Tyndall M W, Kidula N, Sande J, Ombette J, Temmerman M
Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada.
Sex Transm Dis. 1999 Sep;26(8):476-82. doi: 10.1097/00007435-199909000-00010.
Sexually transmitted infections (STIs) continue to exert a tremendous health burden on women in developing countries. Poor socioeconomic status, inadequate knowledge, lack of diagnostic facilities, and shortages of effective treatment all contribute to the high incidence of STIs. The use of clinical algorithms for the detection and management of STIs has gained widespread acceptance in settings where there are limited resources. Evaluation of these algorithms have been few, especially in women who are not recognized as members of high-risk groups.
To develop a simple scoring system based on historical and demographic data, physical findings, microscopy, and leukocyte esterase (LE) urine dipsticks to predict cervical gonococcal and chlamydial infection among asymptomatic women.
One thousand and forty-eight women attending an urban family planning clinic in Nairobi were randomly selected to participate. After the identification of factors that were associated with infection, we assigned one point each for: age 25 or younger, single status, two or more sex partners in the past year, cervical discharge, cervical swab leukocytes, and a positive LE urine dipstick. Identification of any one of these six factors gave a sensitivity of 85% and a specificity of 30% for the detection of cervical infections. A positive LE urine dipstick had a sensitivity of 63 % and a specificity of 47% when used alone and did not contribute to the identification of infection if a physical examination was performed. The application of existing clinical algorithms to this population performed poorly.
The use of risk scores, physical examination, microscopy, and the urine LE dipstick, used alone or in combination, as predictors of gonococcal or chlamydial cervical infection was of limited utility in low-risk, asymptomatic women. Accurate diagnostic testing is necessary to optimize treatment.
性传播感染（STIs）继续给发展中国家的女性带来巨大的健康负担。社会经济地位低下、知识不足、缺乏诊断设施以及有效治疗手段短缺，这些因素共同导致了性传播感染的高发病率。在资源有限的环境中，使用临床算法来检测和管理性传播感染已得到广泛认可。对这些算法的评估较少，尤其是在未被视为高危人群的女性中。
基于病史、人口统计学数据、体格检查、显微镜检查和白细胞酯酶（LE）尿试纸条开发一种简单的评分系统，以预测无症状女性的宫颈淋病奈瑟菌和沙眼衣原体感染。
随机选取在内罗毕一家城市计划生育诊所就诊的1048名女性参与研究。在确定与感染相关的因素后，我们为以下因素各赋1分：年龄25岁及以下、单身、过去一年有两个或更多性伴侣、宫颈分泌物、宫颈拭子白细胞以及LE尿试纸条阳性。这六个因素中任何一个因素的存在，对于检测宫颈感染的敏感性为85%，特异性为30%。单独使用时，LE尿试纸条阳性的敏感性为63%，特异性为47%，如果进行了体格检查，则对感染的识别没有帮助。将现有的临床算法应用于该人群时效果不佳。
单独或联合使用风险评分、体格检查、显微镜检查和尿LE试纸条作为淋病奈瑟菌或沙眼衣原体宫颈感染的预测指标，在低风险、无症状女性中的效用有限。准确的诊断检测对于优化治疗是必要的。
