Studies have shown that women's ability to access contraceptive methods depend on their socio-economic, educational, professional status, and the health and well-being of their families and themselves. Therefore, the embarking of the Governments of the Caribbean on important initiatives relating to gynecological matters is very important and timely. Aims: This study aims to examine the perception, attitude and practice of Jamaican women towards the matter of pelvic examination. Patients and Methods: The current study used an extracted sample of 7,168 women in their reproductive years (15-49 yrs) from a study which was undertaken by the National Family Planning Board in 2002 on Reproductive Health. Data was analyzed using SPSS for Windows, Version 16.0 (SPSS Inc.; Chicago, Ill. USA). Logistic regression was used to analyze factors/variables pertaining to Pelvic examination. Results: The findings revealed that older women are more likely to have done a Pelvic examination compared to younger women (χ 2 = 675.29, P < 0.001). Age, number of pregnancies that resulted in miscarriages, number of pregnancies that resulted in induced abortion, age of first sexual intercourse, number of years of schooling, area of residence and socio-economic class are statistically significant factors of Pelvic examinations in Jamaica. Therefore, the model had significant predictive power where (χ 2 = 1022.79, P < 0.001). Conclusion: The multidimensional nature of the variables, which emerged in the current study, indicate that a multisectoral approach should be used to address low pelvic and Pap smear examination among Jamaican women.

Perception, attitude and practices of women towards pelvic examination and Pap smear in Jamaica

Background: Sexually transmissible infections (STIs) are common in female sex workers (FSWs), most of which are asymptomatic and therefore under-reported. Our aim was to determine the sensitivity and specificity of reported symptoms obtained via questionnaire augmented with leukocyte esterase (LE) urine dipstick test for the detection of Chlamydia trachomatis (Ct), Neisseria gonorrhea (Ng) and Trichomonas vaginalis (Tv) detected using polymerase chain reaction (PCR). Methods: In November 2003, a cohort of FSWs was screened for STIs and completed a questionnaire. Results: We enrolled 129 FSWs (90% participation rate) of whom 48 (37%), 30 (23%) and 53 (41%) were diagnosed with Ng, Ct and Tv, respectively, by PCR. Of those diagnosed with any of these infections, 78% reported anogenital symptoms and of those without infections, 28% reported symptoms. Anogenital symptoms were present in over 50% FSWs. Genital odour (present in 26%), lower abdominal pain (present in 29%), dysuria (present in 19%) had a sensitivity around (50%), specificity (>80%) and all were significantly associated with positive PCR results for individual organisms; however, the sensitivity of these symptoms to detect the presence of any positive PCR result was low ( 1 was combined with the presence of three reported symptoms the sensitivity was 86%, specificity of 73% and a positive predictive value of 72%; a better predictor of infections. Conclusions: Our finding suggest an approach that incorporates LE urine dipstick test >1 and multiple symptoms may be a feasible option for screening infections among FSWs in resource constraint settings.

A cross-sectional study of reported symptoms for sexually transmissible infections among female sex workers in Papua New Guinea.

Young women in Jamaica face significant risk for HIV and other STIs. A clearer understanding of the factors associated with sexual experience and unprotected intercourse is needed. Data were collected from 330 adolescent females aged 13 to 17 recruited through community based organizations in Kingston, Jamaica, from 2009-2011. Nearly one-third of sexually experienced participants reported not using a condom the last time they had sex. Characteristics associated with sexual experience included older age, marijuana use, and less comfort talking to mother about sexual topics. Characteristics associated with condom use included perceived importance of religion, positive attitudes toward condoms, and not-having multiple sexual partners. Sexually experienced Jamaican female adolescents were engaging in behaviors that made them vulnerable to HIV and other STIs. Interventions with young adolescent girls and their mothers are recommended to postpone sexual debut and promote safer sexual behaviors in those who do engage in sex.

Characteristics Related to Sexual Experience and Condom Use Among Jamaican Female Adolescents

Background: Sexually transmitted infections (STIs) are common i n female sex workers (FSWs). Our aim was to determine if 3 month ly periodic presumptive treatments (PPT) would reduce the incidence of STIs in FSWs in Port Moresby.

