GHENT UNIVERSITY Karoline FONCK - International Centre for ...

After registration by the clinic clerks, the patients were taken inside the clinic. The choice of
the physician who would see the patient depended solely on the number of patients still
queuing in front of the clinician's room. The selection of the patients was in that sense not
entirely random, but the best alternative given the circumstances. The women who were
willing to participate in the study were examined by the research physician. Informed consent
was obtained from all participants. A nurse was responsible for administering a standardized
questionnaire to each woman, and also offered pretest HIV counseling. Data collection
included socio-demographic data, previous reproductive medical history, sexual behavior,
and the presence of genital symptoms. The study physician performed a full gynecologic
examination. Vaginal swabs were taken for wet mount, potassium hydroxide testing, and pH
testing. Cervical samples were obtained for Gram staining and detection of Neisseria
gonorrhoeae and Chlamydia trachomatis. A Papanicolaou smear was taken, and venous
blood was drawn for rapid plasma reagin (RPR) and HIV testing. The patients were treated
according to the national guidelines, following the syndromic approach. During a follow-up
visit the treatment was adapted, when necessary, according to the laboratory findings.
Laboratory Techniques
Saline wet mounts were examined for the presence of motile Trichomonas vaginalis, of yeast
cells indicative of Candida albicans, and of clue cells indicative of bacterial vaginosis. The
analysis of other samples was performed at the laboratory of the Department of Medical
Microbiology (University of Nairobi). Bacterial vaginosis was diagnosed, based on the
following symptoms: vaginal fluid pH of more than 4.5, release of a fishy amine odor from
vaginal fluid mixed with 10% potassium hydroxide, and presence of clue cells on wet mount.
Swabs for N. gonorrhoeae isolation were inoculated onto a Thayer-Martin medium and
incubated in a candle extinction jar at 36 °C for 24 hours to 48 hours. Swabs for chlamydia
were tested with enzyme-linked immunoassay (Syva, Dade-Behring, Brussels, Belgium).
Blood samples were tested for syphilis using the RPR test (Becton Dickenson, Becton-
Benelux, Erembodegem, Belgium) and for HIV-1 using ELISA Detect and Recombigent
(Cambridge-Biotech Corp., Boston, MA). The Papanicolaou smear was read at the
Department of Pathology (University of Nairobi) with quality control at the University of Ghent
(Belgium).
Data Analysis
The data were entered using Epi-info version 6.0. SPSS version 7.0 (SPSS, Inc., Chicago,
IL) for Windows was used for univariate and multivariate analyses.
PREVALENCE AND RISK FACTORS OF STI 24