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Clinical sciences poster session 1: and related syndromes
P3-S1.08 Are there acceptable alternatives to syndromic management for the diagnosis of sexually transmitted infections in HIV positive Kenyan women?
  1. V Woo1,
  2. C R Cohen2,
  3. E A Bukusi3,
  4. M J Huchko2
  1. 1Stanford University, School of Medicine, Stanford, USA
  2. 2University of California, San Francisco, USA
  3. 3Kenya Medical Research Institute, Nairobi, Kenya

Abstract

Background Control of sexually transmitting infections (STIs) is an important aspect of HIV prevention and care. Syndromic management for vaginal discharge, despite a recognised low sensitivity and specificity, is widely employed for STI management among HIV-1 infected women in resource-limited settings. In this pilot study, we evaluated the incremental increase in sensitivity and specificity of multiple, low-cost diagnostic strategies for non-ulcerative STIs diagnosed among HIV-1 infected women receiving care in Kenya.

Methods This cross-sectional study was done among a cohort of HIV-1 infected women enrolled at Family AIDS and Care and Treatment Services (FACES) clinics in Kisumu, Kenya. During their routine clinic visit, participants reported any health complaint and later were asked about general vaginal symptoms (brief symptom ascertainment) and specific complaints of pruritis, odour and discharge (detailed symptom ascertainment). Clients were then examined for cervicitis and vaginal discharge, followed by specimen collection for STI testing. Results of Chlamydia trachomatis and Neisseria gonorrhoeae nucleic acid amplification test and Trichomonas vaginalis (TV) by wet mount was used as the gold standard for sensitivity and specificity calculations.

Results Of the 155 women who were screened between the ages of 23–53 years, the prevalence of N gonorrhoeae was 1.9% (3/155), TV was 6.4% (10/155) and no cases of C trachomatis were detected. See Abstract P3-S1.08 table 1.

Abstract P3-S1.08 Table 1

Sensitivity and specificity of multiple diagnostic strategies for STI diagnosis among HIV-1 infected women receiving care at FACES

Conclusions Syndromic management had a very poor sensitivity for detecting STIs in HIV-1 infected women. The addition of specific questions about STI-related symptoms improved STI detection rates, while a speculum exam led to greater sensitivity and specificity. The feasibility and effectiveness of alternative approaches such as routine use of speculum exams, and point-of-care testing for T vaginalis should be explored to improve the management of STIs among HIV-1 infected women in similar low-resource settings.

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