Ndoye I, Mboup S, De Schryver A, Van Dyck E, Moran J, Samb N D, Sakho M L, Thior I, Wade A, Heymann D L, Meheus A
STD and AIDS Control Programme, Dakar, Senegal.
Sex Transm Infect. 1998 Jun;74 Suppl 1:S112-7.
To study the validity and performance of a number of rapid indicators for the diagnosis of sexually transmitted infections (STIs) in female prostitutes in Dakar, Senegal; characteristics of these indicators were rapidly obtainable, easy to perform, accurate, useful at district level, and reasonable cost.
An STI prevalence study in female prostitutes (n = 374) seen at the STD clinic in Dakar, Senegal was done; a history, clinical examination, simple laboratory tests, and "gold standard" microbiological tests were performed. For a number of sociodemographic data, actual or past symptoms of STI, clinical signs, and rapid laboratory tests, validity variables, performance characteristics, and likelihood ratios for detection of gonococcal or chlamydial cervical infection were determined.
Cervical infection (chlamydial or gonococcal) was present in 24.9% of prostitutes; 46% had trichomoniasis and 29.4% had syphilis. Young age, abnormal vaginal discharge, endocervical mucopus, a positive leucocyte esterase test on urine, and 10 or more leucocytes in Gram stained smears of vaginal, cervical, or urine samples were significantly associated with cervical STI. Some of the rapid indicators had high sensitivity, others high specificity but none had acceptable overall validity. None of the indicators had at the same time a sensitivity above 50% and a positive predictive value above twice the background prevalence of cervical infection. 10 or more leucocytes in the cervical smear had a likelihood ratio of 1.83 increasing pretest probability of 24.9% to post-test probability of 38%, the best result obtained by any of the rapid indicators.
Rapid indicators of cervical STIs are insufficiently valid, which largely restricts their usefulness to high STI prevalence situations for instance, in prostitute populations and in STD patient management.
研究一些快速指标在塞内加尔达喀尔女性性工作者中诊断性传播感染（STIs）的有效性和性能；这些指标的特点是可快速获取、易于操作、准确、在地区层面有用且成本合理。
在塞内加尔达喀尔的性病诊所对女性性工作者（n = 374）进行了一项性传播感染患病率研究；进行了病史询问、临床检查、简单实验室检测以及“金标准”微生物检测。对于一些社会人口统计学数据、性传播感染的实际或既往症状、临床体征以及快速实验室检测，确定了检测淋菌性或衣原体性宫颈感染的有效性变量、性能特征和似然比。
24.9%的性工作者存在宫颈感染（衣原体或淋菌性）；46%患有滴虫病，29.4%患有梅毒。年轻、异常阴道分泌物、宫颈内膜黏液脓性、尿白细胞酯酶试验阳性以及阴道、宫颈或尿液样本革兰染色涂片中白细胞计数10个或更多与宫颈性传播感染显著相关。一些快速指标具有高敏感性，另一些具有高特异性，但没有一个具有可接受的总体有效性。没有一个指标同时具有高于50%的敏感性和高于宫颈感染背景患病率两倍的阳性预测值。宫颈涂片中10个或更多白细胞的似然比为1.83，将检测前概率24.9%提高到检测后概率38%，这是任何一个快速指标所获得的最佳结果。
宫颈性传播感染的快速指标有效性不足，这在很大程度上限制了它们在性传播感染高流行情况（例如在性工作者人群和性病患者管理中）的实用性。
