Signs and symptoms of prevalent and incident cases of gonorrhea and genital chlamydial infection among female prostitutes in Kinshasa, Zaire

Most studies that have examined the clinical features of gonorrhoea and chlamydial infection have been based on prevalent cases (cases of undetermined onset). In their investigation, the authors compared signs and symptoms of incident (new) cases of these infections with those observed in prevalent cases (involving the same women) that were diagnosed at enrolment in a prospective study of female prostitutes in Kinshasa, Zaire. Neisseria gonorrhoeae or Chlamydia trachomatis was present at enrolment in 29.2% (225 of 771) of the women in the study. As they were followed during the study, 509 (66.0%) had at least one episode of gonorrhoea or chlamydial infection. No symptom was significantly associated with these infections at enrolment or during follow-up. Clinical signs, such as endocervical mucopus (P <0.001) and vaginal discharge (P = 0.001), were associated with both the prevalent and incident cases. However, none of these signs was simultaneously sensitive and specific for detection of these infections. The frequency of clinical signs was significantly reduced after successful treatment (all P values, <0.05). This study shows that a syndromic approach to screening for gonococcal and chlamydial infections in female prostitutes is as problematic for acute incident cases as for prevalent cases. Therefore, the authors believe that there is still an urgent need for simple, cheap, reliable tests that could be used in sexually transmitted disease intervention programmes in developing countries