Study to Evaluate Targeted Management and Syndromic Management in Women Presenting with Abnormal Vaginal Discharge

Abstract

Introduction Vaginal discharge is a commonest complaint among women in reproductive age group. Infective vaginal discharge can be broadly categorized into vaginitis or mucopurulent cervicitis. Vaginitis is predominantly caused by bacterial vaginosis, vaginal candidiasis, vaginal trichomoniasis, etc. Mucopurulent cervicitis is due to chlamydia or gonococcal infection. The targeted management is based on identification of causative organism and targeting the therapy against it, while syndromic management is based on high risk factors's presence. Aims and Objectives To study the effect of targeted management as compared to syndromic management in achieving a complete cure for abnormal vaginal discharge and to study the microbial flora of women presenting with abnormal vaginal discharge. Method The study is a randomized control trial conducted at tertiary health care on 200 women who presented with abnormal vaginal discharge, distributed in two groups A and B each consisted of 100 women. Group A underwent laboratory investigations, and treatment was started as soon as reports were available. Group B was given syndromic management based on high risk factors's presence. Both groups were followed up after 2 weeks. 123Results The prevalence of various organisms in vaginal discharge was candidiasis 39 %, bacterial vaginosis 28 %, trichomoniasis 5 %, N. gonorrhoeae 5 % and chlamydia 2 % among the 100 women in group A. Response to treatment for vaginitis was 76.3 % in group A, whereas it was 41 % in group B. With cervicitis, 71.4 % women responded to treatment in targeted group as compared to 54 % in syndromic management group. Conclusion There is a potential disadvantage of syndromic management because of its total reliability on a subjective clinical assessment.

Clinical presentation, diagnosis and management of bacterial vaginosis: a hospital based cross-sectional study

“…19 Meena V et al, found, 60% of cases with BV had grayish white discharge and none had yellow discharge. 21 Study found that in this study cases who had bacterial vaginosis, 1.2% cases had mucoid discharge, 19.8% cases had thick discharge, 79.1% cases had thin discharge. While Kiran CK et al, found that among cases with BV 100% of cases had thin discharge.…”

“…19 Meena V et al, found dysuria in 78.6% cases with BV. 21 Narayankhedkar A et al, found 100% of cases with bacterial vaginosis had dysuria. 4 Landers DV et al found that women who had dysuria, 56% had bacterial vaginosis.…”

Simultaneous Detection of Seven Pathogens of Cervicitis Among Young Female Sex Workers by Multiplex Real Time PCR in Dhaka, Bangladesh

“…1,38,39,40 So syndromic approach led to many cases untreated or over diagnosed. 41,42 Multiplex PCR are being developed to diagnose multiple organisms in a single clinical samplefrom endocervical specimen in both symptomatic and asymptomatic cervicitis patients which might be helpful to diagnose all the microbes in a single test and also to the clinicians to prescribe appropriate antibiotics for patients according to results. Therefore, this study was designed to detect Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum and Trichomonas vaginalis from endocervical swabsamong FSWs aged of 10-24 years by multiplex real time PCR and compare the results of PCR with that of other conventional methods.…”

Evaluation of Sexual Satisfaction in Pregnant Women with Vaginal Candidiasis

“…Genital infections are one of the main reasons why women go to medical centers, so that more than ten million women in the United States go to medical centers every year. According to the World Health Organization, three factors, Candida, Trichomonas and bacteria, are the main causes of vaginitis and make up about 90% of vaginal infections [1,2]. Candidiasis is one of the most important and most common opportunistic fungal diseases in humans that is acute or chronic in the skin, nails, digestive tract, bron-chus, and vaginal mucosa.…”