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Direct Questioning Is More Effective Than Patient-Initiated Report for the Detection of Sexually Transmitted Infections in a Primary Care HIV Clinic in Western Kenya

Woo, Victoria Gah Hay MD*†; Cohen, Craig R. MD, MPH; Bukusi, Elizabeth A. MBChB, MMed, PhD, MPH†‡; Huchko, Megan J. MD, MPH

doi: 10.1097/OLQ.0b013e318278bf97

Abstract: In resource-limited settings, detection of sexually transmitted infections (STIs) often relies on self-reported symptoms to initiate management. We found self-report demonstrated poor sensitivity for STI detection. Adding clinician-initiated questions about symptoms improved detection rates. Vaginal examination further increased sensitivity. Including clinician-initiated screening in resource-limited settings would improve management of treatable STIs.

A study in a resource-limited, primary care HIV clinic found that detection of sexually transmitted infections increased with the addition of directed questions compared with self-report after a general health question.

From the *Stanford University School of Medicine, Palo Alto; †Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA; and ‡Research Care and Training Program, Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.

We would like to thank our study and clinical staff at Family AIDS Care and Education Services for their hard work in sexually transmitted infection screening and treatment. We also thank the Director of Kenya Medical Research Institute and the Director of Center of Microbiology Research for their permission to publish this manuscript.

Statement of disclosure: No conflict of interest exists for any of the authors.

Funding: Victoria Woo was supported by a grant from the Doris Duke Charitable Foundation to the University of California, San Francisco. Megan Huchko was supported by the Clinical and Translational Science Institute, University of California, San Francisco, KL2/KL2 RR024130-04 program.

Correspondence: Megan J. Huchko, MD, MPH, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 50 Beale St, Suite 1200, San Francisco, CA 94105. E-mail:

Received for publication June 30, 2012, and accepted October 11, 2012.

© Copyright 2013 American Sexually Transmitted Diseases Association