Genital Tract Infection during Pregnancy and its Association with Preterm Delivery

Tri Nugraha Susilawati, Yohanes Aditya Adhi Satria

Abstract views = 650 times | downloads = 328 times


Genital tract infection (GTI) remains a significant health concern. It is estimated that in 2016, there were 370 million people who suffer from chlamydia, gonorrhea, and trichomoniasis; and 708 million others suffer from genital herpes and condyloma acuminatum. It has been reported that in pregnant women, GTI is associated with preterm delivery. The mechanisms of GTI-associated preterm delivery need to be further understood to prevent neonatal mortality and morbidity that could be the risk factor for neonates’ growth and development disorders. This article aims to describe various types of GTI and the associated pathogenesis causing preterm birth. A literature search was conducted to retrieve recent articles published in English from online databases including Pubmed, ScienceDirect, and Google Scholar. This literature study found that GTI evokes inflammatory responses that trigger several mechanisms leading to preterm delivery. The inflammatory responses in GTI include the production of proinflammatory cytokines and robust activation of neutrophils. The key mechanisms that stimulate preterm delivery in GTI include the events of early uterine contraction, preterm premature rupture of membranes, and induction of cervical ripening; which are under normal circumstances in a full-term pregnancy, those mechanisms are regulated by progesterone and prostaglandin levels along with suppression of the inflammatory responses. In conclusion, this paper has described the underlying mechanisms of preterm delivery in pregnant women with ISG. However, such mechanisms remain unclear in candida and gonococcal infection; thus, prompting the need for further studies. 


Genital tract infection; sexually transmitted infection; preterm delivery; preterm birth; pregnancy

Full Text:



American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins Obstetrics. Practice Bulletin No. 171: Management of preterm labor. Obstet Gynecol. 2016;128(4):e155-64

World Health Organization. Preterm birth: Key facts. World Health Organization. 2018. [cited 2020 Jul 18]

Patel RM. Short-and Long-term outcomes for extremely preterm infants. Am J Perinatol. 2016; 33(3):318-27

Natarajan G, Shankaran S. Short- and long-term outcomes of moderate and late preterm infants. Am J Perinatol. 2016;33(3):305-17

Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000–15: An updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016;388(10063):302735

Gomez-Lopez N, Stlouis D, Lehr MA, SanchezRodriguez EN, Arenas- Hernandez M. Immune cells in term and preterm labor. Cellular & Molecular Immunology. 2014;11(10): 571-81

Diadhiou M, Ba Diallo A, Barry MS, Alavo SC, Mall I, Gassama O, et al. Prevalence and risk factors of lower reproductive tract infections in symptomatic women in Dakar, Senegal. Infect Dis Res Treat. 2019;12:117863371985182

Ahmadnia E, Kharaghani R, Maleki A, Avazeh A, Mazloomzadeh S, Sedaghatpisheh T, et al. Prevalence and associated factors of genital and sexually transmitted infections in married women of Iran. Oman Med J. 2016;31(6):439-45

Lima TM, Teles LMR, de Oliveira AS, Campos FC, Barbosa R de CC, Pinheiro AKB, et al. Vaginal discharge in pregnant women: Comparison between syndromic approach and examination of clinical nursing practice. Rev da Esc Enferm. 2013;47(6):1265-71

World Health Organization. Report on global sexually transmitted infection surveillance. World Health Organization. 2018. [cited 2020 Jul 18]. Available from: health /publications/stis-surveillance-2018/en/

Kenyon C, Colebunders R, Crucitti T. The global epidemiology of bacterial vaginosis: A systematic review. Am J Obstet Gynecol. 2013;209(6):505-23.

Bongomin F, Gago S, Oladele R, Denning D. Global and Multi-National Prevalence of Fungal Diseases— Estimate Precision. J Fungi. 2017;3(4):57

Asiaf A, Ahmad ST, Mohammad SO, Zargar MA. Review of the current knowledge on the epidemiology, pathogenesis, and prevention of human papillomavirus infection. Eur J Cancer Prev. 2014;23(3):206-24

Scott ML, Coleman DT, Kelly KC, Carroll JL, Woodby B, Songock WK, et al. Human papillomavirus type 16 E5-mediated upregulation of Met in human keratinocytes. Virology. 2018;519:111

Georgescu SR, Mitran CI, Mitran MI, Caruntu C, Sarbu MI, Matei C, et al. New insights in the pathogenesis of HPV infection and the associated carcinogenic processes: The role of chronic inflammation and oxidative stress. J Immunol Res. 2018; 5315816

Steben M, Garland SM. Genital warts. Best Pract Res Clin Obstet Gynaecol. 2014;28(7):1063-73

Racicot K, Cardenas I, Wünsche V, Aldo P, Guller S, Means RE, et al. Viral infection of the pregnant cervix predisposes to ascending bacterial infection. J Immunol. 2013;191(2):934-41

Westrich JA, Warren CJ, Pyeon D. Evasion of host immune defenses by human papillomavirus. Virus Res. 2017;231:21-33

Huang Q, Zhong M, Gao Y fei, Huang L ping, Huang Q tao, Wang W, et al. Can HPV vaccine have other health benefits more than cancer prevention? A systematic review of association between cervical HPV infection and preterm birth. J Clin Virol. 2014;61(3):321-8

