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Vallely LM, Toliman P, Ryan C, Rai G, Wapling J, Gabuzzi J, Allen J, Opa C, Munnull G, Kaima P, Kombuk B, Kumbia A, Kombati Z, Law G, Kelly-Hanku A, Wand H, Siba PM, Mola GDL, Kaldor JM, Vallely AJ. Performance of syndromic management for the detection and treatment of genital Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis among women attending antenatal, well woman and sexual health clinics in Papua New Guinea: a cross-sectional study. BMJ Open 2017; 7:e018630. [PMID: 29288183 PMCID: PMC5778337 DOI: 10.1136/bmjopen-2017-018630] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Papua New Guinea (PNG) has among the highest estimated prevalences of genital Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) of any country in the Asia-Pacific region. Diagnosis and treatment of these infections have relied on the WHO-endorsed syndromic management strategy that uses clinical presentation without laboratory confirmation to make treatment decisions. We evaluated the performance of this strategy in clinical settings in PNG. DESIGN Women attending antenatal (ANC), well woman (WWC) and sexual health (SHC) clinics in four provinces were invited to participate, completed a face-to-face interview and clinical examination, and provided genital specimens for laboratory testing. We estimated the performance characteristics of syndromic diagnoses against combined laboratory diagnoses. RESULTS 1764 women were enrolled (ANC=765; WWC=614; SHC=385). The prevalences of CT, NG and TV were highest among women attending ANC and SHC. Among antenatal women, syndromic diagnosis of sexually transmitted infection had low sensitivity (9%-21%) and positive predictive value (PPV) (7%-37%), but high specificity (76%-89%) and moderate negative predictive value (NPV) (55%-86%) for the combined endpoint of laboratory-confirmed CT, NG or TV. Among women attending WWC and SHC, 'vaginal discharge syndrome' had moderate to high sensitivity (72%-78%) and NPV (62%-94%), but low specificity (26%-33%) and PPV (8%-38%). 'Lower abdominal pain syndrome' had low sensitivity (26%-41%) and PPV (8%-23%) but moderate specificity (66%-68%) and high NPV (74%-93%) among women attending WWC, and moderate-high sensitivity (67%-79%) and NPV (62%-86%) but low specificity (26%-28%) and PPV (14%-33%) among SHC attendees. CONCLUSION The performance of syndromic management for the detection and treatment of genital chlamydia, gonorrhoea and trichomonas was poor among women in different clinical settings in PNG. New diagnostic strategies are needed to control these infections and to prevent their adverse health outcomes in PNG and other high-burden countries.
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Affiliation(s)
- Lisa M Vallely
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Pamela Toliman
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Claire Ryan
- The Macfarlane Burnet Institute for Medical Research and Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Glennis Rai
- School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Papua New Guinea
| | - Johanna Wapling
- The Macfarlane Burnet Institute for Medical Research and Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Josephine Gabuzzi
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Joyce Allen
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Christine Opa
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Gloria Munnull
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Petronia Kaima
- Tininga clinic, Mt Hagen General Hospital, Mount Hagen, Papua New Guinea
| | - Benny Kombuk
- Obstetrics and Gynaecology, Mt Hagen General Hospital, Mount Hagen, Papua New Guinea
| | - Antonia Kumbia
- Obstetrics and Gynaecology, Eastern Highlands Provincial Hospital, Goroka, Papua New Guinea
| | - Zure Kombati
- Department of Pathology, Mt Hagen General Hospital, Mt Hagen, Papua New Guinea
| | - Greg Law
- Sexual Health and Disease Control Branch, National Department of Health, Poert Moresby, Papua New Guinea
| | - Angela Kelly-Hanku
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Handan Wand
- Biostatistics and Database Program, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Peter M Siba
- Former Director, Papua New Guinea Institute of Medical Research, Port Moresby, Papua New Guinea
| | - Glen D L Mola
- School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Papua New Guinea
| | - John M Kaldor
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrew J Vallely
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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