RAPID AND INEXPENSIVE APPROACHES TO MANAGING ABNORMAL VAGINAL DISCHARGE OR LOWER ABDOMINAL-PAIN - AN EVALUATION IN WOMEN ATTENDING GYNECOLOGY AND FAMILY-PLANNING CLINICS IN PERU

Objectives: To assess low abdominal pain, yellow vaginal discharge, ot her symptoms and signs, and demographic and behavioural variables as p redictors for cervical or vaginal infection. Methods: A cross sectiona l study of women attending gynaecology and family planning clinics in Lima, Peru was undertaken. 630 consecutive eligible female patients wi th chief or elicited complaints of yellow vaginal discharge, low abdom inal pain, or both were interviewed and examined, together with a comp arable reference group without these complaints. Vaginal specimens wer e tested for trichomoniasis and bacterial vaginosis. Endocervical spec imens were tested for Neisseria gonorrhoeae and Chlamydia trachomatis using the ligase chain reaction. Results: Infections found included ch lamydial infection in 69 women (10.9%), gonorrhoea in 10 (1.6%), and e ither infection in 77 (12.2%); trichomoniasis in 46 (7.3%), bacterial vaginosis in 189 (30%), and either infection in 209 (33.2%). Cervical infection with C trachomatis and/or N gonorrhoeae was independently as sociated with history of a new sex partner within the last 3 months, m ore than one sex partner within the last year, use of condoms never or in less than 50% of sex acts, history of sex partner with STD within the last year; with symptoms of persistent low abdominal pain and of y ellow vaginal discharge; and with signs of profuse and yellow vaginal discharge, cervical ectopy, easily induced endocervical bleeding, or b rown cervical secretion. Using these findings, an algorithm was create d that had a positive predictive value (PPV) of 36% for cervical infec tion among women reporting chief or elicited complaint of this abnorma l vaginal discharge and a PPV of 25% among those without a complaint. A chief complaint of yellow vaginal discharge had a PPV of 50% for tri chomoniasis or bacterial vaginosis. Among women without a chief compla int of yellow vaginal discharge, clinical findings of yellow vaginal d ischarge had a PPV of 55%. Conclusions: Where economic and technical c onstraints preclude testing, clinical findings and risk assessment are helpful in detecting vaginal and cervical infections. Several demogra phic, behavioural, clinical, and laboratory variables were predictive of infection in this population.