Keelan JA. Intrauterine inflammatory activation, functional progesterone withdrawal, and the timing of term and preterm birth. J Reprod Immunol. 2018;125(December 2016):89-99

Iliodromiti Z, Antonakopoulos N, Sifakis S, Tsikouras P, Daniilidis A, Dafopoulos K, et al. Endocrine, paracrine, and autocrine placental mediators in labor. Hormones. 2012;11(4):397-409

Nadeem L, Shynlova O, Matysiak-Zablocki E, Mesiano S, Dong X, Lye S. Molecular evidence of functional progesterone withdrawal in human myometrium. Nat Commun. 2016;7(May):11565

Kobty M. Herpes simplex virus: Beyond the basics. Neonatal Netw. 2015;34(5):279-83

LeGoff J, Péré H, Bélec L. Erratum: Diagnosis of genital herpes simplex virus infection in the clinical laboratory. Virol J. 2015;12:167

Behzadi P, Behzadi E, Pawlak-Adamska EA. Urinary tract infections (UTIs) or genital tract infections (GTIs)? It’s the diagnostics that count. GMS Hyg Infect Control. 2019;14:Doc14

Nadeau HCG, Subramaniam A, Andrews WW. Infection and preterm birth. Semin Fetal Neonatal Med. 2016;21(2):100-5

McGee D, Smith A, Poncil S, Patterson A, Bernstein AI, Racicot K. Cervical HSV-2 infection causes cervical remodeling and increases risk for ascending infection and preterm birth. PLoS One. 2017;12(11):e0188645 28. Vink J, Mourad M. The pathophysiology of human premature cervical remodeling resulting in spontaneous preterm birth: Where are we now? Semin Perinatol. 2017;41(7):427-37

Witkin SS, Minis E, Athanasiou A, Leizer J, Linhares IM. Chlamydia trachomatis: The persistent pathogen. Clin Vaccine Immunol. 2017;24(10):1-9

Malhotra M, Sood S, Mukherjee A, Muralidhar S, Bala M. Genital Chlamydia trachomatis: An update. Indian J Med Res. 2013;138(SEP):303-16

Rours GIJG, Duijts L, Moll HA, Arends LR, De Groot R, Jaddoe VW, et al. Chlamydia trachomatis infection during pregnancy associated with preterm delivery: A population-based prospective cohort study. Eur J Epidemiol. 2011;26(6):493-502

Rours GIJG, De Krijger RR, Ott A, Willemse HFM, De Groot R, Zimmermann LJI, et al. Chlamydia trachomatis and placental inflammation in early preterm delivery. Eur J Epidemiol. 2011;26(5):421-8

Caloone J, Rabilloud M, Boutitie F, Traverse-Glehen A, Allias-Montmayeur F, Denis L, et al. Accuracy of several maternal seric markers for predicting histological chorioamnionitis after preterm premature rupture of membranes: A prospective and multicentric study. Eur J Obstet Gynecol Reprod Biol. 2016;205:133-40

Park JY, Romero R, Lee JH, Chaemsaithong P, Chaiyasit N, Yoon BH. An elevated amniotic fluid prostaglandin F2α concentration is associated with intra-amniotic inflammation/infection, and clinical and histologic chorioamnionitis, as well as impending preterm delivery in patients with preterm labor and intact membranes. J Matern Neonatal Med. 2016;29(16):2563-72

Mejuto P, Boga JA, Leiva PS. Chlamydia trachomatis infection in pregnant women: an important risk to maternal and infant health. Infec Dis Obestet Gynecol. 2017;02(01):1-11

Kaul G, Thippeswamy H. Role of heat shock proteins in diseases and their therapeutic potential. Indian J Microbiol. 2011;51(2):124-31

Ziegert M, Witkin SS, Sziller I, Alexander H, Brylla E, Härtig W. Heat shock proteins and heat shock protein-antibody complexes in placental tissues. Infect Dis Obstet Gynecol. 1999;7(4):180-5

Quillin SJ, Seifert HS. Neisseria gonorrhoeae host adaptation and pathogenesis. Nat Rev Microbiol. 2018;16(4):226-40

Morgan MK, Decker CF. Gonorrhea. Dis Mon. 2016;62(8):260-8

Tsevat DG, Wiesenfeld HC, Parks C, Peipert JF. Sexually transmitted diseases and infertility. Am J Obstet Gynecol. 2017;216(1):1-9

Unemo M, Del Rio C, Shafer WM. Antimicrobial resistance expressed by Neisseria gonorrhoeae: A major global public health problem in the 21st century. Microbiol Spectr. 2016;4(3) doi:10.1128/microbiolspec.EI10-0009-2015 4

World Health Organization. WHO guidelines for the treatment of Neisseria gonorrhoeae. World Health Organization. 2016. [cited 2020 Jul 18]. Available from: tions/rtis/gonorrhoea-treatment-guidelines/en/


  • There are currently no refbacks.

Copyright (c) 2021 Indonesian Journal of Tropical and Infectious Disease

View My Stats

IJTID Indexed by : 


IJTID (pISSN 2085-1103eISSN 2356-0991is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Lembaga Penyakit Tropis (Institute of Tropical Disease)

Universitas Airlangga

Kampus C Mulyorejo

Surabaya 60115