Date Published: February 7, 2019
Publisher: Public Library of Science
Author(s): Shunji Suzuki, Shin-ichi Hoshi, Akihiko Sekizawa, Yoko Sagara, Masanobu Tanaka, Katsuyuki Kinoshita, Tadaichi Kitamura, William M Shafer.
We evaluated the current prevalence of gonococcal cervicitis among pregnant women in institutes that either do or do not routinely screen for gonococcal infection in Japan. We requested 2,330 obstetrical facilities to provide information on Neisseria gonorrhoeae cervicitis in pregnant women. A total of 1,876 (80.5%) of them responded. The universal screening test for gonococcal cervicitis, involving nucleic acid amplification for all pregnant women, was performed in 281 institutes (13.9% of institutes across Japan). The total rate of pregnant women with gonococcal cervicitis was 1.3% in the institutes performing the screening test during pregnancy, while it was only 0.2% (p < 0.01) in those not performing it. This suggests that 84% of infected women may have been missed in the institutes that do not routinely perform the screening test for gonococcal cervicitis. It may be time to examine the cost-effectiveness of providing gonococcal screening for all pregnant women in Japan.
Neisseria gonorrhoeae infection is one of the most common bacterial sexually transmitted diseases (STD). Untreated gonococcal cervicitis in pregnancy has been reported to lead to miscarriage, premature labor associated with chorioamnionitis, and infections of the eyes and pharynx of neonates [1–6]. In 2017, the incidence of gonococcal infection in females was 1.67 per fixed-point medical institution (total of 5,000 institutions) in Japan according to a report on STDs from the Japanese Ministry of Health, Labour and Welfare . Therefore, pregnant women with suspected infection should receive genetic testing for Neisseria gonorrhoeae in early pregnancy.
The protocol for this study was approved by the Ethics Committee of the Japan Association of Obstetricians and Gynecologists (JAOG).
Of the 1,876 obstetrical facilities responding with valid information, the screening test for gonococcal cervicitis was performed for all pregnant women at various times during pregnancy in 281 institutes (13.9% of institutes). Table 1 shows the prevalence of the institutes with and without the universal screening test for gonococcal cervicitis during pregnancy in each region of Japan or types of institute. The proportion of screening of gonococcal cervicitis attributable to each region was similar regardless of whether comparing all screening or non-screening clinics or hospitals as shown in Table 1.
In this study, the rate of pregnant women with gonococcal cervicitis in the institutes performing a screening test for gonococcal cervicitis was significantly higher than in those not performing it. Based on the current results, in institutes without the screening test for gonococcal cervicitis, 84% of infected women may have been missed. Although urethral infections caused by Neisseria gonorrhoeae among men can produce symptoms, gonococcal infections in women are commonly asymptomatic or might not produce recognizable symptoms until the development of complications such as pelvic inflammatory disease [8,9,14]. Because cervicitis usually does not cause obvious clinical signs or symptoms, patients may only become aware of the condition after a pelvic examination. When gonococcal infection occurs in neonates, it results from perinatal exposure to the mother’s infected cervix. In these cases, it can manifest as an acute illness such as ophthalmia neonatorum and sepsis leading to arthritis and/or meningitis developing 2–5 days after delivery [4–6,14]. Therefore, prenatal screening and the treatment of pregnant women may be the best methods to prevent gonococcal infection among neonates. The current results may support the recommendation.