Assessing therapeutic management of vaginal and urethral symptoms in an anonymous HIV testing centre in Luanda, Angola

Abstract

Introduction: This study aimed to estimate the prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infections and to assess the therapeutic management of vaginal/urethral discharge and dysuria in patients with human immunodeficiency virus in Luanda, Angola, taking into account World Health Organization recommendations for sexually transmitted infection syndromic management. Methodology: Socio-demographic and medical data were obtained from 436 individuals, and clinical examinations were performed in 104 women and 8 men. Vaginal/cervical and urethral specimens were collected from 112 individuals for observation of Trichomonas vaginalis, yeasts and bacterial vaginosis, while urine samples were obtained from 415 patients (221 symptomatic and 194 asymptomatic). Diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis was performed by polymerase chain reaction assay. Results: The prevalence of N. gonorrhoeae and C. trachomatis was 8.4% (35/415) and 7.9%, (33/415) respectively. Eight of the 35 N. gonorrhoeae positive cases were treated. All men and women (79) who presented a positive wet mount/Gram stain were etiologically treated according to microscopy results. In contrast, 53.3% of the female patients (16/30) and 33.3% (1/3) of the male patients who presented microscopy negative results were treated for urinary tract infection or by syndromic approach. Among non-examined patients, 15% of women (12/80) and 52.5% of men (21/40) were treated without an etiological result. Syndromic treatment was preferentially given to nonexamined males (19/40-47.5%) over females (12/80-15%) (p<0.01). Conclusions: The prevalence of N. gonorrehaea and C. trachomatis found in this study was high. WHO-recommended syndromic management of vaginal/urethral discharge is not being consistently and correctly applied.

Genital Chlamydia trachomatis and Neisseria gonorrhoeae infections among women in sub-Saharan Africa: A structured review

“…Median size of study population was 448 participants (range: 100–6514). Characteristics of 88 studies reporting on prevalence in women recruited in the general community, 20,52–69 at PHC settings 6,7,19,35,70–104 and FSWs 105…”

Performance and comparison of self-reported STI symptoms among high-risk populations – MSM, sex workers, persons living with HIV/AIDS – in El Salvador

“…In a HIV voluntary testing and counselling setting, syndromic management can lead to many missed diagnoses and 3.2% overtreatment rates, while in a pharmacy setting the majority of symptomatic individuals were seropositive for an STI. 16,17 Additionally, efficacy of these guidelines can vary by gender and disease type 10–15 as some STIs can be asymptomatic, 18,19 in which case syndromic management would have limited application and can lead to missed diagnoses.…”

Developing and validating a risk algorithm to diagnose Neisseria gonorrhoeae and Chlamydia trachomatis in symptomatic Rwandan women

“…Syndromic STI management systems [7][8][9][10][11][12][13][14] remain the standard of care across much of Africa due to the high cost of culture-based and molecular diagnostics. While STI symptoms may be useful in identifying STIs in men, they are less easily interpreted in women who often experience non-STI genital conditions that produce discharge [15].…”