Screening and syndromic approaches to identify gonorrhea and chlamydial infection among women

The standard diagnostic tools to identify sexually transmitted infections a re often expensive and have laboratory and infrastructure requirements that make them unavailable to family planning and primary health-care clinics i n developing countries. Therefore, inexpensive, accessible tools that rely on symptoms, signs, and/or risk factors have been developed to identify and treat reproductive tract infections without the need for laboratory diagno stics. Studies were reviewed that used standard diagnostic tests to identif y gonorrhea and cervical chlamydial infection among women and that provided adequate information about the usefulness of the tools for screening. Aggr egation of the studies' results suggest that risk factors, algorithms, and risk scoring for syndromic management are poor indicators of gonorrhea and chlamydial infection in samples of both low and high prevalence and, conseq uently, are not effective mechanisms with which to identify or manage these conditions. The development and evaluation of other approaches to identify gonorrhea and chlamydial infections, including inexpensive and simple labo ratory screening tools, periodic universal treatment, and other alternative s must be given priority.