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

Abstract

Background Resource-limited countries have limited laboratory capability and rely on syndromic management to diagnose sexually transmitted infections (STI). We aimed to estimate the sensitivity, specificity and positive predictive value (PPV) of STI syndromic management when used as a screening method within a study setting. Methods Men who have sex with men (MSM), female sex workers (FSWs) and people living with HIV/AIDS (PLWHA) participated in a behavioural surveillance study. Data were obtained on demographics, sexual behaviours, STI history and service utilisation. Biological specimens were tested for genital inflammatory infections (Neisseria gonorrhoeae [GC], Chlamydia trachomatis [CT], Mycoplasma genitalium [MG], Trichomonas vaginalis [TV]) and genital ulcerative infection (syphilis and Herpes simplex virus-2). Results There was a high prevalence of Herpes simplex virus-2 (MSM 48.1%, FSW 82.0% and PLWHA 84.4%). Most participants reported no ulcerative symptoms and the majority of men reported no inflammatory symptoms. Sensitivity and PPV were poor for inflammatory infections among PLWHA and MSM. Sensitivity for FSWs inflammatory infections was 75%. For ulcerative infections, sensitivity was poor, but specificity and PPV were high. Conclusions Reliance on self-reported symptoms may not be an effective screening strategy for these populations. STI prevention studies should focus on symptom recognition and consider routine screening and referral for high-risk populations.

Sexual Risk Behavior and Its Change among HIV-Positive Persons after Notifying their HIV Infection Status: A Retrospective Survey

“…The descend range in our study is larger than that of some other studies [17,18]. Besides, the proportions of number of sexual partners more than 1 and having temporary sexual partners in our study are less than both Dave's [19] and Shah's [20] studies. This may be attributed to different culture, HIV-positive patients' different levels of knowledge on AIDS, and different style of subjects, as some studies just focus on MSM.…”

Treatment-seeking behaviour and barriers to service access for sexually transmitted diseases among men who have sex with men in China: a multicentre cross-sectional survey

“…The prevalence of suspected STD infections (24.4%) found in our study was much higher than reported among MSM in Guangzhou (23.2% in 2012 and 17.0% in 2013) [25] and central Brazil (4.3%) [26], but lower than among MSM in the Jiangsu province of China (34.1%) [27] and El Salvador (49.8%) [28] and among female sex workers (FSWs) in Shanxi province (53.6%) [29] of China (the comparisons of prevalence of suspected STD infection were all made under the same definition). The HIV prevalence among suspected STD-infected MSM was 16.7%, which was also higher than Chinese MSM in general (6.5%) [30] and Chinese FSWs (0.2%) [31], as reported in two recently published meta-analyses.…”

Performance of syndromic management for the detection and treatment of genitalChlamydia trachomatis,Neisseria gonorrhoeaeandTrichomonas vaginalisamong women attending antenatal, well woman and sexual health clinics in Papua New Guinea: a cross-sectional study

“…It is therefore difficult to estimate the impact of undiagnosed MG on the performance of syndromic management in the current study. Research from elsewhere indicates that inclusion of MG has little impact on performance 21 27 and that the majority of MG infections in women are asymptomatic, 28 and therefore not amenable to syndromic management strategies.…”