title: Syndromic versus laboratory-based diagnosis of cervical infections among female sex workers in Benin: implications of nonattendance for return visits.
abstract: BACKGROUND
  The syndromic diagnostic approach is the most realistic and cost-effective strategy for controlling sexually transmitted infections (STIs) in the developing world. Its potential advantages should be evaluated.
  
  
  OBJECTIVE
  The goal of the current study was to examine whether the syndromic approach might diagnose more cases of cervicitis due to Neisseria gonorrhoeae or Chlamydia trachomatis than laboratory tests.
  
  
  METHODS
  The participants were 481 female sex workers in Benin, screened for STIs and treated on the basis of the clinical findings. They were asked to return to the clinic within 10 days for laboratory test results and appropriate treatment when necessary.
  
  
  RESULTS
  The prevalence of cervical infections was 24.5%. In comparison to the gold standard, the sensitivity of the syndromic diagnosis approach for the detection of N gonorrhoeae/C trachomatis infections was 48.3%; that of the locally performed laboratory tests was 74.6%. However, the sensitivity of the laboratory tests dropped to 28.8% when it was taken into consideration that 57.6% of the infected women did not return to the clinic within 10 days.
  
  
  CONCLUSIONS
  The syndromic diagnosis approach should continue to be used for female sex workers in Benin because returning for treatment is problematic. Presumptive treatment at their initial visit could be a complement to this approach, given the high prevalence of cervicitis in this population.
authors.affiliation: Epidemiology Research Group, Hôpital du Saint-Sacrement du CHA and Université Laval, Québec, Québec, Canada.
authors.forename: Léonard
authors.initials: L
authors.lastname: Mukenge-Tshibaka
authors.forename: Michel
authors.initials: M
authors.lastname: Alary
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Lowndes
authors.forename: Eddy
authors.initials: E
authors.lastname: Van Dyck
authors.forename: Aristide
authors.initials: A
authors.lastname: Guédou
authors.forename: Nassirou
authors.initials: N
authors.lastname: Geraldo
authors.forename: Séverin
authors.initials: S
authors.lastname: Anagonou
authors.forename: Edgard
authors.initials: E
authors.lastname: Lafia
authors.forename: Jean R
authors.initials: JR
authors.lastname: Joly
mesh_terms: D000328:Adult; D000465:Algorithms; D001541:Benin / Q000453:epidemiology; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology; D002692:Chlamydia trachomatis; D019411:Clinical Laboratory Techniques; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D010808:Physical Examination; D015995:Prevalence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011477:Sex Work; D002575:Uterine Cervicitis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology