Sexually transmitted diseases are common in women attending Jamaican family planning clinics and appropriate detection tools are lacking

ABSTRACT

OBJECTIVES: To assess sexually transmitted diseases (STD) among women attending Jamaican family planning clinics and to evaluate decision models as alternatives to STD laboratory diagnosis. METHODS: Women attending two family planning clinics in Kingston were interviewed and tested for syphilis seroreactivity using toluidine red unheated serum test and Treponema pallidum haemagglutination, for gonorrhoea using culture, for chalamydial infection using enzyme linked immunoassay, and for trichomoniasis using culture. Urine was tested with leucocyte esterase dipstick (LED). The women were treated based upon a clinical algorithm. Computer simulations explored the use of risk inclusive decision models for detection of cervical infection and/or trichomoniasis. RESULTS: Among 767 women, 206 (26.9 percent) had at least one STD. The prevalence of gonorrhoea was 2.7 percent chlamydial infection 12.2 percent, gonococcal and/or chlamydial cervical infection 14.1 percent; trichomoniasis 11.5 percent; syphilis seroreactivity 5.9 percent. The clinical algorithm was 3.7 percent sensitive and 96.7 percent specific in detecting cervical infection. Detection of cervical infection and/or trichomoniasis was 63.5 percent sensitive and 60.6 percent specific using LE and 57.7 percent sensitive and 46.2 percent specific using the risk inclusive algorithm employed in Jamaica STD clinics. Either cervical friability or LED (+) or family planning clinic attender less than 25 years old with more than one sexual partner in the past year was 72.5 percent sensitive and 53.3 percent specific. The positive predictive values of the STD clinic algorithm, LED, and two developed decision models ranged from 25.0 percent to 33.4 percent to detect cervical infection and/or trichomoniasis in these women. CONCLUSION: STDs were quite prevalent in these mainly asymptomatic family planning clinic attenders. None of the evaluated decision models can be considered a good alternative to case detection using laboratory diagnosis. Appropriate detection tools are needed. In the meantime, available STD control strategies should be maximised, such as promotion of condom use; adequate treatment of symptomatic STD patients and partners; and education of women and men (AU)