Improvement of clinical algorithms for the diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis by the use of gram-stained smears among female sex workers in Accra, Ghana

Background: Screening for cervical infection is difficult in developing cou ntries. Screening strategies must be improved for high-risk women, such as female sex workers. Goal: To evaluate the sensitivity and specificity of screening algorithms f or cervical infection pathogens among female sex workers in Accra, Ghana. Study Design: A cross-sectional study among female sex workers was conducte d. Each woman underwent an interview and a clinical examination. Biologic s amples were obtained for the diagnosis of HIV, syphilis, bacterial vaginosi s, yeast infection, Trichomonas vaginalis, Neisseria gonorrhoeae, and Chlam ydia trachomatis infection. Signs and symptoms associated with cervicitis a gents were identified. Algorithms for the diagnosis of cervical infection w ere tested by computer simulations. Results: The following prevalences were observed: HIV, 76.6%; N gonorrhoeae , 33.7%; C trachomatis, 10.1%; candidiasis, 24.4%; T vaginalis, 31.4%; bact erial vaginosis, 2.3%; serologic syphilis, 4.6%; and genital ulcers on clin ical examination, 10.6%. The best performance of algorithms were reached wh en using a combination of clinical signs and a search for gram-negative dip lococci on cervical smears (sensitivity, 64.4%; specificity, 80.0%), Conclusions: In the algorithms, examination of Gram-stained genital smears in female sex workers without clinical signs of cervicitis improved sensiti vity without altering specificity for the diagnosis of cervical infection.