title: Risk assessment and other screening options for gonorrhoea and chlamydial infections in women attending rural Tanzanian antenatal clinics.
abstract: Sexually transmitted diseases (STDs) are a major cause of morbidity and mortality in developing countries and may play a key role in enhancing the heterosexual transmission of human immunodeficiency virus (HIV). Treatment of STDs is one of the most cost-effective of all health interventions in developing countries; however, STDs among women in rural populations have received little attention. In this study, we report that prevalences of STDs among 964 women attending antenatal clinics in a rural area of the United Republic of Tanzania. A total of 378 (39%) of these women were infected with at least one STD pathogen, 97 (10%) had syphilis, and 81 (8%) has Neisseria gonorrhoeae (NG) and/or Chlamydia trachomatis (CT) infection. The recommended syndromic approach to screening for NG/CT infection, based on reported genital symptoms, had a low sensitivity (43%) and failed to discriminate between infected and uninfected women. A risk score approach that we developed, based on sociodemographic and other factors associated with NG/CT infection, had a higher sensitivity and lower cost per true case treated than other approaches, although its positive predictive value was only about 20%.
authors.affiliation: Department of Clinical Sciences, London School of Hygiene and Tropical Medicine, England.
authors.forename: P
authors.initials: P
authors.lastname: Mayaud
authors.forename: H
authors.initials: H
authors.lastname: Grosskurth
authors.forename: J
authors.initials: J
authors.lastname: Changalucha
authors.forename: J
authors.initials: J
authors.lastname: Todd
authors.forename: B
authors.initials: B
authors.lastname: West
authors.forename: R
authors.initials: R
authors.lastname: Gabone
authors.forename: K
authors.initials: K
authors.lastname: Senkoro
authors.forename: M
authors.initials: M
authors.lastname: Rusizoka
authors.forename: M
authors.initials: M
authors.lastname: Laga
authors.forename: R
authors.initials: R
authors.lastname: Hayes
mesh_terms: D000328:Adult; D002690:Chlamydia Infections / Q000517:prevention & control*; D002692:Chlamydia trachomatis; D003362:Cost-Benefit Analysis; D005260:Female; D006069:Gonorrhea / Q000517:prevention & control*; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011295:Prenatal Care / Q000191:economics / Q000379:methods*; D015995:Prevalence; D018570:Risk Assessment; D012423:Rural Health; D012680:Sensitivity and Specificity; D013636:Tanzania