Prevalence and determinants of Neisseria gonorrhoea and Chlamydia trachomatis infections in patients with pelvic inflammatory disease at Lusaka, Zambia

Abstract

Background: Pelvic inflammatory disease (PID) is an inflammatory process affecting typically the endometrium, fallopian tubes, ovaries, parametrium and pelvic peritoneum with its surrounding structures. More than 85% of spontaneous PID is caused by sexually transmitted infections like gonorrhea, chlamydia, mycoplasma and others. WHO estimates that 340 million new cases of N. gonorrhea, Chlamydia and other sexually transmitted infections occur every year of which 85% are in developing countries. Gonorrhea and chlamydia account for 62 million and 92 million new infections respectively. In Zambia, 10% of outpatient attendance at health institutions is due to sexually transmitted infections. At University Teaching Hospital, pelvic inflammatory disease accounts for about 10 - 15% of gynaecological attendance. Despite these, there is no adequate information on magnitude and prevalence of these two organisms among patients with PID in Lusaka.
Objective: The objective was to determine the prevalence and determinants of Neisseria gonorrhea and Chlamydia trachomatis infection among gynaecological patients diagnosed clinically to have PID at University Teaching Hospital, Lusaka. Several socio-demographic factors, sexual behaviour and clinical factors associated with chlamydia and gonorrhea were studied.
Methodology: This was a descriptive cross sectional study conducted on women presenting clinically with pelvic inflammatory disease to the emergency outpatient gynaecological ward at UTH. Information about demographic, sexual behavioural history and clinical presentation was obtained using a structured questionnaire. Endo-cervical smear was obtained and screened for gonorrhea and chlamydia using respective immunoassay rapid test and gram stain for gonorrhea.
Results: A total of 6 respondents were recruited out of which 43 (37%) had gonorrhoea while no chlamydia (0/6) was isolated. 4 (98.3%) had sexual partners while 2 had no sexual partner and no gonorrhea was isolated from them. Among those with sexual partners, 101(78.3%) had steady sexual partners, 19 (4.8%) had casual partners and 9 (7.0%) had anonymous sexual partners with 37 (36.6%), 10 (52.6%) and 6 (66.7%) gonorrhea isolation respectively. Some had multiple sexual partners. Gonorrhea was isolated from 4 (28.6%) of the 14 respondents who had one new sexual partner, and those who had two or more sexual partners had gonorrhea isolated. Gonorrhea isolation in relation to frequency of sexual intercourse per week was as follows: once 1/13 (7.7%), twice 2/11 (18.2%), thrice 3/11 (27.3%) and more than three times 32/65 (49.2%). Gonorrhea was high in those who had sex with casual or anonymous sexual partner under influence of alcohol 6/11 (54.5%) or obtained anonymous sexual partner from market, shopping centre 4/5 (80%), street, bar, disco, or night club 7/9 (77.8%). Regarding relationship to clinical features gonorrhea detection was as follows: 18/36 (50.0 %) for those with adnexial tenderness, 21/45 (46.7%) with inflamed cervix, 37/92 (40.2%) with lower abdominal tenderness and 32/87 (36.8%) with normally appearing cervix.
Conclusion: The prevalence of Neisseria gonorrhea in gynaecological patients with PID at UTH in Lusaka was 37%. There was no chlamydia isolated. Low socioeconomic status and young age were the sociodemographic factors associated with a higher risk of gonorrhea. The sexual risk behaviours associated with gonorrhea were; the number of casual or anonymous sexual partners, frequency of sexual intercourse and non use of condoms. Lower abdominal pain and tenderness with cervical motion and adnexial tenderness were associated with higher gonorrhea isolation. There was no specific clinical predictor of either gonorrhea or chlamydia