VALUE OF CLINICAL ALGORITHMS TO SCREEN FOR GONOCOCCAL AND CHLAMYDIAL INFECTION AMONG WOMEN ATTENDING ANTENATAL AND FAMILY-PLANNING CLINICS

Objectives. To determine the value of using KwaZulu-Natal; Provincial Health Department algorithms for sexually transmitted disease (STD) tr eatment to detect infection with Neisseria gonorrhoeae and/or Chlamydi a trachomatis among women attending antenatal and family planning clin ics. Methods. 327 women attending antenatal clinics and 189 attending a family planning clinic in Hlabisa, KwaZulu-Natal, were questioned an d examined clinically and microbiologically. Data were used to determi ne the sensitivity, specificity and predictive values of the algorithm used with a speculum and the algorithm when no speculum was available . Results. Prevalence of infection with N. gonorrhaeae and/or C. trach omatis was high among both pregnant women (18.9%) and those attending the family planning clinic (11.1%). Associations between abnormal. sym ptoms and signs and infection were weak, odds ratios ranging from 1.1 to 5.4. Both algorithms performed poorly with sensitivity ranging from 42.9% to 70.0%, specificity from 30.7% to 75.6%, and positive predict ive values from 17% to 18.8%. Conclusions. Prevalence of infection is high among these women. The algorithms tested perform poorly - most in fected women remain untreated and most of those treated are uninfected . Alternative strategies for diagnosis and/or treatment are required.