Value of clinical algorithms to screen for gonococcal and chlamydial infection among women attending antenatal and family planning clinics

David Wilkinson, A. Willem Sturm

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Abstract

Objectives. To determine the value of using KwaZulu-Natal Provincial Health Department algorithms for sexually transmitted disease (STD) treatment to detect infection with Neisseria gonorrhoeae and/or Chlamydia trachomatis among women attending antenatal and family planning clinics. Methods. 327 women attending antenatal clinics and 189 attending a family planning clinic in Hlabisa, KwaZulu-Natal, were questioned and examined clinically and microbiologically. Data were used to determine the sensitivity, specificity and predictive values of the algorithm used with a speculum and the algorithm when no speculum was available. Results. Prevalence of infection with N. gonorrhoeae and/or C. trachomatis was high among both pregnant women (18.9%) and those attending the family planning clinic (11.1%). Associations between abnormal symptoms and signs and infection were weak, odds ratios ranging from 1.1 to 5.4. Both algorithms performed poorly, with sensitivity ranging from 42.9% to 70.0%, specificity from 30.7% to 75.6%, and positive predictive values from 17% to 18.8%. Conclusions. Prevalence of infection is high among these women. The algorithms tested perform poorly - most infected women remain untreated and most of those treated are uninfected. Alternative strategies for diagnosis and/or treatment are required.

Original languageEnglish
Pages (from-to)900-905
Number of pages6
JournalSouth African Medical Journal
Volume88
Issue number7 SUPPL.
Publication statusPublished - 1998
Externally publishedYes

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