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Morgan STURGIS, Victoria BUCKMAN, Samiya DIAWARA, F FIQUITASP, M ADRIENM, Xixi ZHAO, Supriya MEHTA, Jennifer TOWBIN, Stephanie CRANE. AN ESSENTIAL TOOL TO BE OPTIMIZED: SYNDROMIC MANAGEMENT OF VAGINAL DISCHARGE IN HAITI. Afr J Infect Dis 2023; 18:28-34. [PMID: 38058415 PMCID: PMC10696650 DOI: 10.21010/ajidv18i1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 12/08/2023] Open
Abstract
Background Haiti, like many low-income countries in crisis, has limited resources for etiologic diagnosis of vaginal discharge. As such, we sought to characterize variability in diagnoses of women presenting with vaginal discharge syndrome, with the goal to improve standardization of syndromic management. Materials and Methods Participants aged 18 years and older endorsing vaginitis, or dysuria were recruited at Jerusalem Clinic over two, one-week periods in April 2018 and July 2019. We calculated Spearman rank correlations among history, exam findings, and diagnoses based on clinical presentation, to understand presentation groupings and their management. Results Among 98 women, median age was 33.5 years, and most frequent symptoms were: vaginal discharge (97%), vaginal itch (73%), and/or suprapubic pain (68%). Most common physical exam findings were vaginal discharge (86%), suprapubic/lower quadrant tenderness (29%), cervical motion tenderness (24%), and cervical erythema (20%). Most symptoms and physical exam findings were weakly correlated with each other. Nearly one-third (31%) were diagnosed with normal physiologic vaginal discharge or no diagnosis, followed by Bacterial vaginosis (31%), vulvovaginal candidiasis (15%), cervicitis/PID (13%), and STI (7%). No reported symptoms strongly differentiated diagnostic categories. Diagnoses varied considerably by exam findings. Conclusions The weak correlations between symptoms, exam findings, and diagnoses could represent variability in assessment. In the absence of reliable and accessible laboratory testing, the importance of standardizing syndromic management becomes increasingly relevant. Results from our study support the utility of speculum examination and more standardized documentation of physical exam findings. Next steps include the development of local algorithms to promote standardization of treatment of vaginal discharge syndrome.
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Affiliation(s)
| | | | | | | | | | | | - MEHTA, Supriya
- University of Illinois School of Public Health, Chicago IL USA
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Mitchev N, Singh R, Garrett N, Ramsuran V, Niehaus AJ, Mlisana KP. Performance of TaqMan probes for the detection of sexually transmitted infections in South African women. Afr J Lab Med 2021; 10:1124. [PMID: 33937002 PMCID: PMC8063552 DOI: 10.4102/ajlm.v10i1.1124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/08/2021] [Indexed: 11/29/2022] Open
Abstract
Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium are the four main aetiologies of sexually transmitted infections responsible for vaginal discharge syndrome (VDS). Commercially available multiplex polymerase chain reaction (PCR) assays are expensive and generally not customisable. We evaluated a highly customisable singleplex PCR approach by testing it in parallel with the Anyplex™ II STI-7 detection assay in a cohort of South African women that presented with VDS between May 2016 and January 2017. Our multiple singleplex PCR strategy proved to be a simple, accurate, rapid, affordable and scalable option for diagnosing VDS.
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Affiliation(s)
- Nireshni Mitchev
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Ravesh Singh
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Medical Microbiology, National Health Laboratory Service, Durban, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa.,Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Veron Ramsuran
- KwaZulu-Natal Research Innovation and Sequencing Platform, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Abraham J Niehaus
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Medical Microbiology, National Health Laboratory Service, Durban, South Africa
| | - Koleka P Mlisana
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.,Centre for the AIDS Programme of Research in South Africa, Durban, South Africa.,Department of Academic Affairs, Research and Quality Assurance, National Health Laboratory Service, Durban, South Africa
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van der Eem L, Dubbink JH, Struthers HE, McIntyre JA, Ouburg S, Morré SA, Kock MM, Peters RPH. Evaluation of syndromic management guidelines for treatment of sexually transmitted infections in South African women. Trop Med Int Health 2016; 21:1138-46. [PMID: 27350659 DOI: 10.1111/tmi.12742] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the performance of three different guidelines for the management of vaginal discharge syndrome (VDS) for women living in a rural setting in South Africa. METHODS We conducted a secondary analysis of data from a cross-sectional study in Mopani District, South Africa. The 2015 and 2008 guidelines of the South African Department of Health (DoH) and the most recent WHO guidelines were evaluated for adequate treatment of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis infection. RESULTS Of the 489 women included in this analysis, 35% presented with VDS according to the DoH and 30% per WHO definition of VDS. Fifty-six per cent of the women with VDS would be treated adequately for these STI when using the 2015 DoH guideline, whereas 76% (P = 0.01) and 64% (P = 0.35) would receive adequate treatment with the 2008 DoH and WHO guidelines, respectively. Of the symptomatic women who tested negative for all four STI, STI treatment would have been indicated for 36% as per 2015 DoH guideline vs. 69% (P < 0.001) per 2008 DoH and 67% (P < 0.001) per WHO guidelines. CONCLUSION A considerable proportion of symptomatic women infected with these common curable STI would receive adequate treatment when using a syndromic management approach, and significant differences exist between the three guidelines. Many symptomatic women without these STI receive broad-spectrum antibiotics, so new approaches are needed to improve syndromic STI control.
