title: Lack of utility of risk score and gynecological examination for screening for sexually transmitted infections in sexually active adolescents.
abstract: BACKGROUND
  Sexually transmitted infections constitute the main health risk among adolescents. In developing countries the diagnosis and treatment of cervical infections is based on the syndromic approach. In this study we estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among female adolescents from a Health Sector of the city of Goiânia, Brazil, and validated cervicitis diagnosis using World Health Organization/Ministry of Health risk score and gynecological examination.
  
  
  METHODS
  A cross-sectional community-based sample of 914 15- to 19-year-old female teenagers was randomly selected and referred to the local Family Health Program. Of these, 472 (51.6%) were sexually active and gynecological examinations were carried out for 427. Endocervical samples were collected to perform the polymerase chain reaction for C. trachomatis and N. gonorrhoeae. Performance of risk score, the presence of mucopurulent discharge, friability, ectopia and pain during cervical maneuver were compared with the presence of C. trachomatis or N. gonorrhoeae or both.
  
  
  RESULTS
  The prevalence of C. trachomatis and N. gonorrhoeae was 14.5% and 2.1%, respectively. The risk score had a specificity of 31.9% (95% confidence interval, 21.2 to 44.2) and a positive predictive value of 20.8% (95% confidence interval, 13.5 to 29.7). Friability was the component of the gynecological examination that presented the best performance with a sensitivity of 43.5%, specificity of 81.0%, and 30.6% of positive predictive value.
  
  
  CONCLUSIONS
  The prevalence of infection by C. trachomatis and N. gonorrhoeae was high among these sexually active adolescents. The syndromic approach is clearly inadequate for screening and treating these infections in this population. Therefore, the implantation of other strategies to control these infections among adolescents is urgently required.
authors.affiliation: 1Division of Adolescent Medicine, Department of Pediatrics, Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil. eleusebrito@yahoo.com.br
authors.forename: Eleuse M B
authors.initials: EM
authors.lastname: Guimarães
authors.forename: Mark D C
authors.initials: MD
authors.lastname: Guimarães
authors.forename: Maria Aparecida S
authors.initials: MA
authors.lastname: Vieira
authors.forename: Nádia M
authors.initials: NM
authors.lastname: Bontempo
authors.forename: Mirian S S
authors.initials: MS
authors.lastname: Seixas
authors.forename: Mônica S D
authors.initials: MS
authors.lastname: Garcia
authors.forename: Lyana E S
authors.initials: LE
authors.lastname: Daud
authors.forename: Rejane L M
authors.initials: RL
authors.lastname: Côrtes
authors.forename: Maria de Fátima C
authors.initials: Mde F
authors.lastname: Alves
mesh_terms: D000293:Adolescent; D001938:Brazil; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D003430:Cross-Sectional Studies; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D006302:Health Services Research; D006801:Humans; D008219:Lymphogranuloma Venereum / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D008403:Mass Screening / Q000379:methods*; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D010808:Physical Examination; D016133:Polymerase Chain Reaction / Q000379:methods; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014505:Urban Population; D055815:Young Adult