CLINICAL ALGORITHMS FOR THE SCREENING OF WOMEN FOR GONOCOCCAL AND CHLAMYDIAL INFECTION - EVALUATION OF PREGNANT-WOMEN AND PROSTITUTES IN ZAIRE

A substantial proportion of women with gonococcal and/or chlamydial in fection are asymptomatic. Thus active case detection is problematical, particularly in developing countries, where facilities and materials for laboratory testing are limited. We assessed the diagnostic validit y of the hierarchical clinical algorithms recommended by the World Hea lth Organization as well as that of a nonhierarchical scoring system, using data for 1, 160 pregnant women (a low-prevalence group) and 1,22 2 prostitutes (a high-prevalence group) in Kinshasa, Zaire. Neisseria gonorrhoeae and/or Chlamydia trachomatis was detected in 6.5% and 31.0 % of pregnant women and prostitutes, respectively. No single variable that was both sensitive (>60%) and specific (>60%) was associated with infection. A simple hierarchical algorithm based only on reported sym ptoms had a sensitivity of 48.0% and 54.9% and a specificity of 75.2% and 52.2% for the screening of pregnant women and prostitutes, respect ively. A second algorithm that included a speculum examination had a s ensitivity of only 29.3% but a specificity of 85.3% in pregnant women. When a nonhierarchical scoring system was used, the sensitivity was 7 2.0% and 7 1.0% and the specificity was 73.5% and 55.8% for pregnant w omen and prostitutes, respectively. Scoring systems that incorporate r isk markers as well as symptoms and signs may represent affordable alt ernative methods of screening for gonococcal and/or chlamydial infecti ons among women in resource-poor settings.