Skip to main content
PMC home page
Sexually Transmitted Infections logoLink to Sexually Transmitted Infections
. 2000 Feb;76(1):33–38. doi: 10.1136/sti.76.1.33

Validity of the vaginal discharge algorithm among pregnant and non-pregnant women in Nairobi, Kenya

K Fonck 1, N Kidula 1, W Jaoko 1, B Estambale 1, P Claeys 1, J Ndinya-Achola 1, P Kirui 1, J Bwayo 1, M Temmerman 1
PMCID: PMC1760552  PMID: 10817066

Abstract

Objective: To evaluate the validity of different algorithms for the diagnosis of gonococcal and chlamydial infections among pregnant and non-pregnant women consulting health services for vaginal discharge in Nairobi, Kenya.

Methods: Cross sectional study among 621 women with complaints of vaginal discharge in three city council clinics between April and August 1997. Women were interviewed and examined for symptoms and signs of sexually transmitted infections (STIs). Specimens were obtained for laboratory diagnosis of genital infections, HIV, and syphilis. The data were used to evaluate the Kenyan flow chart as well as several other generated algorithms.

Results: The mean age was 24 years and 334 (54%) were pregnant. The overall prevalence rates were: 50% candidiasis, 23% trichomoniasis, 9% bacterial vaginosis, 7% gonorrhoea, 9% chlamydia, 7% syphilis, and 22% HIV. In non-pregnant women, gonococcal and chlamydial infection was significantly associated with (1) demographic and behavioural risk markers such as being single, younger than 20 years, multiple sex partners in the previous 3 months; (2) symptom fever; and (3) signs including presence of yellow or bloody vaginal discharge, cervical mucopus, cervical erythema, and friability. Among pregnant women only young age, dysuria, and fever were significantly associated with cervical infection. However, none of these variables was either sensitive or specific enough for the diagnosis of cervical infection. Several algorithms were generated and applied to the study data. The algorithm including risk markers performed slightly better than the current Kenyan algorithm.

Conclusion: STIs form a major problem in the Nairobi area and should be addressed accordingly. None of the tested algorithms for the treatment of vaginal discharge would constitute a marked improvement of the existing flow chart. Hence, better detection tools for the specific aetiology of vaginal discharge are urgently needed.

