Ministry of Health, Seychelles N. E. Udonwa J. Nwosu G. Furneau P. M. Thanikachalam F. Didon

1. Sensitivity and Specificity of a Risk Score Method for the Detection of Cervical Infection in Female STD Patients with Vaginal Discharge in Seychelles • Ministry of Health, Seychelles • N. E. Udonwa • J. Nwosu • G. Furneau • P. M. Thanikachalam • F. Didon • University of Brescia, Italy • A. Matteelli • G. Carosi • A. Tabaldi • N. Gulletta Xth International Conference on AIDS and STD in Africa, December 1997 Xth International Conference on AIDS and STD in Africa, December 1997

2. ABSTRACT Objective: To determine sensitivity and specificity of a risk score method to predict cervical infections in women attending an STD clinic for vaginal discharge in the Seychelles. Methods: We enrolled all consecutive women with vaginal discharge or lower abdominal pain attending the only categorical STD clinic in the Seychelles during the period February 1996 – March 1997. Anagraphic and behavioural data were collected by interview. A risk assessment method proposed by the WHO was used, considered to be positive if any one of the following was present: age >21, being single, having more than 1 partner in the past month, or a new partner etiological evidence: Neisseria gonarrhoeae was isolated from cervical swabs onto enriches Tayer martin agar plates; Chlamydia trachomatis antigens were detected from cervical swabs using the EIA Sanofi test. Data were computed in a Dbase file and analysed with the epiinfo6 program. Results: 147 women were enrolled, 98 with vaginal discharge, 13 with lower abdominal pain and 36 with both signs. Complete interview and microbiological information was available for 135. the mean age was 28 (range 16-48), and 32 (24%) were below 21 years, 49 (36%) were single, 7 (5%) had sex with more than one partner during the previous month, and 9 (7%), had changed the partner during the previous three months. A diagnosis of cervical infection was made 10 (7%), all infected by Chlamydia trachomatis including one with Gonococcal coinfection. The sensitivity, specificity, positive predictive value, and negative predictive value of the risk assessment method were 50%, 56%, 8%, 93%. Comments: This study involved a population of women with vaginal discharge/flow abdominal pain, characterized by a low prevalence of STD risk indicators and low prevalence of cervical pathogens. In this setting the epidemiological risk assessment method we used proved neither sensitive non specific in the identification of women with cervical infections. Xth International Conference on AIDS and STD in Africa, December 1997

3. Facts Women presenting with genital discharge or pelvic pain in the Seychelles are much more likely to have vaginal rather than cervical infections However, cervical infections determine more severe morbidity and represent a public health problem due to sexual transmission Xth International Conference on AIDS and STD in Africa, December 1997

4. Questions Can a risk score method assist in the identification of women with cervicitis among those presenting with vaginal discharge or pelvic pain ? Xth International Conference on AIDS and STD in Africa, December 1997

5. Site Comunicable Diseases Control Unit (CDCU), Victoria which acts as the only specialised STD clinic in the Seychelles Period February 1996 to March 1997 Study population All consecutive attendancies related to genital problems during the study period Materials and Methods Xth International Conference on AIDS and STD in Africa, December 1997

6. Culture isolation on Thaier Martin medium RPR TPHA reactive Culture onto Sabouraud destrose agar EIA Antigen detection (Sanofi Pasteur) wet mout preparation of vaginal specimens abnormal discharge AND vaginal PH >5 AND clue cells and vaginal Gram Xth International Conference on AIDS and STD in Africa, December 1997

7. The risk score method by WHO Presence of at least one of the following: • Age below 21 years • No stable parter • More than one partner in the previous month • Have changed fixed partner in the last three months (the presence of symptoms in the partner is usually included among the criteria but is rarely reliably recalled) Xth International Conference on AIDS and STD in Africa, December 1997

8. Prevalence of indicators for risk score method in 147 women with vaginal discharge or pelvic pain Age below 21 35 24% No fixed partners 59 40% >1 partner previous month 7 5% Changed part. previous 3 months 9 6% At least one of the above 70 48% Xth International Conference on AIDS and STD in Africa, December 1997

9. Presence of cervicitis in 147 females with vaginal discarge or pelvic pain Presence of cervicitis n = 12 Xth International Conference on AIDS and STD in Africa, December 1997

10. Risk score method and presence of cervicitis Cervicitis Yes No Total Yes 7 63 70 Risk factors No 5 72 77 Tot 12 135 147 Xth International Conference on AIDS and STD in Africa, December 1997

11. Risk score method and presence of cervicitis • Sensitivity 58% • Specificity 53% • Positive Predictive Value 10% • Negative Predictive Value 94% Xth International Conference on AIDS and STD in Africa, December 1997

12. Comments The risk assessement method proved neither sensitive nor specific in women with vaginal discharge or pelvic pain. This may be due to the low prevalence of STD risk indicators and low prevalence of cervicitis in this population. Xth International Conference on AIDS and STD in Africa, December 1997

13. Poster prepared and printed with the contribution of the European Commission - Project 7 ACP RPR 28 for STD/HIV action in the Indian Ocean Xth International Conference on AIDS and STD in Africa, December 1997