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Affiliation(s)
- Lisette van der Eem
- Anova Health Institute, Johannesburg and Tzaneen, South Africa.,African Woman Foundation, Amsterdam, The Netherlands
| | - Jan Henk Dubbink
- Anova Health Institute, Johannesburg and Tzaneen, South Africa.,Institute for Public Health Genomics, University of Maastricht, Maastricht, The Netherlands.,Department of Medical Microbiology & Infection Control, VU University Medical Centre, Amsterdam, The Netherlands
| | - Helen E Struthers
- Anova Health Institute, Johannesburg and Tzaneen, South Africa.,Department of Internal Medicine, University of Cape Town, Cape Town, South Africa
| | - James A McIntyre
- Anova Health Institute, Johannesburg and Tzaneen, South Africa.,School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Sander Ouburg
- Department of Medical Microbiology & Infection Control, VU University Medical Centre, Amsterdam, The Netherlands
| | - Servaas A Morré
- Institute for Public Health Genomics, University of Maastricht, Maastricht, The Netherlands.,Department of Medical Microbiology & Infection Control, VU University Medical Centre, Amsterdam, The Netherlands
| | - Marleen M Kock
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.,Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
| | - Remco P H Peters
- Anova Health Institute, Johannesburg and Tzaneen, South Africa.,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
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Chauhan V, Shah MC, Patel SV, Marfatia YS, Zalavadiya D. Efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome. Indian J Sex Transm Dis AIDS 2016. [PMID: 27190409 PMCID: PMC4857679 DOI: 10.4103/2589-0557.176215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In spite of a few shortcomings such as over diagnosis and over treatment, syndromic management is a recommended practice in India for sexually transmitted infections (STIs). This study tries to find out the efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome. OBJECTIVE The objective of the study is to find out the effectiveness of syndromic management in terms of symptomatic improvement among females with vaginal discharge syndrome. MATERIALS AND METHODS A longitudinal study was conducted in Gynecology Department of Tertiary Care Hospital including 180 symptomatic females having vaginal discharge syndrome. Demographic profile, presenting complaints, menstrual history, obstetric history, partner history, and contraceptive history were noted. This was followed by clinical examination and specimen collection for laboratory tests and blood tests to find out type of STI including viral STI such as human immunodeficiency virus (HIV), herpes simplex virus (HSV), and hepatitis B surface antigen (HBsAg). Treatment was given according to syndromic management on the same day. All the participants were asked to come for follow-up after 15 days and their improvement in symptoms was noted as complete improvement, some improvement or no improvement on a five point scale. RESULTS 63.9% cases showed complete improvement, while 36.1% showed some improvement. None of the patients was without any improvement. Vaginal discharge syndrome was most common between 20 and 30 years (43.4%), and 67.8% of symptomatic females with vaginal discharge syndrome belonged to the lower socioeconomic group. HSV infection was the most common (15%) associated viral infection with vaginal discharge syndrome, while hepatitis B infection was the least common (0.5%). HIV was reactive in 2.8% cases only. CONCLUSION Syndromic management was found to be effective in relieving symptoms in most of the cases of vaginal discharge syndrome.
