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

Abstract

Objective: To evaluate the validity of diVerent algorithms for the diagnosis 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 discharge in three city council clinics between April and August 1997. Women were interviewed and examined for symptoms and signs of sexually transmitted infections (STIs). Specimens were obtained for laboratory diagnosis of genital infections, HIV, and syphilis. The data were used to evaluate the Kenyan 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 vaginosis, 7% gonorrhoea, 9% chlamydia, 7% syphilis, and 22% HIV. In non-pregnant women, gonococcal and chlamydial infection was significantly associated 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 pregnant women only young age, dysuria, and fever were significantly associated with cervical infection. However, none of these variables was either sensitive or specific enough for the diagnosis of cervical infection. Several algorithms were generated and applied to the study data. The algorithm including risk markers performed slightly better than the current Kenyan algorithm. Conclusion: STIs form a major problem in the Nairobi area and should be addressed accordingly. None of the tested algorithms for the treatment of vaginal discharge would constitute a marked improvement of the existing flow chart. Hence, better detection tools for the specific aetiology of vaginal discharge are urgently needed. (Sex Transm Inf 2000;76:33-38)

Vaginal Discharge in the Prostitutes of the Group Yèrêlon of Bobo-Dioulasso: Epidemiological, Clinical and Etiological Aspects

“…Lack of hygiene, promiscuity, non-use of condoms, the existence of genital tract lesions and high-risk practices during sexual intercourse are factors that promote the transmission of STIs and HIV [1] [6] [12] [13]. Our rate of 50.4% is higher than those of Reed [11] in Indonesia and Wang [10] in China, which were 39% and 41% respectively.…”

“…Our rate of 50.4% is higher than those of Reed [11] in Indonesia and Wang [10] in China, which were 39% and 41% respectively. Higher rates were reported by Nguyen [9] in Vietnam and Fonck [1] in Kenya, which were 75.9% and 94%, respectively. Ulcerations in the genital tract increased the risk of HIV infection, and seropositive women developed precancerous cervical lesions more rapidly (CIN2, CIN3) [1] Indeed, the decline in immunity is recognized as a factor favoring opportunistic infections such as genital candidiasis [16] [17].…”

“…Most data from the literature show high frequencies for vaginal discharge in this target population. It was found frequencies of 51.7%, 90% and 94% respectively in the studies of Desai in India [6], Gaye-Diallo in Senegal [9] and Fonck in Kenya [1].…”

Prevalência e fatores associados à percepção de ocorrência de corrimento vaginal patológico entre gestantes

“…Esta idade é ainda caracterizada não somente por um perí-odo de maior atividade sexual, mas também por uma maior rotatividade de parceiros 2,3,4,12 . Não fosse a maior taxa de uso de preservativos por parte dos adolescentes, conforme demonstrado recentemente pela Pesquisa de Conhecimentos, Atitudes e Práticas relacionadas à DST/AIDS da População Brasileira em 2008 (PCAP-2008), tanto a prevalência de corrimento nesta faixa etária quando suas respectivas RP em relação às demais idades seriam maiores ainda, sobretudo porque o não uso de métodos de barreiras facilita a ocorrência deste tipo de infecção 12,17,18 .…”

HIV-infected women of Burkina Faso: a “reservoir” of mycoplasma infection

“…It has been reported that BV is also associated with poor pregnancy outcomes such as preterm delivery [2]; moreover, several studies have now reported associations between BV and HIV infection [3,4,5]. BV appears to be particularly common in sub-Saharan Africa, where HIV infection is endemic, and it has been reported at high prevalence rates (20-49%) among women presenting with vaginal discharge to STI clinics [6,7,8]. These rates are very much higher than those reported in industrialised countries [9,10].…”