RISK ASSESSMENT AND OTHER SCREENING OPTIONS FOR GONORRHEA AND CHLAMYDIAL INFECTIONS IN WOMEN ATTENDING RURAL TANZANIAN ANTENATAL CLINICS

Sexually transmitted diseases (STDs) are a major cause of morbidity an d mortality in developing countries and may play a key role in enhanci ng the heterosexual transmission of human immunodeficiency virus (HIV) , Treatment of STDs is one of the most cost-effective of all public he alth interventions in developing countries; however, STDs among women in rural populations have received little attention. in this study, we report the prevalences of STDs among 964 women attending antenatal cl inics in a rural area of the United Republic of Tanzania, A total of 3 78 (39%) of these women were infected with at least one STD pathogen, 97 (10%) had syphilis, and 81 (8%) had Neisseria gonorrhoeae (NG) and/ or Chlamydia trachomatis (CT) infection. The recommended syndromic app roach to screening for NG/CT infection, based on reported genital symp toms, had a low sensitivity (43%) and failed to discriminate between i nfected and uninfected women. A risk score approach that we developed, based on sociodemographic and other factors associated with NG/CT inf ection, had a higher sensitivity and lower cost per true case treated than other approaches, although its positive predictive value was only about 20%.