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Affiliation(s)
- Vidyalaxmi Chauhan
- Department of Obstetrics and Gynecology, Government Medical College, Baroda, Gujarat, India
| | - Maitri C. Shah
- Department of Obstetrics and Gynecology, Government Medical College, Baroda, Gujarat, India,Address for correspondence: Dr. Maitri C. Shah, 30, Gulabchand Park, Opposite Ambalal Park, Kareli Baug, Baroda - 390 018, Gujarat, India. E-mail:
| | - Sangita V. Patel
- Department of Community Medicine, Government Medical College, Baroda, Gujarat, India
| | - Yogesh S. Marfatia
- Department of Skin and VD, Government Medical College, Baroda, Gujarat, India
| | - Dhara Zalavadiya
- Department of Community Medicine, Government Medical College, Baroda, Gujarat, India
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Chauhan V, Shah MC, Patel SV, Marfatia YS, Zalavadiya D. Efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome. Indian J Sex Transm Dis AIDS 2016; 37:28-32. [PMID: 27190409 PMCID: PMC4857679 DOI: 10.4103/0253-7184.176215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In spite of a few shortcomings such as over diagnosis and over treatment, syndromic management is a recommended practice in India for sexually transmitted infections (STIs). This study tries to find out the efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome. OBJECTIVE The objective of the study is to find out the effectiveness of syndromic management in terms of symptomatic improvement among females with vaginal discharge syndrome. MATERIALS AND METHODS A longitudinal study was conducted in Gynecology Department of Tertiary Care Hospital including 180 symptomatic females having vaginal discharge syndrome. Demographic profile, presenting complaints, menstrual history, obstetric history, partner history, and contraceptive history were noted. This was followed by clinical examination and specimen collection for laboratory tests and blood tests to find out type of STI including viral STI such as human immunodeficiency virus (HIV), herpes simplex virus (HSV), and hepatitis B surface antigen (HBsAg). Treatment was given according to syndromic management on the same day. All the participants were asked to come for follow-up after 15 days and their improvement in symptoms was noted as complete improvement, some improvement or no improvement on a five point scale. RESULTS 63.9% cases showed complete improvement, while 36.1% showed some improvement. None of the patients was without any improvement. Vaginal discharge syndrome was most common between 20 and 30 years (43.4%), and 67.8% of symptomatic females with vaginal discharge syndrome belonged to the lower socioeconomic group. HSV infection was the most common (15%) associated viral infection with vaginal discharge syndrome, while hepatitis B infection was the least common (0.5%). HIV was reactive in 2.8% cases only. CONCLUSION Syndromic management was found to be effective in relieving symptoms in most of the cases of vaginal discharge syndrome.
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Affiliation(s)
- Vidyalaxmi Chauhan
- Department of Obstetrics and Gynecology, Government Medical College, Baroda, Gujarat, India
| | - Maitri C. Shah
- Department of Obstetrics and Gynecology, Government Medical College, Baroda, Gujarat, India
| | - Sangita V. Patel
- Department of Community Medicine, Government Medical College, Baroda, Gujarat, India
| | - Yogesh S. Marfatia
- Department of Skin and VD, Government Medical College, Baroda, Gujarat, India
| | - Dhara Zalavadiya
- Department of Community Medicine, Government Medical College, Baroda, Gujarat, India
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Shah M, Deshmukh S, Patel SV, Mehta K, Marfatia Y. Validation of vaginal discharge syndrome among pregnant women attending obstetrics clinic, in the tertiary hospital of Western India. Indian J Sex Transm Dis AIDS 2015; 35:118-23. [PMID: 26396446 DOI: 10.4103/0253-7184.142406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Sexually transmitted infections (STIs) are major public health problem. The laboratory tests for diagnosing STI are often unavailable or too expensive. Therefore, World Health Organization has recommended a syndromic approach for diagnosis and management of STI/reproductive tract infections (RTIs). Very few studies so far had evaluated effectiveness of the syndromic approach in diagnosing STI/RTIs in pregnancy. AIMS AND OBJECTIVES Validation of syndromic management for vaginal discharge syndrome in pregnancy. MATERIALS AND METHODS A cross-sectional study was carried out which included 233 pregnant females attending obstetric clinic. They were subjected to clinical examination, vaginal swab collection, and serological tests. RESULTS A total of 183 (78.54%) pregnant females had vaginal discharge on clinical examination and Candida albicans was the most common clinical diagnosis among them. Of 183 cases diagnosed clinically as vaginal discharge syndrome, 38 (20.7%) were tested positive in laboratory investigations. Out of 50 clinically negative cases, 9 (18%) were detected positive for one of the STIs on laboratory testing. CONCLUSION Syndromic approach for management of vaginal discharge syndrome resulted in over-treatment of 78% (false positive) and under-diagnosis of 19.1% (false negative) pregnant females. Hence, integration of antenatal screening services in the form of laboratory tests for vaginal discharge is recommended.
