SEXUALLY-TRANSMITTED DISEASE AMONG MARRIED ZAMBIAN WOMEN - THE ROLE OF MALE AND FEMALE SEXUAL-BEHAVIOR IN PREVENTION AND MANAGEMENT

Objectives: Few studies have evaluated the relation between male and f emale sexual behaviour and STD among married African women. The object ives of this study were to identify male and female sexual behaviour a ssociated with female STD, and to explore whether incorporating male a nd female sexual behaviour and male symptoms can improve algorithms fo r STD management in married African women. Methods: 99 married couples with one symptomatic member (58 males, 41 females) attending an STD c linic in Lusaka, Zambia were interviewed separately about sexual and c ontraceptive behaviour, and had physical examinations. Diagnostic test s for Neisseria gonorrhoeae (GC), Trichomonas vaginalis (TV), and HIV were performed. Bivariate and multivariate odds ratios for the associa tion between sexual behaviour and STD were calculated. Predictive algo rithms based on current Zambian guidelines for management of STD in wo men were created. Results: Among women at baseline, 10% were positive for GC, 14% for TV, 52% for HIV. Female alcohol use before sex, a male 's paying for sex, and a couple's having sex unprotected by condoms or spermicides were associated with female STD. Incorporation of these b ehaviours along with symptoms of urethral discharge and dysuria among husbands increased the predictive ability of algorithms for management of STD in women. Conclusions: The addition of male and female sexual behaviour and male STD symptoms to diagnostic algorithms for female ST D should be explored in other settings. Both husbands' and wives' beha viour independently predict STD in these women; risk reduction program mes should target both men's and women's sexual behaviour.