Romoren Maria, Sundby Johanne, Velauthapillai Manonmany, Rahman Mafizur, Klouman Elise, Hjortdahl Per
Institute of General Practice and Community Medicine, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway.
BMC Infect Dis. 2007 Apr 16;7:27. doi: 10.1186/1471-2334-7-27.
Chlamydia and gonorrhoea are major causes of morbidity among women in developing countries. Both infections have been associated with pregnancy-related complications, and case detection and treatment in pregnancy is essential. In countries without laboratory support, the diagnosis and treatment of cervical infections is based on the syndromic approach. In this study we measured the prevalence of chlamydia and gonorrhoea among antenatal care attendees in Botswana. We evaluated the syndromic approach for the detection of cervical infections in pregnancy, and determined if risk scores could improve the diagnostic accuracy.
In a cross-sectional study, 703 antenatal care attendees in Botswana were interviewed and examined, and specimens were collected for the identification of C trachomatis, N gonorrhoeae and other reproductive tract infections. Risk scores to identify attendees with cervical infections were computed based on identified risk factors, and their sensitivities, specificities, likelihood ratios and predictive values were calculated.
The prevalence of chlamydia was 8%, and gonorrhoea was found in 3% of the attendees. Symptoms and signs of vaginal discharge did not predict cervical infection, and a syndromic approach failed to identify infected women. Age (youth) risk factor most strongly associated with cervical infection. A risk score with only sociodemographic factors had likelihood ratios equivalent to risk scores which incorporated clinical signs and microscopy results. However, all the evaluated risk scores were of limited value in the diagnosis of chlamydia and gonorrhoea. A cut-off set at an acceptable sensitivity to avoid infected antenatal care attendees who remained untreated would inevitably lead to considerable over-treatment.
Although in extensive use, the syndromic approach is unsuitable for diagnosing cervical infections in antenatal care attendees in Botswana. None of the evaluated risk scores can replace this management. Without diagnostic tests, there are no adequate management strategies for C trachomatis and N gonorrhoeae in pregnant women in Botswana, a situation which is likely to apply to other countries in sub-Saharan Africa. Screening for cervical infections in pregnant women is an essential public health measure, and rapid tests will hopefully be available in developing countries within a few years.
衣原体感染和淋病是发展中国家女性发病的主要原因。这两种感染都与妊娠相关并发症有关，因此孕期的病例检测和治疗至关重要。在没有实验室支持的国家，宫颈感染的诊断和治疗基于症状诊断法。在本研究中，我们测量了博茨瓦纳接受产前检查的孕妇中衣原体和淋病的患病率。我们评估了症状诊断法在孕期检测宫颈感染中的应用，并确定风险评分是否能提高诊断准确性。
在一项横断面研究中，对博茨瓦纳的703名接受产前检查的孕妇进行了访谈和检查，并采集样本以鉴定沙眼衣原体、淋病奈瑟菌和其他生殖道感染。根据确定的风险因素计算识别宫颈感染孕妇的风险评分，并计算其敏感性、特异性、似然比和预测值。
衣原体感染率为8%，淋病感染率为3%。白带症状和体征无法预测宫颈感染，症状诊断法未能识别出感染女性。年龄（年轻）是与宫颈感染最密切相关的风险因素。仅包含社会人口统计学因素的风险评分的似然比与纳入临床体征和显微镜检查结果的风险评分相当。然而，所有评估的风险评分在诊断衣原体和淋病方面价值有限。为避免未治疗的感染产前检查孕妇而设定的可接受敏感性的临界值将不可避免地导致大量过度治疗。
尽管症状诊断法被广泛使用，但它不适用于博茨瓦纳接受产前检查的孕妇宫颈感染的诊断。没有一种评估的风险评分能够替代这种管理方法。由于缺乏诊断检测，博茨瓦纳孕妇沙眼衣原体和淋病奈瑟菌感染没有足够的管理策略，撒哈拉以南非洲的其他国家可能也存在这种情况。对孕妇进行宫颈感染筛查是一项重要的公共卫生措施，希望快速检测方法能在几年内在发展中国家普及。
