Prevalence of and infection and associated factors among asymptomatic pregnant women in Botswana.

Background: () and () are curable sexually transmitted infections (STIs) that cause adverse pregnancy and neonatal outcomes. Most countries, including Botswana, do not offer or screening during antenatal care (ANC) and instead use a syndromic approach for management of STIs.

Methods: The Maduo Study is a prospective, cluster-controlled trial in Botswana evaluating the impact of diagnostic screening for antenatal and infections to prevent adverse neonatal outcomes. Using baseline data from the Maduo Study (March 2021-March 2022), we determined the prevalence of and infection among asymptomatic pregnant women in Botswana and correlates of infection using multivariable logistic regression.

Results: Of 251 women who underwent and screening at first ANC visit, 55 (21.9%, 95%CI 17.0-27.5) tested positive for , 1 (0.4%, 95%CI 0-2.2) for ; and 2 (0.8%, 95%CI 0-2.8) for dual and infection. Older age was associated with lower odds (aOR 0.93; 95%CI 0.88-0.98; = 0.011) while any alcohol use during pregnancy was associated with higher odds (aOR = 3.53; 95%CI 1.22-10.16; = 0.020) of testing positive for or .

Conclusions: A high frequency of infections was detected among asymptomatic pregnant women in Botswana indicating that many antenatal STIs are missed by the syndromic management approach. Our results highlight the need for diagnostic screening during ANC in Botswana and other low- and middle-income countries that rely solely on the syndromic approach for management of STIs.