King Edward VIII Hospital, Durban, South Africa

Objectives-To evaluate the role of detecting asymptomatic bacteriuria and endocervical infections in the black prenatal patients attending King Edward VIII Hospital (KEH), Durban, with the view of justifying a screening programme. Screening for syphilis and human immunodeficiency virus (HIV) infection were also evaluated. Subjects-181 asymptomatic black prenatal patients attending the antenatal clinic for their first antenatal visit volunteered for the study and gave their written consent. Design-Examination of each prenatal patient included obtaining of endocervical swabs to detect endocervical infections (C trachomatis, N gonorrhoeae), serum for syphilitic and HIV testing, and a midstream specimen of urine for microscopy and culture. Results-Asymptomatic bacteriuria was found in 5.6% of patients in this study. Cervical infections were diagnosed microbiologically in 8-2% of women. These were N gonorrhoeae in 4*1% and C trachomatis in 4.7%. Serological tests for sexually transmitted diseases showed the presence of syphilis in 7.6% and antibody to the HIV in 19%. Overall, one or more sexually transmitted diseases were found in 16.5% of the women studied. Conclusions-This study suggests that all women presenting for routine antenatal care in a setting such as Durban should be screened for lower genital tract infections. Ideally this should include a midstream urine specimen for culture, serum for syphilitic and HIV antibody testing and endocervical swabs for sexually transmitted pathogens. In developing communities, however, more reliable and cheaper methods of endocervical screening need to be available before antenatal screening for cervicovaginal infections can be justified. Introduction Sexually transmitted diseases (STD) are associated with a wide range of serious complications. In pregnancy, sexually transmitted pathogens, in particular organisms causing cervico-vaginal infections, have additional significance because they may lead to premature rupture of membranes, preterm labour and intra-uterine death.' These complications are thought to be consequent upon transplacental spread or chorioamnionitis due to ascending infection. Foetal acquisition may also occur at the time of delivery. Hillier et all isolated micro-organisms more commonly from pregnant women with chorioamniomitis than those without. Complications of infections with Neisseria gonorrhoeae and Chlamydia trachomatis in pregnancy include post-partum endometritis,2 ophthahnia neonatorum3 and neonatal pneumonitis.4 Bacterial infections of the urinary tract, most of which are asymptomatic, represent one of the common medical complications of pregnancy. Of greatest concem is the risk of developing pyelonephritis and its complications including septicaemia and preterm delivery.5 Data on lower urogenital tract infections in pregnancy in developing communities are lacking. Currently, there is no screening programme for asymptomatic bacteriuria or lower genital tract infections caused by N gonorrhoeae and C trachomatis in pregnancy at King Edward VIII Hospital (KEH), Durban. However, a screening programme for syphilis is well established and screening for antibody to the human immunodeficiency virus (HIV) in pregnant women has recently been introduced. This study was therefore performed to determine the prevalence of asymptomatic bacteriuria and sexually transmitted pathogens in women attending the antenatal clinic with the view of justifying the need for a screening programme.