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P2.137 Syndromic Management of Vaginal Discharge: Is It Justified?
  1. P Mittal1,
  2. S C Sonkar2,
  3. P K Mishra3,
  4. J Suri1,
  5. A Kumar1,
  6. P Ghope1,
  7. D Saluja4
  1. 1VM Medical college & Safdarjung Hospital, Delhi, India
  2. 2Dr B.R. Ambedkar Center for Biomedical Research, university of Delhi, India
  3. 3Dr B.R. Ambedkar Center for Biomedical Research, University of Delhi, India
  4. 4Dr B.R. Ambedkar Center for Biomedical Research, university of Delhi, India

Abstract

Introduction Vaginal discharge constitutes an important symptom in women attending gynaecology outpatient clinics. Some of these cases are due to sexually transmitted organisms such as N. gonorrheae, C. trachomatis and T. vaginalis and can lead to poor reproductive health and co-infection with HIV. The control of these infections can lead to substantial reduction in the transmission of HIV. Given the high cost of diagnosis, National Aids Control Organisation advocates syndromic management of patients with genitourinary complaints and treatment with drugs that target the most frequent etiological agents. However, it can lead to emergence of antibiotic resistant strains due to overtreatment. Therefore, we tried to find out prevalence of these three pathogens in cases of symptomatic vaginal discharge and to determine the number of patients who were over-treated following syndromic approach.

Methods 320 non-pregnant women (16 – 60 years) attending the gynaecology outpatient clinic of VMMC & Safdarjung Hospital, New Delhi, with complaint of vaginal discharge and clinically suspected to be infected by N. gonorrhoeae, C. trachomatis & T. Vaginali were recruited. Endocervical swabs were used for detection of these organisms by PCR.

Results Of the 320 subjects 24 (7.5%) were positive for C. trachomatis, 19 (5.9%) for N. gonorrhoeae & 13 (4.6%) for T. vaginalis. Furthermore, 8(2.5%) patients had co-infection of C. trachomatis & N. gonorrhoeae, 07(2.1%) had co-infection of C. trachomatis & T. vaginalis, 07(2.1%) had N. gonorrheae & T. vaginalis and 06 (1.8%) cases had C. trachomatis, N. gonorrheae & T. vaginalis. Infection was found in 49/320 patients with infection rate of 15.3%. Since all the patients (320) were treated the overtreatment rate was 84.6%.

Conclusion Cost-effective technology for simultaneous detection of these pathogens is urgently required in developing countries so that all clinically suspicious cases of vaginal discharge are given treatment only after confirmed diagnosis.

  • Syndromic Management
  • Vaginal Discharge

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