to 8.3%, especially in cases with A2058T mutations. The genetic characterisation of strains and epidemiological surveillance of cases are needed to detect populations at increased risk of treatment failure in this infection.