Problems, solutions and challenges in syndromic management of sexually transmitted diseases

HIV/AIDS Department, Family Health International, Arlington, Virginia 22201, USA.
Sexually Transmitted Infections (Impact Factor: 3.4). 07/1998; 74 Suppl 1:S1-11.
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    • "Similar observations were also made by this study. As such this study supports earlier suggestions that a syndromic approach should not be used as a screening tool for CT and NG [25-28]. "
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    ABSTRACT: Background Many studies have shown an overlap in the epidemiology of sexually transmitted infections (STIs) and urogenital schistosomiasis among young women living in schistosomiasis endemic areas. Yet we found no study assessing the prevalence of STI infections in urogenital schistosomiasis endemic areas in Ghana. As part of an epidemiological study on urogenital schistosomiasis and HIV, we sought to assess the prevalence of both Chlamydia trachomatis (CT) and Neisseria gonorhoeae (NG) infections among women living in schistosomiasis endemic communities and explore the relationship between the sexually transmitted infections (STIs) and demographic characteristics, sexual behaviour and self-reported symptoms. Methods This was a cross-sectional study in which endocervical samples were collected from 191 women aged 15–49 years from October 2005 to March 2006. Samples were examined for CT and NG using Polymerase Chain Reaction (PCR). A structured questionnaire was also used to elicit information on study participant’s gynaecological and obstetric history and symptoms for genital infection. Chi-square test and binary logistic regression were used to assess association between CT and NG and other variables such as age, sexual behaviour and self-reported symptoms. Results The overall prevalence of CT and NG were 6.3% and 2.6% respectively.The highest prevalence rates of CT were in the 15 to 19 year group while only individuals between 15 and 39 years were positive for NG. There was no association between CT and age, contraceptive use and the other variables assessed. NG on the other hand was found to be associated with age, number of births and number of sexual partners only by chi-square test. Conclusions Our research revealed higher prevalence of CT and NG infections when compared to previous studies conducted among higher risk groups in non-urogenital schistosomiasis areas in Ghana. We therefore recommend further studies of these STIs in urogenital schistosomiasis endemic areas in the country.
    BMC Research Notes 06/2014; 7(1):349. DOI:10.1186/1756-0500-7-349
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    • "The burden of disease for STIs is extremely difficult to quantify for a number of reasons [22] [23]. First, surveillance is inadequate, particularly in many of the resource poor settings where STI incidence is possibly highest; second there are sensitivities over the reporting of stigmatized conditions; third many infections are asymptomatic and many symptoms are not unique to particular infections; fourth the causal association between the STIs and disease is often difficult to quantify, as is the case for infertility caused by chlamydia [24] and preterm labor caused by trichomonas [25] and HIV transmission associated with all the different STDs [20]. "
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    ABSTRACT: Sexually transmitted diseases, a source of widespread morbidity and sometimes mortality, are caused by a diverse group of infections with a common route of transmission. Existing vaccines against hepatitis B virus (HBV) and human papilloma virus 16, 18, 6 and 11 are highly efficacious and cost effective. In reviewing the potential role for other vaccines against sexually transmitted infections (STIs) a series of questions needs to be addressed about the burden of disease, the potential characteristics of a new vaccine, and the impact of other interventions. These questions can be viewed in the light of the population dynamics of sexually transmitted infections as a group and how a vaccine can impact these dynamics. Mathematical models show the potential for substantial impact, especially if vaccines are widely used. To better make the case for sexually transmitted infection vaccines we need better data and analyses of the burden of disease, especially severe disease. However, cost effectiveness analyses using a wide range of assumptions show that STI vaccines would be cost effective and their development a worthwhile investment.
    Vaccine 03/2014; 32(14):1536–1542. DOI:10.1016/j.vaccine.2013.11.007 · 3.62 Impact Factor
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    • "As FSW may receive only intermittent healthcare and advanced diagnostics in low resource settings are limited, cervicitis in FSW, when diagnosed, is most often treated syndromically [12]. Syndromic management has drawbacks such as the underdiagnosis of subclinical STI and a potential overuse of antimicrobials [13]. Since FSW are particularly vulnerable to STI, and cervicitis may increase rates of STI transmission to the general population, accurate local epidemiological data is essential for guiding syndromic management of cervicitis in FSW. "
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    ABSTRACT: Background Cervicitis is a syndrome of cervical inflammation and a common condition in female sex workers (FSW), a subpopulation vulnerable to sexually transmitted infections. Local data is essential for guiding syndromic management of cervicitis in FSW working in Peru. We sought to describe the prevalence and etiologies of cervicitis in this population. We also aimed to identify sociodemographic, behavioral and biological factors associated with cervicitis, including bacterial vaginosis (BV), a condition with a possible role in cervicitis. Methods FSW 18 years of age or older presenting to a free public sexual health clinic in Callao-Lima, Peru were eligible for inclusion upon consent. 467 participants completed a face-to-face questionnaire and underwent genital examination. Vaginal, endocervical and blood samples were collected and tested for C. trachomatis (CT), N. gonorrhea (GC), T. vaginalis (TV), BV, HIV and Human T-Cell Lymphotropic Virus −1. Logistic regression was used to determine whether sociodemographic, behavioral, or other sexual health related characteristics were associated with the diagnosis of cervicitis. Results Cervicitis was detected in 99 (24.9%) of 397 FSW. The presence of cervicitis was unable to be determined in 70 participants. In women with cervicitis, CT was present in 4.6% (4/87), TV in 4.0% (4/99), GC in 0% (0/87) and no pathogen was detected on cervical microbiology in 91.9% (91/99). BV was detected on vaginal microbiology in 36.9% (31/84) of cervicitis cases. BV was more common in women with cervicitis, however this association did not reach statistical significance (aOR = 1.47 [0.87, 2.48], p = 0.15). Other STI were not associated with cervicitis. Regular clinic attendance (aOR = 0.54 [0.34, 0.87], p = 0.01) and Ecuadorian nationality (aOR = 0.31 [0.13, 0.76], p = 0.01) were associated with reduced risk of cervicitis. Conclusions Cervicitis was common in FSW working Peru and was predominantly nongonococcal and non-chlamydial in etiology. Further study is warranted to clarify the role of BV and other emerging cervicitis pathogens in this population. The current Peruvian program of free health checks for FSW may be effective for reducing rates of cervicitis. The protective effect of Ecuadorian nationality prompts further study.
    BMC Infectious Diseases 04/2013; 13(1):195. DOI:10.1186/1471-2334-13-195 · 2.61 Impact Factor
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