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Affiliation(s)
- Maitri Shah
- Department of Obstetrics and Gynaecology, Government Medical College, Baroda, India
| | - Shetal Deshmukh
- Department of Obstetrics and Gynaecology, Government Medical College, Baroda, India
| | - Sangita V Patel
- Department of Community Medicine, Government Medical College, Baroda, India
| | - Kedar Mehta
- Department of Community Medicine, GMERS Medical College, Gotri, Gujarat, India
| | - Yogesh Marfatia
- Department of Skin and VD, Government Medical College, Baroda, India
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Chauhan V, Shah M, Thakkar S, Patel SV, Marfatia Y. Sexually transmitted infections in women: A correlation of clinical and laboratory diagnosis in cases of vaginal discharge syndrome. Indian Dermatol Online J 2014; 5:S1-5. [PMID: 25506555 PMCID: PMC4252942 DOI: 10.4103/2229-5178.144498] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims: This study compares the clinical and laboratory diagnosis of vaginal discharge syndrome. Settings and Design: This cross-sectional study was carried out at the gynaecology outpatient department of a tertiary care hospital in Gujarat, India. Material and Methods: Total of 180 females diagnosed as vaginal discharge or cervicitis based on syndromic approach and were recruited for the study. Their clinical profile was noted and they were investigated for bacterial vaginosis, trichomoniasis, candidiasis, gonorrhoea and chlamydia infection. Results: Lower abdominal pain (35%) followed by burning micturition (23.9%) were the common associated complaints. Bacterial vaginosis was the most common clinical diagnosis, while trichomoniasis was least common. Upon laboratory investigation, 35.6% of cases of vaginal discharge and 12% of cases of cervicitis tested positive. Percentage of cases confirmed by laboratory investigation was 50, 27.8 and 41.7 for bacterial vaginosis, trichomoniasis and candidiasis respectively. Conclusion: Among all the females diagnosed as vaginal discharge syndrome, a very small percentage actually turned out to be positive upon laboratory testing.
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Affiliation(s)
- Vidyalaxmi Chauhan
- Department of Obstetrics and Gynaecology, Government Medical College, Baroda, Gujarat, India
| | - Maitri Shah
- Department of Obstetrics and Gynaecology, Government Medical College, Baroda, Gujarat, India
| | - Sejal Thakkar
- Department of Skin and VD, GMERS Medical College, Gotri, Baroda, Gujarat, India
| | - Sangita V Patel
- Department of Community Medicine, Government Medical College, Baroda, Gujarat, India
| | - Yogesh Marfatia
- Department of Skin and VD, Government Medical College, Baroda, Gujarat, India
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Shah M, Deshmukh S, Patel SV, Mehta K, Marfatia Y. Validation of vaginal discharge syndrome among pregnant women attending obstetrics clinic, in the tertiary hospital of Western India. Indian J Sex Transm Dis AIDS 2014; 35. [PMID: 26396446 PMCID: PMC4553839 DOI: 10.4103/2589-0557.142406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Sexually transmitted infections (STIs) are major public health problem. The laboratory tests for diagnosing STI are often unavailable or too expensive. Therefore, World Health Organization has recommended a syndromic approach for diagnosis and management of STI/reproductive tract infections (RTIs). Very few studies so far had evaluated effectiveness of the syndromic approach in diagnosing STI/RTIs in pregnancy. AIMS AND OBJECTIVES Validation of syndromic management for vaginal discharge syndrome in pregnancy. MATERIALS AND METHODS A cross-sectional study was carried out which included 233 pregnant females attending obstetric clinic. They were subjected to clinical examination, vaginal swab collection, and serological tests. RESULTS A total of 183 (78.54%) pregnant females had vaginal discharge on clinical examination and Candida albicans was the most common clinical diagnosis among them. Of 183 cases diagnosed clinically as vaginal discharge syndrome, 38 (20.7%) were tested positive in laboratory investigations. Out of 50 clinically negative cases, 9 (18%) were detected positive for one of the STIs on laboratory testing. CONCLUSION Syndromic approach for management of vaginal discharge syndrome resulted in over-treatment of 78% (false positive) and under-diagnosis of 19.1% (false negative) pregnant females. Hence, integration of antenatal screening services in the form of laboratory tests for vaginal discharge is recommended.
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Affiliation(s)
- Maitri Shah
- Department of Obstetrics and Gynaecology, Government Medical College, Baroda, India,Address for correspondence: Dr. Maitri Shah, 30, Gulabchand Park, Opposite Ambalal Park, Kareli Baug, Baroda - 390 018, Gujarat, India. E-mail:
| | - Shetal Deshmukh
- Department of Obstetrics and Gynaecology, Government Medical College, Baroda, India
| | - Sangita V. Patel
- Department of Community Medicine, Government Medical College, Baroda, India
| | - Kedar Mehta
- Department of Community Medicine, GMERS Medical College, Gotri, Gujarat, India
| | - Yogesh Marfatia
- Department of Skin and VD, Government Medical College, Baroda, India
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