Search

The struggle against sexually transmitted diseases (STD) constitutes a priority of public health in developing countries: STD cause complications, particularly in pregnant women, and facilitate the transmission of HIV. One of the strategies in the struggle against STD is the diagnosis and the early treatment of these infections. The STD, and in particular infections of Neisseria gonorrhea and Chlamydia trachomatis, are difficult to diagnose in women without complementary analyses, which primary health care may not be able to supply. Health care provided to patients could be standardized and improved by considering the signs and symptoms. We studied the prevalence and risk factors of STD among 192 pregnant women consulting the health clinic in Libreville, Gabon, in September 1993. The prevalence of STD was high (13.5% rate of cervical infection with gonorrhea or Chlamydia trachomatis). We then evaluated the different diagnostic strategies or algorithms. Regardless of the type of examination (medical interview, simple clinical examination or examination with a speculum), the use of scores integrating risk factors, the clinical signs and symptoms outperformed hierarchical algorithms. This approach was more sensitive and specific and easy to perform. Use of this method may enable more effective screening of STD and also avoid most maternal and perinatal complications.

The prevalence of some sexually transmitted disease is determined in 250 gynaecology patients and in 200 pregnant women seen in primary health centers in Pikine, Senegal. The main reason for consultation at gynaecology is infertility. Gonorrhoea and Chlamydia trachomatis infection are present respectively in 1.5% and 7% of pregnant women and in 4.4% and 7.6% of gynaecology patients. Human papillomavirus infection, determined by DNA extraction and hybridization technique, is seen in 4% of obstetric and in 1.2% of gynecology patients. Cytological anomalies is found in 5.5% of pregnant women and in 4.8% of gynecology patients.