Validation of the syndromic management of sexually transmitted diseases in antenatal and family planning clinics in Alexandria

Abstract EN

Objectives : To assess validity and cost of WHO algorithm in syndromic approach in management of STDs and compare it with other approaches : risk score, medical examination and etiologic laboratory investigation .Methods : a cross sectional study was conducted among patients attending the main two study centers during the last 9 months and a quasi clinical trial was directed to enroll 600 patients complaining from vaginal discharge.

Patients were interviewed by pre trained personnel to collect sociodemographic, obstetric and gynecological data, they were subjected to clinical examination and samples from 100 subjects were investigated in laboratory for identification of Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and Candida albicans (CA).

Data presenting the clinical characteristics were summarized.

Sensitivity and specificity were calculated for each approach compared to the gold standard.

Comparing between different approach's performance was assessed by LR and ROC analysis.

The cost of syndromic algorithm compared to etiological approach were also compared.

Results.

Participants were aged 18-56 years, almost 86 % of them were married and 5.5 % were newly married.

The prevalence of STD's among patients attending family planning centers was 25 % compared to 18 % in the antenatal university clinics.

50 % were at high risk in family planning compared to 45 % in antenatal university clinics.

The cure rate of syndromic approach exceeded 90 % in the two study centers.

Sensitivity (TP %) varied between 88.5 %, 32.7 %, 3.8 % and for syndromic, risk approach and clinical approaches respectively.

Specificity (TN %) varied between 14.6 %, 87.5 %, and 91.7 % respectively.

Over treatment rate (FP % ) reported for syndromic was as high as 85.4 % compared to 11.5 % for risk approach and 8.4 % for clinical approach.

Performance parameters were reported for combined syndromic with clinical (AUC was 0.82 and LR + was 1.4 ) followed by the combined risk, clinical and syndromic approach (AUC was 0.80 and LR + was 4.12).

In addition to the validation of different approaches, the study explored that 27.3 % of the study subjects have reported high risk : new marriage, symptomatic partner, before 21 years age and risky partner's occupation.

The cost varied from 5$per case in syndromic to 30$if laboratory diagnosis was further adopted with therapeutic cost.

Conclusions The WHO approach is considerably valid for management of STD's in developing countries and reduction of its limitation of over treatment can be achieved by combination with either clinical and or risk approach.

The elements of risk approach score should be adjusted in different geographical settings.