Assessment of the validity of and adherence to sexually transmitted infection algorithms at a female sex worker clinic in Abidjan, Côte d'Ivoire

Background: Algorithms for sexually transmitted infection (STI) case management were designed in a female sex worker (FSW) clinic in Abidjan, Côte d'Ivoire, in 1993.

Goal: The goal was to evaluate the long-term validity of the algorithms for returning clients of the clinic and to assess the adherence of the health workers to their application.

Study design: A cross-sectional study was conducted from 1999 to 2000 among FSWs attending as returning clients.

Results: The prevalences of genital infections were as follows: Neisseria gonorrhoeae and/or Chlamydia trachomatis, 8.2%; Trichomonas vaginalis, 16.7%; bacterial vaginosis, 62.3%; and Candida albicans, 6.2%. The sensitivity of the algorithms was 20% and the positive predictive value was 14% for cervical infection. The proportion of cases for which all steps of the algorithm were correctly applied was 30%.

Conclusion: Algorithms for the treatment of STIs in FSWs should be periodically reevaluated and adapted to the changing population. To maintain healthcare workers' adherence to the algorithms, supervision should be ongoing and reinforced.