Studies of female sex workers in Port Moresby, Papua New Guinea

Background: Syndromic management of sexually transmissible infections is commonly used in resource-poor settings for the management of common STIs; abnormal vaginal discharge (AVD) flowcharts are used to identify and treat cervical infection including Neisseria gonorrhoea and Chlamydia trachomatis. A systematic review and meta-analysis was undertaken to measure the diagnostic test performance of AVD flowcharts, including both World Health Organization (WHO)- and locally-adapted AVD flowcharts. Methods: A systematic search of multiple electronic databases was conducted to locate eligible studies published between 1991 and 2014. Flowcharts were categorised into one of 14 types based on: 1) use of WHO guidelines or locally-adapted versions; 2) use of risk assessment, clinical examination or both; and 3) symptomatic entry. Summary diagnostic performance measures calculated included summary sensitivity, summary specificity and diagnostic odds ratio. Results: Thirty-six studies, including data on 99 flowcharts, were included in the review. Summary sensitivity estimates for WHO flowcharts ranged from 41.2 to 43.6%, and for locally adapted flowcharts from 39.5 to 74.8%. Locally adapted flowcharts performed slightly better than the WHO flowcharts. A difference in performance was not observed between use of risk assessment or clinical examination. The AVD flowchart performed slightly better when it was not restricted to symptomatic women only. Conclusions: There was considerable variation in the performance of the AVD flowchart but overall it was a poor diagnostic tool regardless of whether risk assessment or clinical examination was included, or whether the flowchart was WHO or locally developed. Many women were treated unnecessarily and many women with cervical infection were not detected. We caution against their continued use for management of cervical infection.

http://dro.deakin.edu.au/eserv/DU:30110121/bennett-syndromicmanage-2018.pdf

Syndromic management of sexually transmissible infections in resource-poor settings: a systematic review with meta-analysis of the abnormal vaginal discharge flowchart for Neisseria gonorrhoea and Chlamydia trachomatis.

Family planning (FP) clinics that plan to add sexually transmitted infection (STI) services should consider alternatives to modified WHO risk-inclusive algorithms for identifying infected women. A sample of 767 FP clients from Kingston Jamaica were interviewed and examined and specimens were obtained to detect the agents that cause gonorrhea chlamydia and trichomoniasis. Serum was tested to detect the bacteria that cause syphilis. Decision models for classifying women with STI were compared using clinical statistical criteria. Models included STI classifications based on the weighted sum of STI risk factors on the presence of two or more factors identified via an interview or on an interview augmented with a urine dipstick test (i.e. rapid risk assessment). These models were compared with a modified WHO algorithm originally intended for STI clients in Jamaica. Individual factors associated with gonorrhea chlamydia and trichomoniasis were urine leukocyte esterase dipstick test outcomes >1+ (indicating the likelihood of infection based on the concentration of white blood cell enzymes on a scale of negative trace 1+ 2+ and 3+) multiple partners in the past year friable cervix and age <25 years. An additional risk factor for cervical infection alone (gonorrhea or chlamydia) was spotting after sex. Reported vaginal discharge was not significantly associated with infection. For cervical infection the WHO risk-inclusive algorithm was least accurate (a positive predictive value of 14%) the weighted-risk algorithms were best (a positive predictive value of 23%) while the interview-alone and the rapid risk assessment were slightly less accurate (positive predictive values of 20%). The modified WHO risk-inclusive algorithm appeared inappropriate for asymptomatic women. The rapid risk assessment was easier to perform and more predictive. Urine leukocyte esterase dipstick tests may be useful when pelvic examinations are not feasible. The STI assessment models other than the WHO algorithm should be evaluated in other settings where STI prevalence is high or where patients are unlikely to seek further evaluation to better identify women in need of counseling further evaluation or treatment. (authors)

/pdf/strategies-for-detection-of-sexually-transmitted-infection-gyj9fl7a6m.pdf

Strategies for detection of sexually transmitted infection among family planning clients in Jamaica.

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Strategies for detection of sexually transmitted infection among family planning clients in Jamaica.