Article

Syndromic and laboratory diagnosis of sexually transmitted infection: A comparative study in China

National Center for STD Control, China CDC, Nanjing, China.
International Journal of STD & AIDS (Impact Factor: 1.05). 07/2008; 19(6):381-4. DOI: 10.1258/ijsa.2007.007273
Source: PubMed

ABSTRACT

The rate of sexually transmitted infections (STIs) has soared in China. Yet, there is no universal consensus about the accuracy of the syndromic approach to STI management. This study aims to compare the syndromic approach with laboratory tests. A randomly selected sample of market vendors in eastern China (n = 4510) was recruited and assessed for the five most common STIs (Chlamydia trachomatis infection, gonorrhoea, genital herpes [herpes simplex type 2, HSV-2] syphilis and trichomoniasis [female only]). Symptom-based assessments made by physicians were compared with laboratory tests. Laboratory test results were used as the gold standard for the comparisons. The overall sensitivity of physician symptom-based assessment was about 10%; sensitivity was lower for males (1.6%) than for females (17.2%). The sensitivity of physician assessments for those who reported STI symptoms was relatively higher (36.7%) than for those who reported no symptoms (5.1%). More than half (54.37%) of the participants were diagnosed with STI of trichomoniasis. For the other four types of STIs, physicians correctly identified only <10% of the positive cases. The study detected a low sensitivity of STI diagnosis made by physicians in an Eastern city of China. The failure in the detection of asymptomatic patients remains one of the limitations of the syndromic approach.

Download full-text

Full-text

Available from: Li Li
  • Source
    • "The authors reported that the STIs symptoms had low sensitivity and high specificity consistent with our findings. Low sensitivity and high specificity of self-reported STIs symptoms were also reported in a Chinese study by Yin et al. [19]. A study by Mukenge-Tshibaka et al. [13] among female sex workers in Benin reported poor sensitivity of the STIs symptoms. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Sexually transmitted infections (STIs) are highly prevalent in sub-Saharan Africa, where there is a severe HIV epidemic. Thus, accurate recognition and diagnosis of STIs are essential for successful HIV prevention programs in the region. Due to lack of trained personnel and adequate laboratory infrastructure in the region, information regarding the profile of STIs relies essentially on self-reported or physician-diagnosed symptoms. The main objective of the study was to assess the effectiveness of the syndromic diagnosis of STIs, which is often used as a proxy for laboratory diagnosis of STIs in sub-Saharan Africa and other resource-limited settings. The study builds on previously collected data from a community-based survey in Northern Tanzania. We found no significant agreements between patient-reported STIs symptoms and laboratory-confirmed STIs tests. The reported STIs symptoms had high specificity (range = 85-99%) and poor sensitivity (range = 2-17%). Knowledge gained from our study will have significant public health implications, and can help improve the syndromic diagnosis of STIs.
    Full-text · Article · Mar 2014
  • Source
    • "erious underreporting , and for STI symptoms do not necessarily lead to accurate assessment of prevalence ( Chen et al . , 2005 ; Qian et al . , 2005 ; H . Wang et al . , 2009b ) . Because a majority of infections are asympto - matic , diagnoses based on symptomatic assessments may miss a large subset of infections or lead to incorrect diagnoses ( Yin et al . , 2008 ) . Assessment of"
    [Show abstract] [Hide abstract]
    ABSTRACT: Female sex workers (FSW) are at greater risk for HIV and STIs. A systematic literature review of HIV and STI prevalence and incidence data for FSW in China was conducted to assess current trends. Studies between 1996 and 2010 detailing seroprevalence or incidence data, other laboratory-based tests, and clinical diagnoses of infections among FSW were reviewed. Select articles from Chinese literature around street-based and drug-abusing FSW were also reviewed. Results revealed high median prevalence for a variety of STIs among FSW: active syphilis range 0.8-12.5% (median = 6.9%), herpes range 29.7-70.8% (median = 56.2%), chlamydia range 3.9-58.6% (median = 25.7%), gonorrhea range 2.0-85.4% (median = 16.4%), and trichomoniasis range 7.1-43.2% (median = 12.5%). HIV prevalence has remained relatively low and stable with a range of 0-10.3% (median = 0.6%), with the exception of higher prevalence in several areas of Yunnan and some areas of Guangxi. The FSW who are injecting drug users may be at even greater risk for HIV infection with 12-49% found to be HIV positive and 7-25% self-reporting positive status. A number of gaps in the literature remain, especially in the number of studies that detail prevalence confirmed by laboratory testing or that collect incidence data. Assessment of incidence and prevalence according to sampling methodology appropriate for the population, behavioral risks such as injecting drug use, and diverse venues especially those at the lower end are needed. Theory-based interventions to reduce the incidence and prevalence of HIV/STIs need to be piloted with successful models scaled-up.
    Full-text · Article · Jun 2011 · AIDS Care
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: to describe the prevalence and behavioral profile of genital infections in women attended at a Primary Health Unit in Vitoria, ES. a transversal study including 14 to 49-year-old women attended by the Family Health Program (FHP). Exclusion criteria were: having been submitted to gynecological examination in less than one year before, and history of recent treatment (in the last three months) for genital infections. An interview including socio-demographic, clinical and behavioral data was applied. Genital specimens were collected for cytology, GRAM bacterioscopy and culture, and urine sample for molecular biological test for Chlamydia trachomatis. two hundred and ninety-nine women took part in the study. The median age was 30.0 (interquartile interval: 24;38) years old; the average age of the first intercourse was 17.3 (sd=3.6) years old. The first pregnancy average age was 19.2 (3.9) years old. About 70% reported up to 8 years of schooling; 5% reported previous Sexually Transmitted Diseases (STD), and 8%, the use of illicit drugs. Only 23.7% reported consistent use of condoms. Clinical complaints were: genital ulcer (3%); dysuria (7.7%); vaginal discharge (46.6%): pruritus (20%) and pelvic pain (18%). Prevalence rates were: Chlamydia trachomatis 7.4%; gonorrhea 2%; trichomoniasis 2%; bacterial vaginosis 21.3%; candidiasis 9.3%; and cytological changes suggestive of HPV 3.3%. In the final logistic regression model, the factors independently associated to genital infections were: abnormal cervical mucus, OR=9.7 (CI95%=5.6-13.7), previous HIV testing, OR=6.5 (CI95%=4.0-8.9), having more than one partner during the previous year, OR=3.9 (CI95%=2.7-5.0), and having more than one partner in life, OR=4.7 (CI95%=2.4-6.8). results show a high rate of genital infections and the need of preventive measures, such as STD surveys and risk reduction programs for women that look for routine gynecological service.
    Full-text · Article · Aug 2008 · Revista brasileira de ginecologia e obstetrićia: revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia
Show more