Prevalence of reproductive tract infections and the predictive value of girls' symptom-based reporting: findings from a cross-sectional survey in rural western Kenya.
Prevalence of reproductive tract infections and the predictive value of girls' symptom-based reporting: findings from a cross-sectional survey in rural western Kenya.
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DOI：
10.1136/sextrans-2015-052371
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发表时间：
2016-06
影响因子：
3.6
通讯作者：
Phillips-Howard PA
中科院分区：
文献类型：
--
作者：
Kerubo E;Laserson KF;Otecko N;Odhiambo C;Mason L;Nyothach E;Oruko KO;Bauman A;Vulule J;Zeh C;Phillips-Howard PA
青春期女孩中的生殖道感染，包括获得性感染，是一个公共卫生问题，但很少有研究衡量中低收入国家的发病率。这项研究的目的是根据报告的症状检查肯尼亚农村女学生的流行率。2013年，对542名14-17岁的青春期女学生进行了一项调查，她们参加了月经可行性研究。在训练有素的护士对女孩的症状进行面对面采访后，进行阴道自我擦拭。计算有症状的女孩和实验室确认的感染的患病率，以及症状与实验室结果比较的敏感性、特异性、阳性预测值和阴性预测值。在515名同意自我擦拭的女孩中，有510人回答了症状问题。四分之一(24%)报告了一种或多种症状；最常见的是阴道分泌物(11%)、疼痛(9%)或瘙痒(4%)。实验室检测证实，28%的女孩有一次或多次RTI。患病率随着年龄的增长而上升；在16-17岁的 女孩中，33%有感染。细菌性阴道病最常见(18%)，其次是白色念珠菌(9%)、沙眼衣原体(3%)、阴道毛滴虫(3%)和淋球菌(1%)。报告的症状敏感度和阳性预测值都很低。四分之三患有细菌性阴道病和白色念珠菌的女孩，以及50%患有阴道毛滴虫的女孩没有症状。在肯尼亚农村，青春期女学生感染RTI的比例很高。需要公共努力来识别和治疗女孩中的感染，以减少长期后遗症，但症状报告的可靠性较差，最大限度地减少了基于症状的诊断在这一人群中的效用。ISRCTN17486946。
Reproductive tract infections (RTIs), including sexually acquired, among adolescent girls is a public health concern, but few studies have measured prevalence in low-middle-income countries. The objective of this study was to examine prevalence in rural schoolgirls in Kenya against their reported symptoms. In 2013, a survey was conducted in 542 adolescent schoolgirls aged 14–17 years who were enrolled in a menstrual feasibility study. Vaginal self-swabbing was conducted after girls were interviewed face-to-face by trained nurses on symptoms. The prevalence of girls with symptoms and laboratory-confirmed infections, and the sensitivity, specificity, positive and negative predictive values of symptoms compared with laboratory results, were calculated. Of 515 girls agreeing to self-swab, 510 answered symptom questions. A quarter (24%) reported one or more symptoms; most commonly vaginal discharge (11%), pain (9%) or itching (4%). Laboratory tests confirmed 28% of girls had one or more RTI. Prevalence rose with age; among girls aged 16–17 years, 33% had infections. Bacterial vaginosis was the most common (18%), followed by Candida albicans (9%), Chlamydia trachomatis (3%), Trichomonas vaginalis (3%) and Neisseria gonorrhoeae (1%). Reported symptoms had a low sensitivity and positive predictive value. Three-quarters of girls with bacterial vaginosis and C. albicans, and 50% with T. vaginalis were asymptomatic. There is a high prevalence of adolescent schoolgirls with RTI in rural Kenya. Public efforts are required to identify and treat infections among girls to reduce longer-term sequelae but poor reliability of symptom reporting minimises utility of symptom-based diagnosis in this population. ISRCTN17486946.