EVALUATION OF SEXUALLY-TRANSMITTED DISEASES DIAGNOSTIC ALGORITHMS AMONG FAMILY-PLANNING CLIENTS IN DAR-ES-SALAAM, TANZANIA

Objectives: To determine the prevalence of sexually transmitted diseas es (STDs) and to assess the validity of STD screening approaches among family planning clients in Dar es Salaam, Tanzania. Methods: Between March and September 1995, information about sociodemographic character istics, contraceptive use, sexual behaviour, and medical history was o btained from consenting women (n = 908). After interview blood and gen ital specimens were collected for diagnosis of STDs and HIV. Based on the information obtained at interview and clinical examination, STD di agnostic algorithms were developed and validated. Results: The prevale nce of STDs was HN (16.9%), gonococcal and/or chlamydial cervicitis (8 .2%), and Trichomonas vaginalis and/or Candida albicans (27.2%). The r isk of cervicitis was increased among unmarried women and among women with a husband less than or equal to 25 years of age and women having more than one sex partners in the past 3 months or a new sex partner d uring the past month. Most women with cervicitis (62.2%) and vaginitis (67.6%) were asymptomatic. A screening strategy for cervicitis based on symptoms had a sensitivity of 29.7%, a specificity of 84.1%, and a positive predictive value (PPV) of 15.9%. The corresponding figures fo r an algorithm based on clinical signs were 20.3%, 90.2%, and 15.6%. T he sensitivity of a simple risk assessment algorithm ranged from 20.3% to 73%. An approach based on both risk assessment (risk score greater than or equal to 1) and clinical signs (cervical mucopus and friabili ty) had a sensitivity of 37.8%, a specificity of 87.5%, and a PPV of 2 1.4%. A syndromic approach for vaginitis resulted in a higher sensitiv ity than the approach based on the type of vaginal discharge. Conclusi on: Although there is no single screening strategy for cervicitis whic h can be advocated for large scale application, risk assessment might be the only cost effective strategy for identifying women with cervici tis in family planning clinics in Tanzania.