Kapiga S H, Vuylsteke B, Lyamuya E F, Dallabetta G, Laga M
Department of Epidemiology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania.
Sex Transm Infect. 1998 Jun;74 Suppl 1:S132-8.
To determine the prevalence of sexually transmitted diseases (STDs) and to assess the validity of STD screening approaches among family planning clients in Dar es Salaam, Tanzania.
Between March and September 1995, information about sociodemographic characteristics, contraceptive use, sexual behaviour, and medical history was obtained from consenting women (n = 908). After interview, blood and genital specimens were collected for diagnosis of STDs and HIV. Based on the information obtained at interview and clinical examination, STD diagnostic algorithms were developed and validated.
The prevalence of STDs was HIV (16.9%), gonococcal and/or chlamydial cervicitis (8.2%), and Trichomonas vaginalis and/or Candida albicans (27.2%). The risk of cervicitis was increased among unmarried women and among women with a husband < or = 25 years of age and women having more than one sex partners in the past 3 months or a new sex partner during the past month. Most women with cervicitis (62.2%) and vaginitis (67.6%) were asymptomatic. A screening strategy for cervicitis based on symptoms had a sensitivity of 29.7%, a specificity of 84.1%, and a positive predictive value (PPV) of 15.9%. The corresponding figures for an algorithm based on clinical signs were 20.3%, 90.2%, and 15.6%. The sensitivity of a simple risk assessment algorithm ranged from 20.3% to 73%. An approach based on both risk assessment (risk score > or = 1) and clinical signs (cervical mucopus and friability) had a sensitivity of 37.8%, a specificity of 87.5%, and a PPV of 21.4%. A syndromic approach for vaginitis resulted in a higher sensitivity than the approach based on the type of vaginal discharge.
Although there is no single screening strategy for cervicitis which can be advocated for large scale application, risk assessment might be the only cost effective strategy for identifying women with cervicitis in family planning clinics in Tanzania.
确定坦桑尼亚达累斯萨拉姆计划生育服务对象中性传播疾病（STD）的患病率，并评估STD筛查方法的有效性。
1995年3月至9月期间，从同意参与的女性（n = 908）中获取有关社会人口学特征、避孕方法使用、性行为和病史的信息。访谈后，采集血液和生殖器标本用于诊断STD和HIV。根据访谈和临床检查获得的信息，制定并验证了STD诊断算法。
STD的患病率分别为：HIV（16.9%）、淋菌性和/或衣原体性宫颈炎（8.2%）、滴虫和/或白色念珠菌（27.2%）。未婚女性、丈夫年龄≤25岁的女性以及在过去3个月内有多个性伴侣或在过去1个月内有新性伴侣的女性患宫颈炎的风险增加。大多数宫颈炎（62.2%）和阴道炎（67.6%）患者无症状。基于症状的宫颈炎筛查策略灵敏度为29.7%，特异度为84.1%，阳性预测值（PPV）为15.9%。基于临床体征的算法相应数字分别为20.3%、90.2%和15.6%。简单风险评估算法的灵敏度在20.3%至73%之间。基于风险评估（风险评分≥1）和临床体征（宫颈黏液脓性分泌物和脆性增加）的方法灵敏度为37.8%，特异度为87.5%，PPV为21.4%。阴道炎的综合征法比基于阴道分泌物类型的方法灵敏度更高。
虽然没有一种宫颈炎筛查策略可推荐用于大规模应用，但风险评估可能是坦桑尼亚计划生育诊所识别宫颈炎女性患者的唯一具有成本效益的策略。
