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Sex Transm Dis. 1994 Mar-Apr;21(2 Suppl):S84-5.

Rapid sexually transmitted disease assessment in two developing countries.

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1
World Bank, Washington, DC 20009.

Abstract

Two rapid assessment studies of the magnitude of sexually transmitted disease (STD) were performed in Senegal and Uganda in 1989 and 1990. The study objectives were: to develop and validate STD indicators for the "rapid" assessment of the frequency of STD in populations; and to develop a standardized survey methodology to assess STD prevalence using these indicators. The World Bank, World Health Organization (WHO), and Senegal and Ugandan government officials desired a product similar to the WHO/UNICEF immunization coverage survey instrument, which is an accepted and proven methodology, implemented by national programs and donors worldwide. Three indicators were used: 1) past or present signs of selected STD; 2) symptoms as noted by a clinician; and 3) simple laboratory tests performed and results obtained at examination. Each indicator was validated against a confirmatory laboratory test considered the gold standard in indicating the presence or absence of an STD. Male military members, women seeking prenatal care, and female prostitutes were the three population groups chosen. With the exception of the rapid plasma reagin (RPR) test for syphilis, symptoms, signs, and simple laboratory tests failed to accurately predict STD in individuals in all three of these population groups. Indicators for the major STD other than syphilis among populations not seeking STD care will have to be the "gold standard laboratory tests" until easy-to-perform and low-cost alternatives are found.

PIP:

World Health Organization technical advisors traveled to Senegal in 1990 and to Uganda in 1991 to conduct rapid assessment studies of the prevalence of sexually transmitted diseases (STDs). They aimed to generate and authenticate STD indicators for the rapid assessment of the frequency of STD at the district and national levels and to construct a standardized survey methodology to measure STD prevalence using these indicators. Methodology qualifiers were low cost and easy to perform. The researchers validated each of the 3 STD indicators against a confirmatory laboratory test (the gold standard). The 3 indicators were self- reported past or present signs of an STD, symptoms noted by a clinician during an exam, and simple laboratory tests that produce results during the exam. They conducted epidemiologic surveys on male military personnel, pregnant women seeking prenatal care, and female prostitutes. STD rates were greatest among prostitutes (2.2- 29.2% vs. 1.3-9.2% for pregnant women and 0.6-5.7% for military personnel), except for trichomoniasis which was greatest in pregnant women (32.7% vs. 29.2%). Overall, symptoms, signs, and simple laboratory tests did not accurately predict STD in all 3 groups. Yet, the serologic rapid plasma reagin (RPR) test for syphilis was sensitive and specific and is a good rapid and simple indicator for syphilis. A self-reported history of STD symptoms in men and pregnant women with low STD prevalence and prostitutes with high STD prevalence had both low sensitivity and specificity. Even though clinician-noted signs and simple laboratory tests had greater sensitivity than did the first indicator, they still did not always identify the presence of STD in some people. These findings show that the gold standard laboratory tests must be used for prevalence assessments of gonorrhea, chlamydia, and trichomoniasis. Inexpensive, easy-to-perform alternatives to the gold standard are needed for these 3 STDs.

PMID:
8042125
[Indexed for MEDLINE]
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