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Lack of utility of risk score and gynecological examination for screening for sexually transmitted infections in sexually active adolescents
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Lack of utility of risk score and gynecological examination for screening for sexually transmitted infections in sexually active adolescents
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Journal Article
Lack of utility of risk score and gynecological examination for screening for sexually transmitted infections in sexually active adolescents
2009
Overview
Background
Sexually transmitted infections constitute the main health risk among adolescents. In developing countries the diagnosis and treatment of cervical infections is based on the syndromic approach. In this study we estimated the prevalence of
Chlamydia trachomatis
and
Neisseria gonorrhoeae
among female adolescents from a Health Sector of the city of Goiânia, Brazil, and validated cervicitis diagnosis using World Health Organization/Ministry of Health risk score and gynecological examination.
Methods
A cross-sectional community-based sample of 914 15- to 19-year-old female teenagers was randomly selected and referred to the local Family Health Program. Of these, 472 (51.6%) were sexually active and gynecological examinations were carried out for 427. Endocervical samples were collected to perform the polymerase chain reaction for
C. trachomatis
and
N. gonorrhoeae
. Performance of risk score, the presence of mucopurulent discharge, friability, ectopia and pain during cervical maneuver were compared with the presence of
C. trachomatis
or
N. gonorrhoeae
or both.
Results
The prevalence of
C. trachomatis
and
N. gonorrhoeae
was 14.5% and 2.1%, respectively. The risk score had a specificity of 31.9% (95% confidence interval, 21.2 to 44.2) and a positive predictive value of 20.8% (95% confidence interval, 13.5 to 29.7). Friability was the component of the gynecological examination that presented the best performance with a sensitivity of 43.5%, specificity of 81.0%, and 30.6% of positive predictive value.
Conclusion
The prevalence of infection by
C. trachomatis
and
N. gonorrhoeae
was high among these sexually active adolescents. The syndromic approach is clearly inadequate for screening and treating these infections in this population. Therefore, the implantation of other strategies to control these infections among adolescents is urgently required.
Publisher
BioMed Central,BioMed Central Ltd,BMC
Subject
/ Brazil
/ Chlamydia trachomatis - isolation & purification
/ Female
/ Humans
/ Lymphogranuloma Venereum - diagnosis
/ Lymphogranuloma Venereum - pathology
/ Lymphogranuloma Venereum - physiopathology
/ Medicine
/ Methods
/ Neisseria gonorrhoeae - isolation & purification
/ Polymerase Chain Reaction - methods
/ Prevalence studies (Epidemiology)
/ Sexually transmitted diseases
/ Youth
