Skip to main content
PMC home page
Sexually Transmitted Infections logoLink to Sexually Transmitted Infections
. 2004 Jun;80(3):230–235. doi: 10.1136/sti.2003.007534

Low prevalence of cervical infections in women with vaginal discharge in west Africa: implications for syndromic management

J Pepin 1, S Deslandes 1, N Khonde 1, D Kintin 1, S Diakite 1, M Sylla 1, H Meda 1, F Sobela 1, C Asamoah-Adu 1, T Agyarko-Poku 1, E Frost 1
PMCID: PMC1744831  PMID: 15170011

Abstract

Objectives: To measure prevalence and risk factors for cervical infections among a large sample of women consulting for vaginal discharge in west Africa and to evaluate its syndromic management through a two visit algorithm.

Methods: In 11 health centres in Bénin, Burkina Faso, Ghana, Guinée, and Mali 726 women who presented with a vaginal discharge without abdominal pain and who denied being a sex worker (SW) were enrolled. Cervical samples were tested for the detection of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) with polymerase chain reaction (PCR) assays. All participants were treated with single dose (2 g) metronidazole and clotrimazole cream for 3 days. They were randomised to be told either to come back on day 7 only if there was no improvement in the discharge (group A), or to come back on day 7 regardless of response to treatment (group B).

Results: Overall, the prevalence of NG and CT was only 1.9% (14/726) and 3.2% (23/726) respectively. Risk factors previously recommended by the WHO were not associated with the presence of cervical infection, with the exception of the number of sex partners in the past 3 months. When taken together, these risk factors had a positive predictive value of only 6.4% to identify cervical infections. Prevalence of cervical infection was not higher in women who came back on day 7, regardless of the strategy used. Prevalence of NG/CT was lower in Ghana and Bénin (5/280, 1.8%), where comprehensive interventions for SW have been ongoing for years, than in the three other countries (27/446, 6.1%, p = 0.01).

Conclusions: NG and CT infections are uncommon in west African women who consult for vaginal discharge and who are not SW. Syndromic management of vaginal discharge should focus on the proper management of vaginitis. The control of gonococcal and chlamydial infection should be redesigned around interventions focusing on sex workers.

