GHENT UNIVERSITY Karoline FONCK - International Centre for ...

Introduction
It is now well documented that the presence of ulcerative and non-ulcerative sexually
transmitted diseases (STDs) facilitates the transmission and acquisition of HIV (Wasserheit
1992, Sewankambo 1997, Schacker 1998, Plummer 1991, Kreiss 1994, Moss 1995, Laga
1993). Therefore, STD control has been recognized as a key strategy to reduce HIV infection
(Laga 1994, Grosskurth 1995). Furthermore, STD and their ensuing complications are a
major burden of morbidity and mortality, particularly among women and neonates in
developing countries (Piot 1990, Ryder 1991, Temmerman 1992, Temmerman 1990). A
related problem in southern and eastern African countries is cancer of the cervix, the most
frequently detected cancer among African women (Mati 1984). Cervical dysplasia rates of
2% to 12% have been reported in selected populations (Maggwa 1993, Engels 1992).
In Kenya, STD treatment using syndromic management has been introduced in different
primary health care centers. Health care providers were trained and first-line drug kits were
distributed in the health sector. Patients requiring second-line treatment or patients with
complicated reports of symptoms had to be referred to one of the STD referral clinics. The
STD clinic in downtown Nairobi is well equipped with supplies, drugs, and a trained staff, and
is well known among the local population. This study was undertaken to identify the burden
and pattern of disease in the STD referral clinic in Nairobi. The specific objectives were to
(1) determine the prevalence of sexually transmitted infections among women attending the
main STD referral clinic in Nairobi, (2) determine the prevalence of cervical intraepithelial
neoplasia (CIN) in this population, and (3) study risk markers for STD, HIV, and CIN in this
population.
Methods
Population Examined and Clinical Assessment
The target study group included women attending the Special Treatment Clinic, the main
STD referral clinic in Nairobi, Kenya. The Special Treatment Clinic is well known in Nairobi,
particularly among persons with a lower socio-economic background. Many self-referred
patients also frequent the clinic.
The average attendance in the clinic is approximately 150 patients per day, half of whom are
women. After registration, patients are referred to the clinical officers in one of the
consultation rooms. Study enrollment took place from June 1996 to April 1997.
PREVALENCE AND RISK FACTORS OF STI 23