Beyond syndromic management: Opportunities for diagnosis-based treatment of sexually transmitted infections in low- and middle-income countries

Abstract

IntroductionIn light of the limited impact the syndromic management approach has had on the global sexually transmitted infection (STI) epidemic, we assessed a care model comprising point-of-care (POC) STI testing, immediate treatment, and expedited partner therapy (EPT) among a cohort of young women at high HIV risk in South Africa.Methods and findingsHIV negative women presenting for STI care underwent POC testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV), and swabs were sent for NG culture and susceptibility testing. Results were available within 2 hours and women with STIs were immediately treated and offered EPT packs, including medication, condoms, and information for sexual partners. An EPT questionnaire was administered after one week, and women retested for STIs after 6 and 12 weeks. 267 women, median age 23 (IQR 21–26), were recruited and 88.4% (236/267) reported genital symptoms. STI prevalence was CT 18.4% (95%CI 13.7–23.0), NG 5.2% (95%CI 2.6–7.9) and TV 3.0% (95%CI 1.0–5.0). After 12 weeks, all but one NG and two CT infections were cleared. No cephalosporin-resistant NG was detected. Of 63/267 women (23.6%) diagnosed with STIs, 98.4% (62/63) were offered and 87.1% (54/62) accepted EPT. At one week 88.9% (48/54) stated that their partner had taken the medication. No allergic reactions or social harms were reported. Of 51 women completing 6-week follow up, detection rates were lower amongst women receiving EPT (2.2%, 1/46) compared to those who did not (40.0%, 2/5), p = 0.023. During focus group discussions women supported the care model, because they received a rapid, specific diagnosis, and could facilitate their partners’ treatment.ConclusionsPOC STI testing and EPT were acceptable to young South African women and their partners, and could play an important role in reducing STI reinfection rates and HIV risk. Larger studies should evaluate the feasibility and cost-effectiveness of implementing this strategy at population level.

Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward

“…The utility of GeneXpert has been evaluated in remote populations such as an aboriginal community in Australia ; in routine antenatal care in Papua New Guinea (with STI rates by GeneXpert of CT 20%, NG 11.2% and TV 37.6%) ; in HIV‐infected pregnant women in South Africa (40.2% with STIs) . Another utility study in South Africa in HIV‐negative women presenting for STI care or with symptoms (CT 18.4%, NG 5.2%, TV 3%) resulted in STI testing of symptomatic and asymptomatic women and the same‐day treatment, with expedited partner treatment and reduced reinfection after six months . A study in Rwanda has shown that integrating POCTs for BV, TV (OSOM) and CT/NG (GeneXpert) in women with urogenital symptoms and increased risk of STIs has improved diagnostic accuracy, with moderate sensitivity and high specificity for CT/NG/TV compared with using syndromic management, and has remarkably reduced overtreatment .…”

“…Thus, syndromic management provides an entry point for STI management and control. However, there are clearly limitations to the syndromic approach for the management of STIs, the likely impact on the control of STIs and the link with AMR .…”

“…There is also a high rate of false negatives, resulting in missed treatment, which can facilitate further transmission and severe complications and/or sequelae. On the other hand, RDTs and POCTs (Table ) can reduce overtreatment and missed treatment by adapting antibiotic prescriptions according to test results, and can facilitate partner notification .…”

HIV pre‐exposure prophylaxis for female sex workers: ensuring women’s family planning needs are not left behind

“…However, many programmes among FSWs in resource‐limited settings currently rely on syndromic management of STIs, and given that the majority of STIs are asymptomatic, this approach is likely to result in untreated STIs and ongoing transmission . To uphold improvements in SRHR through integrated PrEP delivery, there is demonstrated need to invest in improvements for STI services, including low‐cost point‐of‐care STI tests where possible , vaccination for human papilloma virus and viral hepatitis, and other modalities for STI management .…”

Eskişehirde Kadın Doğum Kliniklerine Başvuran Kadınlarda Trichomonas vaginalis Görülme Sıklığının Farklı Yöntemlerle Araştırılması ve Çeşitli Sosyal Değişkenlerle olan İlişkisinin Değerlendirilmesi

“…Trichomonas vaginalis'in (T. vaginalis) ürogenital insanda sisteme yerleşmesiyle oluşan hastalığa Trichomoniasis denir. Dünyada viral olmayan seksüel geçişli hastalıklar arasında ilk sırada, en yaygın görülen vajinit etkenleri arasında da üçüncü sırada yer almaktadır (1)(2)(3)(4)(5). Bulaşım cinsel yolla olmakta birlikte, daha az sıklıkla tuvalet eşyası, yüzme havuzları ve alafranga tuvaletlerle de olabileceği bilinmektedir.…”