Schneider H, Coetzee D J, Fehler H G, Bellingan A, Dangor Y, Radebe F, Ballard R C
Department of Community Health, University of Witwatersrand, Johannesburg, South Africa.
Sex Transm Infect. 1998 Jun;74 Suppl 1:S147-52.
This paper reports on a study undertaken in a rural area of South Africa, to develop a non-laboratory tool to screen for sexually transmitted diseases (STDs) among family planning clients.
A cross sectional study was performed of 249 consecutive women attending a family planning service between November and December 1994. A questionnaire was administered, and a clinical examination and laboratory tests conducted. Sociodemographic, clinical, and other non-laboratory variables that were significantly associated with laboratory evidence of infection were combined to produce non-hierarchical scoring systems for three "syndromes": gonococcal and/or chlamydial cervical infection, trichomoniasis, and cervical infection and/or trichomoniasis combined. The sensitivity, specificity, and predictive values of the scoring systems as a screening tool were assessed against the gold standard of laboratory tests.
The prevalence of reproductive tract infections among the study participants was as follows: Chlamydia trachomatis 12%, Neisseria gonorrhoeae 3%, Trichomonas vaginalis 18%, and bacterial vaginosis 29%. Although vaginal discharge and other symptoms were frequently reported, symptoms bore no relation to the presence of infection. The following independent associations with gonococcal/chlamydial cervical infection were found: age less than 25 years and cervical mucopus and/or friability. Abnormal discharge on examination, visible inflammatory changes of the cervix (increased redness), no recent travel, and unemployment were associated with trichomoniasis. The combination of trichomonas and/or cervical infection ("STD syndrome") was associated with cervical mucopus/friability, unemployment, lack of financial support, and increased redness of the cervix. Of the three scoring systems developed on the basis of these associations, that of the "STD syndrome" achieved the best performance characteristics as a screening tool, with a sensitivity of 62%, specificity of 74%, and positive predictive value of 48%.
STDs are common in a population of rural, sexually active women attending a family planning service. In resource poor settings, non-laboratory screening tools could play some role in identifying and treating infections in these women, especially since the majority would not otherwise have been reached. However, such screening tools cannot be viewed as the only way to identify STDs and should be considered as part of an overall strategy of STD control that includes, for example, good management of symptomatic individuals and their partners.
本文报告了在南非农村地区开展的一项研究，旨在开发一种非实验室工具，用于对计划生育服务对象进行性传播疾病（STD）筛查。
对1994年11月至12月期间连续前来接受计划生育服务的249名女性进行了横断面研究。发放了问卷，并进行了临床检查和实验室检测。将与感染实验室证据显著相关的社会人口统计学、临床及其他非实验室变量相结合，针对三种“综合征”生成非分层评分系统：淋菌性和/或衣原体性宫颈感染、滴虫病，以及宫颈感染和/或滴虫病合并症。以实验室检测的金标准为对照，评估评分系统作为筛查工具的敏感性、特异性和预测值。
研究参与者中生殖道感染的患病率如下：沙眼衣原体12%，淋病奈瑟菌3%，阴道毛滴虫18%，细菌性阴道病29%。尽管经常报告有白带异常及其他症状，但症状与感染的存在并无关联。发现以下因素与淋菌性/衣原体性宫颈感染独立相关：年龄小于25岁、宫颈有黏液脓性分泌物和/或宫颈易脆。检查时白带异常、宫颈可见炎症改变（发红增加）、近期无外出旅行及失业与滴虫病相关。滴虫和/或宫颈感染合并症（“STD综合征”）与宫颈黏液脓性分泌物/易脆、失业、缺乏经济支持及宫颈发红增加相关。基于这些关联开发的三种评分系统中，“STD综合征”评分系统作为筛查工具表现最佳，敏感性为62%，特异性为74%，阳性预测值为48%。
在前来接受计划生育服务的农村性活跃女性人群中，性传播疾病很常见。在资源匮乏地区，非实验室筛查工具在识别和治疗这些女性的感染方面可发挥一定作用，特别是因为否则大多数人无法得到诊治。然而，此类筛查工具不能被视为识别性传播疾病的唯一方法，应被视为性传播疾病控制总体策略的一部分，该策略包括，例如，对有症状个体及其性伴的妥善管理。
