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Treat for cervicitis Laboratory Procedures Figure 1: Algorithm for vaginal discharge used as the national policy in Kenya. Wet mounts were analyzed directly at STC and from the PHC clinics they were transported in a drop of saline to the laboratory of the department of medical microbiology, University of Nairobi. The wet mounts were examined for the presence of motile Trichomonas vaginalis and of yeast cells indicative of Candida albicans. In the laboratory, vaginal smears were heat fixed, Gram stained, and examined for the presence of clue cells, indicative of bacterial vaginosis, and for yeast. The diagnosis of C. albicans was made by wet prep and Gram stain. Bacterial vaginosis was defined by the presence of at least three of the following criteria: (1) vaginal fluid pH >4.5; (2) release of a fishy amine odor from vaginal fluid mixed with 10% potassium hydroxide; (3) presence of clue cells; and (4) vaginal discharge (Hillier 1990, Easmon 1992). Cervical swabs for N. gonorrhoeae isolation were inoculated directly onto Thayer-Martin medium and incubated in a candle extinction jar at 33-35˚ C for 24-48 hours. Cervical swabs for C. trachomatis PCR were processed in the laboratory (Abbott). Venous blood samples were tested for syphilis using the rapid plasma reagin test (RPR test, Becton Dickenson) and for HIV-1 using ELISA Detect (Biotech) and Recombigent (Cambridge). Data analysis and definitions Treat for vaginitis Improvement after 7 days Patient complains of vaginal discharge Lower abdominal pain present No Yes Follow PID flow chart Tenderness on bimanual examination No Yes Yes No Discharge patient Treat for cervicitis Treat for vaginitis DIAGNOSIS AND MANAGEMENT OF SEXUALLY TRANSMITTED INFECTIONS 59
Data were entered and analyzed in SPSS for Windows (SPSS, Chicago, IL, USA). In univariate analysis, the odds ratio (OR) and 95% confidence intervals (CI) were used for the measurement of associations. Comparisons were made using Pearson's χ 2 and Fisher's exact tests. Means were compared using the Student's t test. Stepwise logistic regression was used to take into account risk factors, symptoms, and signs related to the presence of gonococcal and chlamydial infection. The principal outcome was the presence of cervical infections. Cervical infections were defined as the presence of either gonococcal or chlamydial infections or both. Different algorithms were applied to the study population based on personal data from the interview and physical examination. We used the results of the analysis of association between risk, symptoms, and signs to create six different algorithms. Algorithm A was the flow chart as in use in Kenya (Fig 1). Algorithm B is the Kenyan algorithm but without the abdominal examination. Algorithm C includes a risk assessment of the patient. This is based on the WHO algorithm with risk score, but without presence of symptoms in the partner. Also, the risk assessment we used was simplified and considers the risk score positive if any of the risk factors are present whereas the WHO algorithm requires at least two risk factors. Algorithm D is based on the presence of yellow or bloody vaginal discharge. Algorithm E included presence of endocervical mucopus. And algorithm F combined the risk score and the presence of yellow or bloody vaginal discharge. The microbiological results were used as gold standard for cervical infections. The validity of the algorithms was evaluated by calculating their sensitivity, specificity, and positive predictive value compared with the gold standard. We determined the correct treatment rate and the cost for each algorithm. Details on definitions and calculations are not presented here but can be obtained from the authors. Results Socio-demographic Factors and Prevalence of STDs A total of 621 women with complaints of vaginal discharge were enrolled in the study. In STC, located in downtown Nairobi, 214 women were recruited and 255 and 152 were recruited in the two health centers, both located in the suburbs of Nairobi. The women attending the STD clinic were more often single, employed, and had more sex partners. Three hundred and thirty four (54%) of the women were pregnant at the time of the interview. DIAGNOSIS AND MANAGEMENT OF SEXUALLY TRANSMITTED INFECTIONS 60
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GHENT UNIVERSITY STI PREVENTION AND
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AIDS Acquired Immune Deficiency Syn
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1.1. Sexually Transmitted Infection
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countries, the rate of reporting co
Page 9 and 10: district of Uganda randomized villa
Page 11 and 12: By identifying where significant
Page 13 and 14: 4.5%, 3.9%, 67.7% and 30.1% while t
Page 15 and 16: female primary health care or anten
Page 17 and 18: The research data have been publish
Page 19 and 20: 2.1. OBJECTIVES 2.1.1. General obje
Page 21 and 22: 2.2.3. Laboratory procedures The mi
Page 23 and 24: C HAPTER 3 PREVALENCE AND RISK FACT
Page 25 and 26: After registration by the clinic cl
Page 27 and 28: The majority of the women were infe
Page 29 and 30: eing single, ever having been treat
Page 31 and 32: prevalence found in a family planni
Page 33 and 34: 3.2. Declining Syphilis Prevalence
Page 35 and 36: Training Nurses at the antenatal cl
Page 37 and 38: We believe that the observed declin
Page 39 and 40: Wasserheit 1992, Laga 1993). In Nai
Page 41 and 42: Table 1: Demographic data of 471 pa
Page 43 and 44: women. Overall, significantly fewer
Page 45 and 46: Stigmatization by health staff also
Page 47 and 48: 4.2. Health-Seeking Behavior and Se
Page 49 and 50: Between September and November 1998
Page 51 and 52: Table 2: Healthcare-seeking behavio
Page 53 and 54: Thirteen women had engaged in sex w
Page 55 and 56: Men reported more extramarital affa
Page 57 and 58: C HAPTER 5 DIAGNOSIS AND MANAGEMENT
Page 59: discharge and abdominal pain-two co
Page 63 and 64: One of the peripheral health center
Page 65 and 66: Evaluation of Algorithms The result
Page 67 and 68: In this study of symptomatic women,
Page 69 and 70: C HAPTER 6 PREVENTION OF SEXUALLY T
Page 71 and 72: Table 1: Syphilis Rapid Plasma Reag
Page 73 and 74: One should keep these problems in m
Page 75 and 76: The use of mailed reminders did not
Page 77 and 78: Table 1: Characteristics of women w
Page 79 and 80: studies, indicating that couples ar
Page 81 and 82: 6.3. A Randomized, Placebo-controll
Page 83 and 84: esistance patterns in bystander flo
Page 85 and 86: In univariate analysis, the odds ra
Page 87 and 88: Widows, divorcees and separated wom
Page 89 and 90: They did not report much condom use
Page 91 and 92: The low prevalence of the other STD
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Page 95 and 96: Table 1. Characteristics of HIV- po
Page 97 and 98: A significantly higher prevalence o
Page 99 and 100: There is now considerable evidence
Page 101 and 102: patients. The analysis revealed hig
Page 103 and 104: contributory factor may be that mal
Page 105 and 106: use in Kenya. In a supplement of Se
Page 107 and 108: with intensive behavioral change in
Page 109 and 110: C HAPTER 8 FINAL REMARKS STIs illus
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to protect themselves and be empowe
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Bell G, Ward H, Day S et al. Partne
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Fleming D and Wasserheit J. From ep
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Jackson DJ, Rakwar JP, Chohan B et
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Manning B, Moodley J, Ross SM. Syph
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Oberlander L, Elverdam B. Malaria i
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Serwadda D, Gray R, Wawer M et al.
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Van Dam J, Anastasi MC. Male Circum
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WHO Collaborating Center on HIV/AID
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S UMMARY Sexually transmitted infec
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notification. Innovative and locall
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connaissance des femmes sur la sant
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Nous avons démontré que le coût
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vonden we een hoge prevalentie van
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We hebben aangetoond dat de kost va
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