Direct questioning is more effective than patient-initiated report for the detection of sexually transmitted infections in a primary care HIV clinic in Western Kenya

Abstract

In resource-limited settings, detection of sexually transmitted infections (STIs) often relies on self-reported symptoms to initiate management. We found self-report demonstrated poor sensitivity for STI detection. Adding clinician-initiated questions about symptoms improved detection rates. Vaginal examination further increased sensitivity. Including clinician-initiated screening in resource-limited settings would improve management of treatable STIs.

Figure 1

Study schematic depicting the order of evaluation methods for diagnosis of STIs in HIV-infected women in Western Kenya.

Figure 2

Sensitivity, specificity, and positive predictive value of 4 evaluation methods for diagnosis of STIs: self-report in response to general health question at a routine visit, brief prompt defined as a single screening question: detailed prompt defined as specific questions targeted toward STI detection, and clinical examination defined as genital examination with speculum.