title: Improvement of clinical algorithms for the diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis by the use of Gram-stained smears among female sex workers in Accra, Ghana.
abstract: BACKGROUND
  Screening for cervical infection is difficult in developing countries. Screening strategies must be improved for high-risk women, such as female sex workers.
  
  
  OBJECTIVE
  To evaluate the sensitivity and specificity of screening algorithms for cervical infection pathogens among female sex workers in Accra, Ghana.
  
  
  METHODS
  A cross-sectional study among female sex workers was conducted. Each woman underwent an interview and a clinical examination. Biologic samples were obtained for the diagnosis of HIV, syphilis, bacterial vaginosis, yeast infection, Trichomonas vaginalis, Neisseria gonorrhoeae, and Chlamydia trachomatis infection. Signs and symptoms associated with cervicitis agents were identified. Algorithms for the diagnosis of cervical infection were tested by computer simulations.
  
  
  RESULTS
  The following prevalences were observed: HIV, 76.6%; N. gonorrhoeae, 33.7%; C. trachomatis, 10.1%; candidiasis, 24.4%; T. vaginalis, 31.4%; bacterial vaginosis, 2.3%; serologic syphilis, 4.6%; and genital ulcers on clinical examination, 10.6%. The best performance of algorithms were reached when using a combination of clinical signs and a search for gram-negative diplococci on cervical smears (sensitivity, 64.4%; specificity, 80.0%).
  
  
  CONCLUSIONS
  In the algorithms, examination of Gram-stained genital smears in female sex workers without clinical signs of cervicitis improved sensitivity without altering specificity for the diagnosis of cervical infection.
authors.affiliation: Epidemiology Research Group, Centre Hospitalier Affilé Universitaire de Québec, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Deceuninck
authors.forename: C
authors.initials: C
authors.lastname: Asamoah-Adu
authors.forename: N
authors.initials: N
authors.lastname: Khonde
authors.forename: J
authors.initials: J
authors.lastname: Pépin
authors.forename: E H
authors.initials: EH
authors.lastname: Frost
authors.forename: S
authors.initials: S
authors.lastname: Deslandes
authors.forename: A
authors.initials: A
authors.lastname: Asamoah-Adu
authors.forename: V
authors.initials: V
authors.lastname: Bekoe
authors.forename: M
authors.initials: M
authors.lastname: Alary
mesh_terms: D000328:Adult; D000465:Algorithms; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000382:microbiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D003430:Cross-Sectional Studies; D005260:Female; D005840:Gentian Violet; D005869:Ghana; D006069:Gonorrhea / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D010619:Phenazines; D012680:Sensitivity and Specificity; D011477:Sex Work; D002575:Uterine Cervicitis / Q000175:diagnosis* / Q000382:microbiology; D014626:Vaginal Smears / Q000379:methods
chemical_list: C035863:Gram's stain; D010619:Phenazines; D005840:Gentian Violet