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What role for routine curative health services in the detection of asymptomatic sexually transmitted infections?


Unique Identifier : AIDSLINE ICA12/98398889

OBJECTIVES: (i) to assess the prevalence of laboratory confirmed STI's among patients attending the OPD of a district hospital; (ii) to assess the proportion of patients with STI who were missed by the health workers, (iii) to assess the performance of different strategies for the detection of asymptomatic infections; (iv) to estimate the number of STI's that are detected by partner notification. METHODS: Consecutive men and women attending the outpatient department of a rural hospital were approached after they were seen by regular hospital staff. With informed consent they were interviewed about STD related complaints, and underwent a full genital examination with laboratory testing. Their medical records were then checked for the diagnosis and treatment made by health staff. Patients with any indications of STI's were requested to inform their partners, who were interviewed and underwent a full examination. RESULTS: 521 men and 562 women were enrolled, of whom respectively 13% and 51% were suffering from a laboratory proven STI. In addition 3% were suffering from a genital ulceration (5% men and 1.4% women). Of the men 245 with urethritis were identified by the health workers; 50% with genital ulceration. Research staff identified another 10% of men with symptoms, but 46% were asymptomatic. Of the women 18% of STI's were detected by the health workers (25% of genital ulcerations). Research staff detected another 14% with STD related complaints and 35% were asymptomatic. Screening of urine of men with LED and applying a risk score to women as a screening tool, would increase the detection of STI's in this population but the positive predictive values were generally low. 0.37 partners per index case were seen, in male partners 11% had a laboratory confirmed STI; in female partners this percentage was 51%. The detection rate of STI's was 0.19 infections per male index patient, 0.04 infections per female index patient. CONCLUSIONS: Under routine conditions, the performance of syndromic management can be low. Moreover, since over half of the infected population denies having any STI symptom, alternative strategies are urgently warranted for STI screening. In resource-poor settings, screening of male urethritis using an LED could be an alternative. Careful questioning of women may help. Partner notification, even in the context of syndromic management, is a useful strategy to detect and treat asymptomatic STI cases.

MEETING ABSTRACTS Contact Tracing Diagnostic Errors/STATISTICS & NUMER DATA Female Hospitals, District Hospitals, Rural Human Male Mass Screening/*METHODS Medical History Taking/*STANDARDS Outpatient Clinics, Hospital Physical Examination/*STANDARDS Prevalence


Information in this article was accurate in December 30, 1998. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.