Chorioamnionitis, prolonged ROMs and premature birth have all been associated with MTCT of HIV and may be interlinked [37-39]. However, a Phase III clinical trial of antibiotics to reduce chorioamnionitis-related perinatal HIV-1 transmission showed no benefit in reducing MTCT in the context of single-dose nevirapine prophylaxis . Although both Chlamydia trachomatis and Neisseria gonorrhoeae have been associated with chorioamnionitis, the organisms usually implicated are those associated
with BV, including Ureaplasma urealyticum ,. A strong association between BV and premature delivery has been reported ,. There are data from Malawi that suggest that BV may be associated with an increased risk of maternal HIV infection in pregnancy as well as premature delivery and MTCT of HIV . A
study in selleck chemical which mothers received zidovudine from 34 weeks of pregnancy reported that maternal fever >38 °C and BV were associated with in utero transmission of HIV with 2.6-fold and 3-fold risks, respectively . It is not known how applicable this is in settings where mothers receive HAART from earlier in pregnancy. A large meta-analysis assessing the effects of antibiotic treatment of BV in pregnancy does not support the routine screening for, and treatment of, BV in pregnant HIV-negative women ,. However, the available evidence cannot rule out a small benefit in pregnancy outcome associated with the screening and treatment of BV. The latest Cochrane analysis concludes that there is little evidence that screening and treating selleck inhibitor all HIV-1-uninfected pregnant women with asymptomatic BV will prevent preterm delivery (PTD) and its consequences. However, there is some suggestion that treatment before 20 weeks’ gestation may reduce the risk of PTD . In HIV-1-uninfected women, data regarding the effect of screening for and treating BV on premature delivery are conflicting. As outlined above, in HIV-positive pregnant women, there are additional considerations regarding the potential effect of
genital infections on MTCT of HIV-1, but these data are largely from the pre-HAART era. In the setting of full virological suppression on HAART, it is unclear to what extent, if any, DNA ligase the presence of any genital infection will contribute to HIV MTCT. Newly diagnosed HIV-positive pregnant women should be screened for sexually transmitted infections as per the routine management of newly diagnosed patients . For pregnant HIV-1-positive women already engaged in HIV care, in the absence of RCTs but for the reasons outlined above, the Writing Group suggests screening for genital tract infections, including evidence of BV. This should be done as early as possible in pregnancy and consideration should be given to repeating this at about 28 weeks. Syphilis serology should be performed on both occasions. In addition, any infection detected should be treated according to the BASHH guidelines (www.bashh.org/guidelines), followed by a test of cure.