1. Xth International Conference on AIDS and STD in Africa, December 1997
Clinical Assessment of Cervical Status is predictive of Cervical Infection in Female STD Patients in The Seychelles
Ministry of Health, Seychelles
N. E. Udonwa
J. Nwosu
G. Furneau
M. Francoise
J. Freminot
P. Confait
Clinic of Infectious and Tropical Diseases
University of Brescia, Italy
A. Matteelli
C. Farina
F. Casteli
L. Signorini
Xth International Conference on AIDS and STD in Africa, December 1997
Xth International Conference on AIDS and STD in Africa, December 1997

2. Xth International Conference on AIDS and STD in Africa, December 1997
ABSTRACT
Objectives: Risk assessment methods has proved to be an insensitive predictors of cervical infections among women presenting with vaginal discharge in the Seychelles. We therefore assessed the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the clinical assessment of cervical status in the same population group.
Methods: All consecutive women with STD related complaints attending the only categorical STD clinic in the Seychelles during the period February 1996 – March 1997 were enrolled. Anagraphic and behavioural data were collected by interview. Physical examination with speculum was performed by any of the physicians and nurses working at the STD clinic. The cervical status was categorized as normal, with mucopus, erosion, or bleeding at touch. A diagnosis of cervicitis was based on etiological evidence: N. gonorrhoea was isolated from cervical swabs onto enriches Tayer Martin agar plates; C. trachomatis antigens were detected from cervical swabs using the EIA Sanofi test. Data were computed in Dbase file and analysed with the epiinfo program.
Results: 170 women were enrolled, of whom 147 (86%) had either vaginal discharge and/or lower abdominal pain. The mean age was 27 (range 14-48) (78%) had a stable job, 70 (41%) were single, 151 (89%) had sex with a single partner during the previous month. Completed clinical and microbiological information was available for (3%), 58 bleeding at clinical assessment. A diagnosis of cervical infection was made in 11 (7%), all infected by Chlamydia trachomatis including one with Gonococcal co-infection. The sensitivity, specification, PPV and NPV of the presence of any one of the above clinical abnormalities of the cervix were 100%, 42%, 12%, 100%.
Comments: Clinical examination with speculum insertion is feasible at central and peripheral stations of the public health system in the Seychelles. The presence of cervical abnormalities seems to be a sensitive, though non specific, indicator of cervical infection in our sample of women with low prevalence of STD risk indicators.
Xth International Conference on AIDS and STD in Africa, December 1997

3. Xth International Conference on AIDS and STD in Africa, December 1997
Facts
The risk assessement method has proved neither sensitive nor specific in women with vaginal discharge or pelvic pain in the Seychelles.
There is low prevalence of STD risk indicators and low prevalence of cervicitis in the population.
Xth International Conference on AIDS and STD in Africa, December 1997

4. Xth International Conference on AIDS and STD in Africa, December 1997
Questions
Can the presence of cervical abnormality be a sensitive indicator of cervical infection in women with low prevalence of STD Risk Indicators?
Xth International Conference on AIDS and STD in Africa, December 1997

5. Xth International Conference on AIDS and STD in Africa, December 1997
Materials and Methods
Period
February 1996 to March 1997
Study population
All consecutive attendancies related to genital problems during the study period
Site
Comunicable Diseases Control Unit (CDCU), Victoria, which acts as the only specialised STD clinic in the Seychelles
Xth International Conference on AIDS and STD in Africa, December 1997

6. Xth International Conference on AIDS and STD in Africa, December 1997
EIA Antigen detection (Sanofi Pasteur)
wet mout preparation of vaginal specimens
abnormal discharge AND
vaginal PH >5 AND
clue cells and vaginal Gram
Culture isolation on Tayer Martin medium
RPR TPHA reactive
Culture onto Sabouraud destrose agar
Xth International Conference on AIDS and STD in Africa, December 1997

7. Xth International Conference on AIDS and STD in Africa, December 1997
Facts
Women presenting with genital discharge or pelvic pain in the Seychelles are much more likely to have vaginal (70%) rather than cervical infections (8%).
However, cervical infections determine more severe morbidity and represent a public health problem due to sexual transmission.
Xth International Conference on AIDS and STD in Africa, December 1997

8. Xth International Conference on AIDS and STD in Africa, December 1997
Results
Study sample: Males
Females 170
Males Females
Age mean
range
% with stable job
% with secondary education
% single
Anagraphic characteristics
Xth International Conference on AIDS and STD in Africa, December 1997

9. Xth International Conference on AIDS and STD in Africa, December 1997
Results (Cont’d)
Sexuals habits
Males Females
% heterosexual habit
Mean age at first coitus
% reporting oral sex
% reporting anal sex
% with > 1 partners (last month)
% changed partner (last 3 months)
% never used condom
Xth International Conference on AIDS and STD in Africa, December 1997

10. Xth International Conference on AIDS and STD in Africa, December 1997
Presence of clinical abnormalities of the cervix in 170 women
Mucopus %
Erosions %
Bleeding at touch %
At least one of the above %
Xth International Conference on AIDS and STD in Africa, December 1997

11. Xth International Conference on AIDS and STD in Africa, December 1997
Aetiological diagnosis among 11 cases of cervical infection
Xth International Conference on AIDS and STD in Africa, December 1997

12. Xth International Conference on AIDS and STD in Africa, December 1997
Cervical abnormalities at clinical examination and presence of cervicitis
Cervicitis
Yes No Total
Yes
Abnormalities No
Tot
Xth International Conference on AIDS and STD in Africa, December 1997

13. Xth International Conference on AIDS and STD in Africa, December 1997
Clinical abnormalities of the cervix and presence of cervicitis
Sensitivity %
Specificity %
Positive Predictive Value 12%
Negative Predictive Value 100%
Xth International Conference on AIDS and STD in Africa, December 1997

14. Xth International Conference on AIDS and STD in Africa, December 1997
Comments
Clinical examination with speculum insertion is feasible at central and peripheral sations of the public health system in the Seychelles.
The presence of cervical abnormalities at clinical examination has higher sensitivity than the risk score method and is feasible at central and peripheral health centres in the Seychelles.
Xth International Conference on AIDS and STD in Africa, December 1997

15. Xth International Conference on AIDS and STD in Africa, December 1997
Poster prepared and printed with the contribution
of the European Commission - Project 7 ACP
RPR 28 for STD/HIV action in the Indian Ocean
Xth International Conference on AIDS and STD in Africa, December 1997