Simple and inexpensive point‐of‐care tests improve diagnosis of vaginal infections in resource constrained settings

Abstract

Summary OBJECTIVE Bacterial vaginosis (BV) and Trichomonas vaginalis infection (TV) have been associated with adverse birth outcomes and increased risk for HIV. We compare the performance of simple inexpensive point-of-care (POC) tests to laboratory diagnosis and syndromic management of BV and TV in poor settings. METHODS Between November 2005 and March 2006, 898 sexually active women attending two reproductive health clinics in Mysore, India were recruited into a cohort study investigating the relationship between vaginal flora and HSV-2 infection. Participants were interviewed and screened for reproductive tract infections. Laboratory tests included serology for HSV-2; cultures for TV, Candida sp., and Neisseria gonorrhoeae; Gram stains; and two POC tests: vaginal pH; and Whiff test. RESULTS Of the 898 participants, 411 [45.7%, 95% confidence interval (95% CI): 42.4–49.0%] had any laboratory diagnosed vaginal infection. BV was detected in 165 women (19.1%, 95%CI: 16.5–21.9%) using Nugent score. TV was detected in 76 women (8.5%, 95%CI: 6.7–10.4%) using culture. Among the entire study population, POC correctly detected 82% of laboratory diagnosed BV cases, and 83% of laboratory diagnosed TV infections. Among women with complaints of vulval itching, burning, abnormal vaginal discharge, and/or sores (445/898), POC correctly detected 83% (60 of 72 cases) of laboratory diagnosed BV cases vs. 40% (29 of 72 cases) correctly managed using the syndromic approach (P < 0.001). Similarly, POC would have detected 82% (37 of 45 cases) of TV cases vs. 51% (23 of 45 cases) correctly managed using the syndromic approach (P = 0.001). CONCLUSIONS In the absence of laboratory diagnostics, POC is not only inexpensive and practical, but also significantly more sensitive than the syndromic management approach, resulting in less overtreatment.

Screening for lower genital tract infections in women of reproductive age group attending a tertiary care hospital

“…This is in accordance with 8.5% estimated by Madhivannan et al 26 As TV is a treatable infection, the consequences like preterm deliveries, transmissibility to sex partner, increased exposure for other sexually transmitted infections can be prevented when appropriate etiological diagnosis is obtained. In developing countries, the screening modalities are mainly aimed at high risk groups leaving behind the study population belonging to community, where the exact prevalence data is submerging.…”

“…The prevalence rate of C.trachomatis by PCR is 7.04% (Dwibedi et al,) and 23% (Saluja D et al). 26 The increased proportion of Chlamydia trachomatis in our study is attributed to the molecular diagnostic technique employed i.e., Real-time PCR detection method which has higher sensitivity when compared to other methods. Jaton K et al, have identified that the sensitivity and specificity of Real time PCR is 95.7% and 100% respectively.…”

Evaluation of different diagnostic methods of bacterial vaginosis

“…Different percentages of vaginal infection were reported by previous studies, some studies reported lower BV incidence rates such as Madhivanan et al, [24], who found that the prevalence of BV is 19% and trichomoniasis 8.5%. And others reported higher BV incidence rates such as Lowe et al, [25], who reported that 42% of cases had bacterial vaginosis, 14% had candidiasis, 2 % trichomoniasis , 16% mixed infections and 26 % negative cases and Thulker et al, [26], who diagnosed cases of vaginitis as bacterial vaginosis (53.8%), followed by mixed vaginitis (36.8%), Candidiasis (6.2%)and Trichomoniasis in (3.2%).…”

Management of Abnormal Vaginal Flora as a Risk Factor for Preterm Birth

“…Being one of the crucial criteria of the Amsel diagnosis of BV, pH is often used as such a surrogate point of care test for BV (Madhivanan et al, 2009). However, in a study where pH was used as a screening tool in pregnancy, only 40% of women with increased vaginal pH had BV (Zodzika et al, 2011).…”