Evaluation of syndromic management of sexually transmitted infections within the Kisumu Incidence Cohort Study

Abstract

Summary Background While laboratory aetiological diagnosis is considered the gold standard for diagnosis and management of sexually transmitted infections, syndromic management has been presented as a simplified and affordable approach for sexually transmitted infection management in limited resource settings. Methods Sexually transmitted infection signs and symptoms were collected using staff-administered computer-assisted personal interview and audio computer-assisted self-interview. Participants underwent a medical examination and laboratory testing for common sexually transmitted infections. The performance of syndromic management was assessed on the agreement between interviewing methods as well as accurate diagnosis. Results We screened 846 participants, of whom 88 (10.4%) received syndromic sexually transmitted infection diagnosis while 272 (32.2%) received an aetiological diagnosis. Agreement between syndromic and aetiological diagnoses was very poor (overall kappa = 0.09). The most prevalent sexually transmitted infection was herpes simplex virus type 2 and the percentage of persons with any sexually transmitted infection was higher among women (48.6%) than men (15.6%, p <0.0001). Agreement between audio computer-assisted self-interview and computer-assisted personal interview interviewing methods for syndromic diagnosis of sexually transmitted infections ranged from poor to good. Conclusion Our findings suggest that syndromic management of sexually transmitted infections is not a sufficient tool for sexually transmitted infection diagnosis in this setting; development and improvement of sexually transmitted infection diagnostic capabilities through laboratory confirmation is needed in resource-limited settings.

Syphilis Infection in a Male Population: Prevalence and Risk Factors

“…In the bivariate analysis, the use of any illicit drug in the past 12 months was a predictive variable for syphilis and is in agreement with other published studies (FAN et al, 2012;PAN et al, 2013;OTIENO et al, 2014). On the other hand, in multivariate analysis, only the realization of circumcision was considered statistically significant as a protective factor for syphilis.…”

“…Other studies have demonstrated differences in the characteristics mentioned above in the studied populations (GUO et al, 2011;PAN et al, 2013). By another hand, in this study, the majority of attended individuals is not married, have had the first sexual relation with less than 16 years, has multiple partners and does not use condoms, these are common features in epidemiological studies of sexually transmitted diseases (FAN et al, 2012;OTIENO et al, 2014).…”

High Prevalence and Incidence of Asymptomatic Sexually Transmitted Infections During Pregnancy and Postdelivery in KwaZulu Natal, South Africa

“…Our findings and that of other recent studies, however, question the validity of this approach based on the large proportion of asymptomatic STIs prevalent in pregnant and other high-risk population groups. 15,[24][25][26][27] When extrapolating our findings to all primary health clinics using the syndromic approach to treating STIs in women, it would appear that an estimated 50% of pregnant women with 1 or more STIs and asymptomatic will go untreated if the syndromic approach is applied. Postdelivery, an estimated 80% of the women who are asymptomatic but infected with 1 or more STIs would be missed.…”

Prevalence of Chlamydia trachomatis and Candida albicans; hospital based study

“…Other studies have also showed predisposing factors for the incidences of chlamydia and candida including multiple sex partners within less than 30 days and sexual intercourse during menses in the previous 6 months 20 . Several studies have demonstrated that circumcision of men does not reduce their risk of acquiring these nonulcerative sexually transmitted infections like chlamydia and candidiasis 21 .…”