Full Text

The Full Text of this article is available as a PDF (74.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alary M., Baganizi E., Guèdèmè A., Padonou F., Davo N., Adjovi C., van Dyck E., Germain M., Joly J., Mahony J. B. Evaluation of clinical algorithms for the diagnosis of gonococcal and chlamydial infections among men with urethral discharge or dysuria and women with vaginal discharge in Benin. Sex Transm Infect. 1998 Jun;74 (Suppl 1):S44–S49. [PubMed] [Google Scholar]
  2. Alary Michel, Mukenge-Tshibaka Léonard, Bernier France, Geraldo Nassirou, Lowndes Catherine M., Meda Honoré, Gnintoungbè Cyriaque A. B., Anagonou Séverin, Joly Jean R. Decline in the prevalence of HIV and sexually transmitted diseases among female sex workers in Cotonou, Benin, 1993-1999. AIDS. 2002 Feb 15;16(3):463–470. doi: 10.1097/00002030-200202150-00019. [DOI] [PubMed] [Google Scholar]
  3. Asamoah-Adu C., Khonde N., Avorkliah M., Bekoe V., Alary M., Mondor M., Frost E., Deceuninck G., Asamoah-Adu A., Pépin J. HIV infection among sex workers in Accra: need to target new recruits entering the trade. J Acquir Immune Defic Syndr. 2001 Dec 1;28(4):358–366. doi: 10.1097/00126334-200112010-00009. [DOI] [PubMed] [Google Scholar]
  4. Behets F. M-T F., Andriamiadana J., Randrianasolo D., Rasamilalao D., Ratsimbazafy N., Dallabetta G., Cohen M. S. Laboratory diagnosis of sexually transmitted infections in women with genital discharge in Madagascar: implications for primary care. Int J STD AIDS. 2002 Sep;13(9):606–611. doi: 10.1258/09564620260216308. [DOI] [PubMed] [Google Scholar]
  5. Behets F. M., Miller W. C., Cohen M. S. Syndromic treatment of gonococcal and chlamydial infections in women seeking primary care for the genital discharge syndrome: decision-making. Bull World Health Organ. 2001;79(11):1070–1075. [PMC free article] [PubMed] [Google Scholar]
  6. Bogaerts J., Ahmed J., Akhter N., Begum N., Van Ranst M., Verhaegen J. Sexually transmitted infections in a basic healthcare clinic in Dhaka, Bangladesh: syndromic management for cervicitis is not justified. Sex Transm Infect. 1999 Dec;75(6):437–438. doi: 10.1136/sti.75.6.437. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Buvé A., Weiss H. A., Laga M., Van Dyck E., Musonda R., Zekeng L., Kahindo M., Anagonou S., Morison L., Robinson N. J. The epidemiology of gonorrhoea, chlamydial infection and syphilis in four African cities. AIDS. 2001 Aug;15 (Suppl 4):S79–S88. doi: 10.1097/00002030-200108004-00009. [DOI] [PubMed] [Google Scholar]
  8. Costello Daly C., Wangel A. M., Hoffman I. F., Canner J. K., Lule G. S., Lema V. M., Liomba N. G., Dallabetta G. A. Validation of the WHO diagnostic algorithm and development of an alternative scoring system for the management of women presenting with vaginal discharge in Malawi. Sex Transm Infect. 1998 Jun;74 (Suppl 1):S50–S58. [PubMed] [Google Scholar]
  9. Dallabetta G. A., Gerbase A. C., Holmes K. K. Problems, solutions, and challenges in syndromic management of sexually transmitted diseases. Sex Transm Infect. 1998 Jun;74 (Suppl 1):S1–11. [PubMed] [Google Scholar]
  10. Fonck K., Kidula N., Jaoko W., Estambale B., Claeys P., Ndinya-Achola J., Kirui P., Bwayo J., Temmerman M. Validity of the vaginal discharge algorithm among pregnant and non-pregnant women in Nairobi, Kenya. Sex Transm Infect. 2000 Feb;76(1):33–38. doi: 10.1136/sti.76.1.33. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Grosskurth H., Mosha F., Todd J., Mwijarubi E., Klokke A., Senkoro K., Mayaud P., Changalucha J., Nicoll A., ka-Gina G. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet. 1995 Aug 26;346(8974):530–536. doi: 10.1016/s0140-6736(95)91380-7. [DOI] [PubMed] [Google Scholar]
  12. Joesoef M. R., Schmid G. P., Hillier S. L. Bacterial vaginosis: review of treatment options and potential clinical indications for therapy. Clin Infect Dis. 1999 Jan;28 (Suppl 1):S57–S65. doi: 10.1086/514725. [DOI] [PubMed] [Google Scholar]
  13. Kamali A., Quigley M., Nakiyingi J., Kinsman J., Kengeya-Kayondo J., Gopal R., Ojwiya A., Hughes P., Carpenter L. M., Whitworth J. Syndromic management of sexually-transmitted infections and behaviour change interventions on transmission of HIV-1 in rural Uganda: a community randomised trial. Lancet. 2003 Feb 22;361(9358):645–652. doi: 10.1016/s0140-6736(03)12598-6. [DOI] [PubMed] [Google Scholar]
  14. Orroth K. K., Korenromp E. L., White R. G., Changalucha J., de Vlas S. J., Gray R. H., Hughes P., Kamali A., Ojwiya A., Serwadda D. Comparison of STD prevalences in the Mwanza, Rakai, and Masaka trial populations: the role of selection bias and diagnostic errors. Sex Transm Infect. 2003 Apr;79(2):98–105. doi: 10.1136/sti.79.2.98. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Pettifor A., Walsh J., Wilkins V., Raghunathan P. How effective is syndromic management of STDs?: A review of current studies. Sex Transm Dis. 2000 Aug;27(7):371–385. doi: 10.1097/00007435-200008000-00002. [DOI] [PubMed] [Google Scholar]
  16. Pépin J., Mabey D. Sexually transmitted infections in Africa: single dose treatment is now affordable. Sex Transm Infect. 2003 Dec;79(6):432–434. doi: 10.1136/sti.79.6.432. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Pépin J., Sobéla F., Deslandes S., Alary M., Wegner K., Khonde N., Kintin F., Kamuragiye A., Sylla M., Zerbo P. J. Etiology of urethral discharge in West Africa: the role of Mycoplasma genitalium and Trichomonas vaginalis. Bull World Health Organ. 2001;79(2):118–126. [PMC free article] [PubMed] [Google Scholar]
  18. Shaw M., van der Sande M., West B., Paine K., Ceesay S., Bailey R., Walraven G., Morison L., McAdam K. Prevalence of herpes simplex type 2 and syphilis serology among young adults in a rural Gambian community. Sex Transm Infect. 2001 Oct;77(5):358–365. doi: 10.1136/sti.77.5.358. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Walraven G., Scherf C., West B., Ekpo G., Paine K., Coleman R., Bailey R., Morison L. The burden of reproductive-organ disease in rural women in The Gambia, West Africa. Lancet. 2001 Apr 14;357(9263):1161–1167. doi: 10.1016/S0140-6736(00)04333-6. [DOI] [PubMed] [Google Scholar]
  20. Wawer M. J., Sewankambo N. K., Serwadda D., Quinn T. C., Paxton L. A., Kiwanuka N., Wabwire-Mangen F., Li C., Lutalo T., Nalugoda F. Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomised community trial. Rakai Project Study Group. Lancet. 1999 Feb 13;353(9152):525–535. doi: 10.1016/s0140-6736(98)06439-3. [DOI] [PubMed] [Google Scholar]

Articles from Sexually Transmitted Infections are provided here courtesy of BMJ Publishing Group

RESOURCES