Work

Chlamydia trachomatis and Neisseria gonorrhoeae in newborns with and without neonatal conjunctivitis: cross-sectional study in Papua New Guinea

Year: 2026

Type: preprint

Abstract: Objectives Neisseria gonorrhoeae and Chlamydia trachomatis can be transmitted from an infected woman to her baby during vaginal birth to cause neonatal conjunctivitis (ophthalmia neonatorum). Little is known about how often these pathogens cause infection in babies without conjunctivitis. The objectives of this study were to investigate the frequency of C. trachomatis and N. gonorrhoeae in newborn babies with and without conjunctivitis and to estimate the prevalence of these infections and the proportion that was asymptomatic. Methods We conducted a cross-sectional study, nested in a randomised controlled trial in Papua New Guinea. At a visit scheduled 1–2-weeks after birth (visit 1), we took conjunctival swabs from babies with clinical signs of conjunctivitis and from a sample of those with no clinical signs. Babies with conjunctivitis received antibiotic treatment. Swabs were tested for N. gonorrhoeae and C. trachomatis by PCR after the end of the study. We estimated the weighted percentage (with 95% confidence intervals, CI) of babies with either organism detected and the asymptomatic proportion. Results From 21 st October, 2017 to 2 nd February, 2022, 1699 of 2055 newborn babies attended visit 1. Among 310 babies with clinical data and a result from any swab, 97 had signs of conjunctivitis and 213 did not. Where results were available, C. trachomatis was detected in 12/97 (12.4%) of babies with conjunctivitis and 7/211 (3.3%) without. N. gonorrhoeae was detected in 1/97 (1.0%) of babies with conjunctivitis and 6/210 (2.9%) without. The weighted estimate of C. trachomatis or N. gonorrhoeae prevalence was 6.6% (3.8-9.9%), of which an estimated 87.0% (74.8%-93.8%) was asymptomatic. Conclusions C. trachomatis and N. gonorrhoeae were detected in the absence of clinical signs of conjunctivitis in about 1 in 15 babies. This finding has implications for estimation of mother-to-child transmission and evaluation of prophylaxis and treatment interventions. Key messages What is already known on this topic ▪ Neisseria gonorrhoeae and Chlamydia trachomatis cause neonatal conjunctivitis (ophthalmia neonatorum), which can lead to permanent vision loss if untreated; ▪ Little is known about the occurrence and frequency of N. gonorrhoeae and C. trachomatis in newborn babies without conjunctivitis. What this study adds ▪ This study included babies with clinical conjunctivitis and a sample of babies without clinical signs of conjunctivitis and tested swabs using PCR at a visit scheduled 1-2 weeks after birth; ▪ The overall prevalence of C. trachomatis or N. gonorrhoeae was estimated to be 6.6% (95% CI 3.8-9.9%), of which an estimated 87.0% (74.8%-93.8%) occurred in babies without clinical signs of conjunctivitis. How this study might affect research, practice or policy ▪ The clinical relevance of asymptomatic C. trachomatis or N. gonorrhoeae detection remains unclear; all samples from babies with asymptomatic detection tested negative at a visit scheduled 4-6 weeks after birth; ▪ The results are important for research about mother-to-child transmission of C. trachomatis and N. gonorrhoeae and evaluation of prophylaxis and treatment interventions conducted using molecular diagnostics.

Source: medRxiv

DOI: 10.64898/2026.07.09.26357364