Detecting Asymptomatic STDs

- Current risk assessment strategies are not a valid tool for identifying STDs in women without symptoms.

The main obstacle to managing STDs other than syphilis in asymptomatic women is the absence of valid, feasible and affordable case-finding and screening strategies, particularly for gonococcal and chlamydial infection. Results of a study conducted by AIDSCAP in Jamaica and by others attempting to define a risk profile for infected asymptomatic women have been disappointing. This study found that risk assessment scores derived from current flowcharts are neither sensitive nor specific enough for widespread use. However, imperfect approaches that include risk assessment may be a better option than doing nothing at all, particularly in areas where STD prevalence is high. Moreover, risk assessment may continue to play a role in the management of STDs in asymptomatic women because risk scores could be used to determine who should be tested for a sexually transmitted infection when an appropriate test becomes available.

- Partner referral is possible in a variety of settings.

Reaching partners of STD patients with treatment — a long neglected component of STD management in most countries — has great potential for improving STD control because it results in treatment of asymptomatic partners, particularly women. AIDSCAP's improved partner management systems in ante-natal clinics in Haiti attained referral rates of 30 percent.

This pilot study found that almost half of the women attending two Haitian ante-natal clinics had one or more STDs. Ninety percent of the women agreed to inform their partners, and 30 percent of the 331 men named by 384 women sought treatment. Health workers found that men were more willing to come for treatment when the problem was framed in the context of preserving fertility or ensuring healthy offspring. When men who had come to the clinic were asked why it was important to them to receive treatment, one of the most common responses was "to protect the child."

- Health workers without any laboratory experience can be trained to perform accurate syphilis blood tests, making it possible to expand syphilis screening of pregnant women.

An effective, affordable treatment for syphilis is available, yet hundreds of thousands of undetected and untreated maternal syphilis cases lead to fetal loss, infant death or congenital abnormalities every year. Too often, logistical and managerial obstacles impede use of the rapid, simple, inexpensive syphilis diagnostic test for routine screening in ante-natal clinics. In Jamaica, AIDSCAP worked with the Ministry of Health to remove some of the obstacles in a successful effort to decentralize syphilis testing.