Objective Determine the diagnostic accuracy of the symptoms and signs used in the syndromic diagnosis of low genital tract infections (LGTIs) in symptomatic women.
Materials and Methods: A diagnostic validity study of sexually active women (14–49 years old) consulting with symptoms of LGTI at three outpatient facilities in Bogota, Colombia were recruited in 2010. Exclusion criteria: hysterectomy, pregnancy or antibiotics in the 7 previous days. Symptoms and signs and syndromic diagnosis were evaluated by a physician for two syndromes: Vaginal discharge caused by Bacterial vaginosis (BV) Candida albicans (CA) and Trichomonas vaginalis (TV) and Cervicitis caused by N. gonorrhoeae (NG), and C trachomatis (CT). Those were compared against PCR for CT and NG; Nugent’s criteria for BV; wet smear for TV and blood agar culture for CA. Sensitivity, specificity, LR (+), LR (-) for each syndrome and its symptoms and signs were calculated
Results 1372 subjects were evaluated. The prevalence of NG and CT was 1.3% (18/1372) and 9.1% (125/1372); for BV, TV and CA infection was 39.9% (548/1372), 0.8% (11/1372) and 11.1% (152/1372). Sensitivity and Specificity are for syndromic approach for cervicitis 13.3%(CI 95 8.2–20) and 90.9% (CI95 89.1–92.4) respectively. Vaginal discharge is the sign with the most sensitivity for cervicitis and BV, TV and CA infections: 93% and 78%, respectively. In cervicitis, the most specific sign is mucopurulent cervical discharge (91.8%) and for BV, TV and CA infections is erythema valvular (68%).
Conclusions SD for vaginal discharge syndrome has a high sensitivity and a low specificity resulting in a high rate of unnecessary antibiotic treatment (64.9%). SD for cervicitis, has a low sensitivity and high specificity resulting in a high % of false negatives and lack of needed antibiotic treatment in 86.7%. SD alone is an ineffective strategy for LGTIs.
Funded by COLCIENCIAS (Colombia) Grant: 621 2009
- sexually transmitted infections
- Syndromic approach