MANAGEMENT OF VAGINAL DISCHARGE IN WOMEN TREATED AT A JAMAICAN SEXUALLY-TRANSMITTED DISEASE CLINIC - USE OF DIAGNOSTIC ALGORITHMS VERSUS LABORATORY TESTING

The management of cervical infections is difficult in developing count ries because laboratory facilities for diagnosing these infections are seldom available; therefore, syndrome-based management has been recom mended by the World Health Organization (WHO). However, such alternati ve approaches need to be evaluated in real field settings. We used alg orithms (flowcharts) for syndromic management of abnormal vaginal disc harge to treat 752 women who presented at a Jamaican sexually transmit ted disease (STD) clinic. Laboratory testing revealed cervical infecti on (gonococcal and/or chlamydial) in 34% of these women; trichomoniasi s was documented for 25%; and at least one STD was documented for 54% of the women. Use of a clinical algorithm for diagnosing cervical infe ction was 73% sensitive (95% CI, 67-78) and 55% specific (95% CI, 49-6 2) when compared with laboratory testing. The risk-assessment-inclusiv e flowchart developed by WHO was 84% sensitive (95% CI, 80-89) and 40% specific (95% CI, 34-46) for diagnosing cervical infection. Positive predictive values for diagnosing cervical infection with use of the al gorithms ranged from 42% to 43%, and negative predictive values ranged from 78% to 81%. The sensitivity of the algorithms for diagnosing tri chomoniasis ranged from 85% to 88%. To treat as many infected women as possible, the most sensitive algorithm was selected for routine use i n Jamaican STD clinics.