Inadequacy of current guidelines for STIs

Adolescent girls reveal alarmingly high rates of sexually transmitted infections (STIs) which remain largely undetected by recommended screening guidelines.

A study in Brazil, reported in the open access journal BMC Medicine , has shown that the syndromic approaches for screening and treating chlamydia and gonorrhoea are woefully inadequate.

Maria de Fátima C. Alves and a team of researchers from the Federal Universities of Goiás and Minas Gerais and the Family Health Program, Brazil, investigated chlamydia and gonorrhoea infections among sexually-active girls, aged 15-19 years in a socially-deprived region of the city of Goiânia. They discovered that the frequency of chlamydial infection was particularly high (14.5%).

The researchers compared screening methods recommended by the World Health Organization (WHO) and the Brazilian Ministry of Health against definitive laboratory methods. They attempted to diagnose infection using the WHO risk assessment score - a questionnaire concerning sexual practices, reproductive life and gynaecological symptoms - and a gynaecological examination. Disturbingly, they found that only 32% of women with a confirmed infection were correctly identified using the WHO risk assessment. The gynaecological examination fared slightly better with a maximum sensitivity of 43.5%. The authors report, "The low sensitivity of the risk assessment score should be of major public health concern and implies that it should not be used as a screening tool or a diagnostic test among asymptomatic or poorly symptomatic women".

Alves notes "These results are worrying. It is well-known that STIs increase the likelihood of HIV transmission therefore the control of STIs is imperative, not only because of the damaging nature of chlamydia and gonorrhoea to young women, but also because of their relationship with HIV."

The authors conclude, "The development of rapid and less costly tests for chlamydia and gonorrhoea diagnosis in resource-poor public health services are urgently needed as are studies regarding the prevalence of infection in other regions of Brazil". The results of this study should convince policy makers in Brazil to devise other strategies for controlling STIs in adolescents.