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

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. gonorrhaeae 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.6 page(s