Description

Behets et al developed a clinical algorithm for diagnosis and management of women seen at a sexually transmitted disease (STD) clinic in Jamaica. This was designed for use in developing countries, where support services may be lacking and there is a need to manage many patients as cheaply as possible.


 

Evaluation and management steps:

(1) take history and determine risk factor score

(2) do pelvic examination, including speculum examination

(3) observe nature of vaginal discharge

(4) clean and inspect cervix

(5) give prevention message.

 

Risk Factor Score

Parameter

Finding

Points

partner has a urethral discharge

yes

2

 

no

0

age

< 21 years

1

 

>= 21 years

0

new partner in the last 3 months

yes

1

 

no

0

number of partners in last 3 months

> 1

1

 

0 or 1

0

living with steady partner

no

1

 

yes

0

 

score =

= SUM(points for 5 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 6

 

Discharge

Type

Treat for

vaginal

runny or malodorous

trichomonas, bacterial vaginosis

 

white, curdlike

yeast

cervical

mucopus

gonorrhea, chlamydia, trichomoniasis

none

score >= 2

gonorrhea, chlamydia, trichomoniasis

 

score < 2

none

 

Algorithm performance:

• Evaluated in a high prevalence population (at least 1 STD in 54% of patients).

• The algorithm deemed 84% sensitive and 40% specific for cervical infection.

• The algorithm was 85-88% sensitive for diagnosing trichomoniasis.

• Positive predictive value for cervical infection about 42%, with negative predictive value 78-81%.

 


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