RISK-FACTORS FOR SEXUALLY-TRANSMITTED DISEASES AMONG WOMEN ATTENDING FAMILY-PLANNING CLINICS IN DAR-ES-SALAAM, TANZANIA

Background: Identification of risk factors fbr sexually transmitted di seases (STDs) assists in development of treatment algorithms, which ar e potentially important components of STD control when microbiologic f acilities are limited. Methods: A cross-sectional study was performed to assess STD and HIV risk factors of 2285 women attending three famil y planning clinics in Dar-es-Salaam, Tanzania during 1991-92. Women we re interviewed and examined for signs of STDs. Specimens were taken fo r laboratory diagnosis of HIV, other sexually transmitted organisms, a nd Candida albicans. Results: The prevalence of gonorrhoea was found t o be 4.2%, prevalence of trichomoniasis was 14.3%, and positive syphil is serology was found in 2.5% of women. Unmarried women were at increa sed risk of trichomoniasis (age-adjusted OR = 1.48 95% CI [1.12, 1.95] ), gonorrhoea (age-adjusted OR = 1.81 95% CI [1.14, 2.86]) and syphili s (age-adjusted OR 1.5 [0.84, 2.68]). An increasing number of sexual p artners in the past five years was associated with an increased risk o f all STDs. Current use of the oral contraceptive pill was positively associated with gonorrhoea, multivariate OR = 1.75 95% CI [1.05, 2.93] . The prevalence of candidiasis was 11.5% and was not associated with any of the demographic or behavioural risk factors examined. Clinical diagnostic algorithms for STDs in this study population had relatively low sensitivity and low positive predictive value. Conclusion: Being unmarried and having a higher number of sexual partners were consisten tly associated with each STD, while the associations for other risk fa ctors varied between STDs, emphasising the complexity of STD distribut ion. Further development of diagnostic algorithms and other methods fo r screening women for STDs are needed to reduce the impact of STDs and HIV in developing countries.