SIGNS AND SYMPTOMS OF PREVALENT AND INCIDENT CASES OF GONORRHEA AND GENITAL CHLAMYDIAL INFECTION AMONG FEMALE PROSTITUTES IN KINSBASA, ZAIRE

Most studies that have examined the clinical features of gonorrhea and chlamydial infection have been based on prevalent cases (cases of und etermined onset). In our investigation, we compared signs and symptoms of incident (new) cases of these infections with those observed in pr evalent cases (involving the same women) that were diagnosed at enroll ment in a prospective study of female prostitutes in Kinshasa, Zaire. Neisseria gonorrhoeae or Chlamydia trachomatis was present at enrollme nt in 29.2% (225 of 771) of the women in the study. As they were follo wed during the study, 509 (66.0%) had at least one episode of gonorrhe a or chlamydial infection. No symptom was significantly associated wit h these infections at enrollment or during follow-up, Clinical signs, such as endocervical mucopus (P <.001) and vaginal discharge (P =.001) , were associated with both the prevalent and incident cases. However, none of these signs was simultaneously sensitive and specific for det ection of these infections. The frequency of clinical signs was signif icantly reduced after successful treatment (all P values, <.05). This study shows that a syndromic approach to screening for gonococcal and chlamydial infections in female prostitutes is as problematic for acut e incident cases as for prevalent cases. Therefore, there is still an urgent need for simple, cheap, reliable tests that could be used in se xually transmitted disease intervention programs in developing countri es.