Risk assessment at the primary health care level in Moshi, Tanzania: limits in predicting sexually transmitted infections among women.

ABSTRACT

OBJECTIVE: To identify risk factors for sexually transmitted infections (STI) and to evaluate the accuracy of using risk assessment for identifying infected women in Moshi, Tanzania. DESIGN: A cross sectional study. SETTING: Three primary health care clinics in Moshi. SUBJECTS: 382 consenting women attending the clinics for routine reproductive health care were interviewed followed by a pelvic examination between September and December 1999. Blood and genital specimens were collected for STI diagnosis. MAIN OUTCOME MEASURES: Prevalent STIs, risk factors and accuracy of using risk factors to identify infected women. RESULTS: Among 382 women, 118 (31%) had at least one STI diagnosed clinically or by a laboratory test; (T. vaginalis 21%, syphilis 4.2%, chlamydia and/or gonococcal cervicitis 3.2%, genital ulcer 4.5% and warts 2%). The risk of CT/GC cervicitis was greater among women aged < 20 years (p = 0.04), with cervical friability (p = 0.01) and with > 10 cervical leucocytes (p < 0.001), while having more than one partner in the past three months (p = 0.008) predicted syphilis infection. Trichomoniasis was associated with the presence of vaginal discharge (p = 0.001) and pH > 4.5 (p < 0.001). However, using these risk factors as a screening tool for various STIs achieved a low sensitivity and a low positive predictive value, hence a low utility for case detection. CONCLUSION: STIs were prevalent in this setting. However, risk factors were not a good tool for identifying infected women. While there is an urgent need to develop low cost microbiological tests for case detection, efforts should be made to maximise the available control strategies, such as proper treatment of symptomatic patients and their partners.