Syndromic management of vaginal discharge among women in a reproductive health clinic in India

Abstract

Objectives:To examine the performance of the syndromic approach in the management of vaginal discharge among women attending a reproductive health clinic in New Delhi, India. Methods: Women who sought services from the clinic and who had a complaint of vaginal discharge were interviewed, underwent a pelvic examination, and provided samples for laboratory investigations of bacterial vaginosis, candidiasis, syphilis, trichomoniasis, and Chlamydia trachomatis and Neisseria gonorrhoeae infections. Data analysis focused on the prevalence of infection and on the performance of the algorithm recommended by the national authorities for the management of vaginal discharge. Results: The most common infection among 319 women was bacterial vaginosis (26%). At least one sexually transmitted infection was detected in 21.9% of women. The prevalence of C trachomatis infection was 12.2%; trichomoniasis 10%; syphilis 2.2%; N gonorrhoeae was not isolated. An algorithm based on risk assessment and speculum assisted clinical evaluation was not helpful in predicting cervical infections associated with C trachomatis (sensitivity 5% and PPV 9%). This algorithm was sensitive (95%) though not specific (22%) in selecting women for metronidazole therapy eVective against bacterial vaginosis or trichomoniasis, and overtreatment was a problem (PPV 38%). The sensitivity, specificity, and PPV of this algorithm for the treatment of candidiasis were 46%, 98%, and 88% respectively. The cost per case assessed using the algorithm was $2 and the cost per infection correctly treated was $4.25. Conclusions:The prevalence of cervical infection associated with C trachomatis was high among these "low risk" women. The syndromic approach is not an eYcient tool for detecting this condition, and alternative approaches to evaluation and intervention are required. The syndromic management of vaginal discharge among women seeking family planning and other reproductive health services should focus on vaginal infections, thus enhancing quality of care and addressing women's concerns about their health. (Sex Transm Inf 2000;76:303-306)

Reproductive tract infections associated with vaginal discharge and their socio-demographic and reproductive determinants among clinic attendees in Bangladesh

“…13,14 These prevalence rates are much lower than those reported in Africa and Central America, 2 although, as in many other studies, we found chlamydia infection rates to be higher in younger women (4.3% in women aged <30 years vs.…”

Prevalence and sociodemographic correlates of vaginal discharge among married women of reproductive age group at a teaching hospital

“…7,8 In the remaining no infectious cause was detected. Recent studies by Vikram Patel et al have shown that there is a strong association between psychosocial adversity and vaginal discharge in South Asian women.…”

Human Trichomoniasis due to Trichomonas vaginalis - Current Perspectives

“…Recent review on Global epidemiology in high risk populations and control of T.vaginalis has highlighed that the burden of infection is found in resourcelimited settings and high risk groups in industrialized settings. The World Health Organization estimated global prevalence figures are based on a wet mount microscopy (sensitivity range of 60-80%), however recent data, using PCR suggests sensitivity may be lower (35-60%), thus underestimating global prevalence (Johnston and Mabey, 2008) In India, hospital based studies reveal 4-10 percent positivity in symptomatic women attending gynaecology clinics and almost similar percentage in asymptomatic women attending infertility, post-natal and family planning clinics (Sharma et al, 1988;Malla et al, 1989;Divekar et al, 2000;Vishwanath et al, 2000;Valadkhani et al, 2003;Chakraborty et al, 2005;Yadav et al, 2006). The significantly higher percentage has been observed amongst contraceptive users (7.31%), antenatal patients (7.59%) and women with gynaecological disorders (9.21%) compared to postnatal (3.62%) and infertile woman (2.83%) (Sharma et al, 1988).…”