Validity of the vaginal discharge algorithm among pregnant and non-pregnant women in Nairobi, Kenya

Objective: To evaluate the validity of different algorithms for the diagnos is of gonococcal and chlamydial infections among pregnant and non-pregnant women consulting health services for vaginal discharge in Nairobi, Kenya. Methods: Cross sectional study among 621 women with complaints of vaginal d ischarge in three city council clinics between April and August 1997. Women were interviewed and examined for symptoms and signs of sexually transmitt ed infections (STIs). Specimens were obtained for laboratory diagnosis of g enital infections, HIV, and syphilis. The data were used to evaluate the Ke nyan flow chart as well as several other generated algorithms. Results: The mean age was 24 years and 334 (54%) were pregnant. The overall prevalence rates were: 50% candidiasis, 23% trichomoniasis, 9% bacterial v aginosis, 7% gonorrhoea, 9% chlamydia, 7% syphilis, and 22% HIV. In non-pre gnant women, gonococcal and chlamydial infection was significantly associat ed with (1) demographic and behavioural risk markers such as being single, younger than 20 years, multiple sex partners in the previous 3 months; (2) symptom fever; and (3) signs including presence of yellow or bloody vaginal discharge, cervical mucopus, cervical erythema, and friability. Among preg nant women only young age, dysuria, and fever were significantly associated with cervical infection. However, none of these variables was either sensi tive or specific enough for the diagnosis of cervical infection. Several al gorithms were generated and applied to the study data. The algorithm includ ing risk markers performed slightly better than the current Kenyan algorith m. Conclusion: STIs form a major problem in the Nairobi area and should be add ressed accordingly. None of the tested algorithms for the treatment of vagi nal discharge would constitute a marked improvement of the existing flow ch art. Hence, better detection tools for the specific aetiology of vaginal di scharge are urgently needed.