Background:
Infections during pregnancy may increase risk of adverse birth outcomes. In many low-income settings, screening of infections in pregnancy is not routinely performed, and treatment is based on an empirical approach. We aimed to describe the prevalence and etiology of genitourinary tract and intestinal parasitic infections among pregnant women in Ethiopia.

Methods:
A prospective pregnancy cohort study was conducted in 12 health centers in rural Amhara. At enrollment (≤24 weeks gestation), clean-catch midstream urine specimens were collected and urine culture and antibiotic susceptibility testing performed (n=618). Urinary tract infection (UTI) was defined as high-burden bacterial growth [≥105 colony forming units (CFU)/ml] or intermediate growth [103-105 CFU/ml] with UTI symptoms. Women provided self-administered vaginal swabs to screen for Chlamydia trachomatis and Neisseria gonorrhoeae (GenXpert, n=628). In a subset of women who reported vaginal symptoms (6.5%), point-of-care diagnostic tests (Diagnosit® BVBLUE, OSOM® Trichomonas) were performed to test for Bacterial vaginosis (BV) and Trichomoniasis (TRICH). Stool samples were collected in participants who had received a prior presumptive mebendazole dose and examined using wet mount technique (n=319).

Results:
The prevalence of UTI was 3.7%, with Escherichia coli (63%) being the predominant uropathogen, followed by Klebsiella pneumoniae and Enterococcus faecalis (8% each). Three-quarters of bacterial isolates were susceptible to nitrofurantoin, and more than one-third were resistant to ampicillin and co-trimoxazole. About 39% (n=125) of women screened had persistent parasitic infections after deworming, and the most common parasites were Entamoeba histolytica (14.4%), Giardia lamblia (13.8%), and Necator americanus (8.2%). Among symptomatic women, 9.8% were positive for BV and 2.6% for TRICH. Only a single case of chlamydia was detected.

Conclusions:
In this cohort, the prevalence of intestinal parasitic infection was high despite deworming, while genitourinary tract infections were uncommon. Strengthening of the management of intestinal parasites in pregnancy is needed in this and similar populations.