Comparative study of syndromic and etiological diagnosis of sexually transmitted infection except human immunodeficiency virus in sexually transmitted infection and reproductive tract infection clinic attendees in central India

Abstract

Comparative study of syndromic and etiological diagnosis of sexually transmitted infection except human immunodeficiency virus in sexually transmitted infection and reproductive tract infection clinic attendees in central India Context: Most of the sexually transmitted infections (STIs), both ulcerative and non-ulcerative are prevalent in India. However, due to lack of adequate laboratory infrastructure in the country, information regarding STIs lies essentially on syndromic basis. Hence, there is very limited data of laboratory proven STIs. Aims: The aim of this study is to determine the prevalent STI and reproductive tract infection (RTI) in the region and comparison of etiological diagnosis with syndromic approach. Settings and Design: Cross-sectional study. Materials and Methods: A total of 1120 patients attending STI/RTI clinic were included in the study with one or more complaints as enunciated by World Health Organization in its syndromic approach. Depending on syndromic presentation, different samples such as ulcer swabs, genital swabs and blood samples were collected. These samples were processed by the standard guidelines of National AIDS Control Organization. Warts, Molluscum contagiosum and genital scabies were diagnosed clinically. Results: Age of acquiring STI in females (20-24 years) was lower than males (25-44 and more). Vaginal discharge syndrome (90.3%) was most common followed by cervical discharge syndrome (20%). The highest incidence of herpes (14.3%) seen in genital ulcerative diseases but clinically human papilloma virus (16.5%) was common. Overall, Candida was the most common isolates. Bacterial STIs like chancroid (0%) and gonorrhea (0.54%) are showing a declining trend. Laboratory confi rmation of syndromic diagnosis was seen in only 409/1120 (36.5%). Conclusions: Viral STIs/RTIs are getting the upper hand over bacterial. Syndromic algorithms have some shortcomings and they need to be periodically reviewed and adapted to the epidemiological patterns of STIs in a given setting.

Microbiological profile of patients attending sexually transmitted infection/reproductive tract infection clinic in a tertiary care hospital

“…5,9 The variation noted may be due to the hygienic habits and socioeconomic status of study population. 6 In present study, only one case (9.1%) of cervical discharge syndrome was diagnosed with N. gonorrhoae. Chlamydia trachomatis is reported to be the leading cause of cervicitis in females.…”

“…Tankhiwale et al reported similar findings showing 96.7% GDS and 6.34% GUD. 6 Choudhary et al have little variable findings showing almost equal percentage i.e. 39% GDS and 30% GUD.…”

“…followed by 9.7% BV and 3.3% TV. 6 Okonko et al reported 27% of Candida sp. followed by 10.5% BV and 1.5% TV.…”

“…Other Studies which shows the comparable results are Okonko et al (39%), Tankhiwale et al (37.5%). 6,10 Are we underdiagnosing the cases by microbiological confirmation which could lead to treatment failures and spread of disease or we are over diagnosing by syndromic approach and contributing to increased drug resistance. A study in Himachal Pradesh reported syndromic management to be highly efficacious whereas study in Delhi found some shortcomings in syndromic algorithms and specified a need of periodic review.…”

A hospital-based study on the prevalence of trichomoniasis and evaluation of accuracy of various diagnostic techniques

“…[ 12 13 14 ] Lower prevalence comparable to the present study has also been reported from Bangaluru, Karnataka(2.1%),[ 15 ] Gujarat (2.8%),[ 16 ] and Maharashtra (3.3%). [ 17 ]…”