PATTERN OF SEXUALLY-TRANSMITTED DISEASES AMONG PREGNANT-WOMEN IN BURKINA-FASO, WEST-AFRICA - POTENTIAL FOR A CLINICAL MANAGEMENT BASED ON SIMPLE APPROACHES

Objectives: (1) To determine the prevalence of sexually transmitted di seases (STDs) in pregnant women in Burkina Faso. (2) To evaluate the p otential of clinical management of STDs based on screening with clinic al data and urine leucocyte esterase test (LET). Methods: Cross sectio nal study among antenatal clinic attendees was conducted in 1994 in Ou agadougou and Bobo-Dioulasso, the two largest urban centres in Burkina Faso, where more than 94% of the pregnant women benefit from antenata l care at least twice during their pregnancy. Each woman selected unde rwent an interview, general and gynaecological examination. Genital sa mples were collected to confirm the presence of STD pathogens. Logisti c regression analysis was done to identify models that predict (a) gon orrhoea and/or chlamydia, (b) trichomoniasis and/or bacterial vaginosi s, (c) candidiasis. Sensitivity, specificity and positive and negative predictive values of these models were assessed using standard method s. Results: All 645 consecutive pregnant women were enrolled in the tw o sites. Among these women 32.4% presented at least one STD. The major STDs were: trichomoniasis (14%), bacterial vaginosis (13%), recent sy philis (3.6%), chlamydial infection (3.1%), genital warts (3%), gonoco ccal infection (1.6%) and genital ulcer (0.8%). Prevalence of vaginal candidiasis was 14%. The use of a risk marker (length of relationship with regular sexual partner < 3 years), and the positivity (+ + +) of the urine LET provided a sensitivity of 80% and a positive predictive value of 7% for the screening of gonococcal and/or chlamydial infectio n. If clinical signs and positivity of the urine LET were taken into a ccount sensitivity and positive predictive value of trichomoniasis and /or bacterial vaginosis screening were 77% and 37%, respectively. Clin ical signs and positivity of the urine LET showed a low sensitivity (2 3%) for screening vaginal candidiasis. Conclusions: The prevalence of STDs in pregnant women is high in urban Burkina Faso. Systematic scree ning combined with effective treatment should be included in antenatal care in the future. Urine LET, if associated with interview and clini cal examination offers a simple, rapid and affordable tool for systema tic screening of STDs in pregnant women. However, the proportion of ov ertreatments with proposed strategies will be high. Further studies ar e needed to develop and validate better algorithms with probably cheap laboratory tests.