- Keywords > Clinical Practice Guidelines (CPGs)
- Keywords > criteria of medicines selection
- Keywords > HIV infection and STIs
- Keywords > opportunistic infections and other HIV-related
- Keywords > reproductive tract infections
- Keywords > sexual and reproductive health
- Keywords > sexually transmitted infections (STIs)
- Keywords > treatment guidelines
- Keywords > treatment protocols
(2004; 88 pages)
1.5. Risk factors for STI-related cervicitis
The algorithms currently available for the management of cervical infection are far from ideal. Initially, it was thought that the finding of vaginal discharge would be indicative of both vaginal and cervical infection. However, it has become clear that while vaginal discharge is indicative of the presence of vaginal infection, it is poorly predictive of cervical infection (gonococcal and/or chlamydial), particularly in adolescent females.
Some clinical signs seem to be more frequently associated with the presence of cervical infection. In the published literature, clinical observations that have been consistently found to be associated with cervical infection are the presence of cervical muco-pus, cervical erosions, cervical friability and bleeding between menses or during sexual intercourse.
A number of demographic and behavioural risk factors have also been frequently associated with cervical infection. Some of those which, in some settings, have been found to be predictive of cervical infection are age below 21 years (or 2 5 in some settings), being unmarried, more than one sexual partner in the last 3 months, new partner in the previous 3 months, currently partner has a sexually transmitted infection and recent use of condoms by the partner. Such risk factors are, however, usually specific for the population group for which they have been identified and validated, and cannot easily be extrapolated to other populations or to other countries. Most researchers have suggested that more than 1 demographic risk factor in any particular patient is more valid than just a single one, but that clinical signs can be valid as a single factor.
Adding these signs and a risk assessment to the vaginal discharge algorithm does increase its specificity and, thus, the positive predictive value, although the latter remains low, especially when the algorithm is applied to populations with relatively low rates of infection.