Key Words: algorithm; sexually transmitted diseases; pregnancy; Kenya

Full Text

The Full Text of this article is available as a PDF (132.4 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. Braddick M. R., Ndinya-Achola J. O., Mirza N. B., Plummer F. A., Irungu G., Sinei S. K., Piot P. Towards developing a diagnostic algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae cervicitis in pregnancy. Genitourin Med. 1990 Apr;66(2):62–65. doi: 10.1136/sti.66.2.62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. 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]
  4. Daly C. C., Maggwa N., Mati J. K., Solomon M., Mbugua S., Tukei P. M., Hunter D. J. Risk factors for gonorrhoea, syphilis, and trichomonas infections among women attending family planning clinics in Nairobi, Kenya. Genitourin Med. 1994 Jun;70(3):155–161. doi: 10.1136/sti.70.3.155. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Diallo M. O., Ghys P. D., Vuylsteke B., Ettiègne-Traoré V., Gnaoré E., Soroh D., Kadjo J. C., Van Dyck E., De Cock K. M., Greenberg A. E. Evaluation of simple diagnostic algorithms for Neisseria gonorrhoeae and Chlamydia trachomatis cervical infections in female sex workers in Abidjan, Côte d'Ivoire. Sex Transm Infect. 1998 Jun;74 (Suppl 1):S106–S111. [PubMed] [Google Scholar]
  6. Easmon C. S., Hay P. E., Ison C. A. Bacterial vaginosis: a diagnostic approach. Genitourin Med. 1992 Apr;68(2):134–138. doi: 10.1136/sti.68.2.134. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Germain M., Alary M., Guèdèmè A., Padonou F., Davo N., Adjovi C., Van Dyck E., Joly J. R., Mahony J. B. Evaluation of a screening algorithm for the diagnosis of genital infections with Neisseria gonorrhoeae and Chlamydia trachomatis among female sexworkers in Bénin. Sex Transm Dis. 1997 Feb;24(2):109–115. doi: 10.1097/00007435-199702000-00009. [DOI] [PubMed] [Google Scholar]
  8. 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]
  9. Kreiss J., Willerford D. M., Hensel M., Emonyi W., Plummer F., Ndinya-Achola J., Roberts P. L., Hoskyn J., Hillier S., Kiviat N. Association between cervical inflammation and cervical shedding of human immunodeficiency virus DNA. J Infect Dis. 1994 Dec;170(6):1597–1601. doi: 10.1093/infdis/170.6.1597. [DOI] [PubMed] [Google Scholar]
  10. Laga M., Alary M., Nzila N., Manoka A. T., Tuliza M., Behets F., Goeman J., St Louis M., Piot P. Condom promotion, sexually transmitted diseases treatment, and declining incidence of HIV-1 infection in female Zairian sex workers. Lancet. 1994 Jul 23;344(8917):246–248. doi: 10.1016/s0140-6736(94)93005-8. [DOI] [PubMed] [Google Scholar]
  11. Laga M., Nzila N., Goeman J. The interrelationship of sexually transmitted diseases and HIV infection: implications for the control of both epidemics in Africa. AIDS. 1991;5 (Suppl 1):S55–S63. [PubMed] [Google Scholar]
  12. Leroy V., Ladner J., Nyiraziraje M., De Clercq A., Bazubagira A., Van de Perre P., Karita E., Dabis F. Effect of HIV-1 infection on pregnancy outcome in women in Kigali, Rwanda, 1992-1994. Pregnancy and HIV Study Group. AIDS. 1998 Apr 16;12(6):643–650. doi: 10.1097/00002030-199806000-00014. [DOI] [PubMed] [Google Scholar]
  13. Mayaud P., Grosskurth H., Changalucha J., Todd J., West B., Gabone R., Senkoro K., Rusizoka M., Laga M., Hayes R. Risk assessment and other screening options for gonorrhoea and chlamydial infections in women attending rural Tanzanian antenatal clinics. Bull World Health Organ. 1995;73(5):621–630. [PMC free article] [PubMed] [Google Scholar]
  14. Mayaud P., Mosha F., Todd J., Balira R., Mgara J., West B., Rusizoka M., Mwijarubi E., Gabone R., Gavyole A. Improved treatment services significantly reduce the prevalence of sexually transmitted diseases in rural Tanzania: results of a randomized controlled trial. AIDS. 1997 Dec;11(15):1873–1880. doi: 10.1097/00002030-199715000-00013. [DOI] [PubMed] [Google Scholar]
  15. Mayaud P., ka-Gina G., Cornelissen J., Todd J., Kaatano G., West B., Uledi E., Rwakatare M., Kopwe L., Manoko D. Validation of a WHO algorithm with risk assessment for the clinical management of vaginal discharge in Mwanza, Tanzania. Sex Transm Infect. 1998 Jun;74 (Suppl 1):S77–S84. [PubMed] [Google Scholar]
  16. Plummer F. A., Simonsen J. N., Cameron D. W., Ndinya-Achola J. O., Kreiss J. K., Gakinya M. N., Waiyaki P., Cheang M., Piot P., Ronald A. R. Cofactors in male-female sexual transmission of human immunodeficiency virus type 1. J Infect Dis. 1991 Feb;163(2):233–239. doi: 10.1093/infdis/163.2.233. [DOI] [PubMed] [Google Scholar]
  17. Ryder R. W., Temmerman M. The effect of HIV-1 infection during pregnancy and the perinatal period on maternal and child health in Africa. AIDS. 1991;5 (Suppl 1):S75–S85. [PubMed] [Google Scholar]
  18. Temmerman M., Chomba E. N., Ndinya-Achola J., Plummer F. A., Coppens M., Piot P. Maternal human immunodeficiency virus-1 infection and pregnancy outcome. Obstet Gynecol. 1994 Apr;83(4):495–501. doi: 10.1097/00006250-199404000-00002. [DOI] [PubMed] [Google Scholar]
  19. Temmerman M., Lopita M. I., Sanghvi H. C., Sinei S. K., Plummer F. A., Piot P. The role of maternal syphilis, gonorrhoea and HIV-1 infections in spontaneous abortion. Int J STD AIDS. 1992 Nov-Dec;3(6):418–422. doi: 10.1177/095646249200300603. [DOI] [PubMed] [Google Scholar]
  20. Temmerman M., Plummer F. A., Mirza N. B., Ndinya-Achola J. O., Wamola I. A., Nagelkerke N., Brunham R. C., Piot P. Infection with HIV as a risk factor for adverse obstetrical outcome. AIDS. 1990 Nov;4(11):1087–1093. doi: 10.1097/00002030-199011000-00006. [DOI] [PubMed] [Google Scholar]
  21. Thomas T., Choudhri S., Kariuki C., Moses S. Identifying cervical infection among pregnant women in Nairobi, Kenya: limitations of risk assessment and symptom-based approaches. Genitourin Med. 1996 Oct;72(5):334–338. doi: 10.1136/sti.72.5.334. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Vuylsteke B., Laga M., Alary M., Gerniers M. M., Lebughe J. P., Nzila N., Behets F., Van Dyck E., Piot P. Clinical algorithms for the screening of women for gonococcal and chlamydial infection: evaluation of pregnant women and prostitutes in Zaire. Clin Infect Dis. 1993 Jul;17(1):82–88. doi: 10.1093/clinids/17.1.82. [DOI] [PubMed] [Google Scholar]
  23. Wawer M. J., Gray R. H., Sewankambo N. K., Serwadda D., Paxton L., Berkley S., McNairn D., Wabwire-Mangen F., Li C., Nalugoda F. A randomized, community trial of intensive sexually transmitted disease control for AIDS prevention, Rakai, Uganda. AIDS. 1998 Jul 9;12(10):1211–1225. doi: 10.1097/00002030-199810000-00014. [DOI] [PubMed] [Google Scholar]

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

RESOURCES