Risk factors and algorithms for chlamydial and gonococcal cervical infections in women attending family planning clinics in Thailand.
OBJECTIVE
To identify risk factors associated with and evaluate algorithms for predicting Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) cervical infections in women attending family planning clinics in Thailand.


METHODS
Eligible women were recruited from family planning clinics from all regions in Thailand. The women were followed at 3-month intervals for 15-24 months. At each visit, the women were interviewed for interval sexually transmitted infection (STI) history in the past 3 months, recent sexual behavior, and contraceptive use. Pelvic examinations were performed and endocervical specimens were collected to test for CT and NG using polymerase chain reaction.


RESULTS
Factors associated with incident CT/NG cervical infections in multivariate analyses included region of country other than the north, age <or=25 years, polygamous marriage, acquiring a new sex partner in the last 3 months, abnormal vaginal discharge, mucopurulent cervical discharge, and easily induced bleeding of the endocervix. Three models were developed to predict cervical infection. A model incorporating demographic factors and sexual behaviors had a sensitivity of 61% and a specificity of 71%. Incorporating additional factors did not materially improve test performance. Positive predictive values for all models evaluated were low.


CONCLUSIONS
In resource-limited settings, algorithmic approaches to identifying incident cervical infections among low-risk women may assist providers in the management of these infections.
Rugpao
Sungwal
S
Research Institute for Health Science, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Rungruengthanakit
Kittipong
K
Werawatanakul
Yuthapong
Y
Sinchai
Wanida
W
Ruengkris
Tosaporn
T
Lamlertkittikul
Surachai
S
Pinjareon
Sutham
S
Koonlertkit
Sompong
S
Limtrakul
Aram
A
Sriplienchan
Somchai
S
Wongthanee
Antika
A
Sirirojn
Bangorn
B
Morrison
Charles S
CS
Celentano
David D
DD
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D002584:Cervix Uteri / Q000382:microbiology; D002690:Chlamydia Infections / Q000453:epidemiology* / Q000382:microbiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D004848:Epithelium / Q000382:microbiology; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D011237:Predictive Value of Tests; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D002577:Uterine Cervical Diseases / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult