Syndromic versus laboratory-based diagnosis of cervical infections among female sex workers in Benin: implications of nonattendance for return visits.

Background: The syndromic diagnostic approach is the most realistic and cost-effective strategy for controlling sexually transmitted infections (STIs) in the developing world. Its potential advantages should be evaluated.

Goal: The goal of the current study was to examine whether the syndromic approach might diagnose more cases of cervicitis due to Neisseria gonorrhoeae or Chlamydia trachomatis than laboratory tests.

Study Design: The participants were 481 female sex workers in Benin, screened for STIs and treated on the basis of the clinical findings. They were asked to return to the clinic within 10 days for laboratory test results and appropriate treatment when necessary.

Results: The prevalence of cervical infections was 24.5%. In comparison to the gold standard, the sensitivity of the syndromic diagnosis approach for the detection of N gonorrhoeae/C trachomatis infections was 48.3%; that of the locally performed laboratory tests was 74.6%. However, the sensitivity of the laboratory tests dropped to 28.8% when it was taken into consideration that 57.6% of the infected women did not return to the clinic within 10 days.

Conclusions: The syndromic diagnosis approach should continue to be used for female sex workers in Benin because returning for treatment is problematic. Presumptive treatment at their initial visit could be a complement to this approach, given the high prevalence of cervicitis in this population.