Targeted point-of-care testing compared with syndromic management of urogenital infections in women (WISH): a cross-sectional screening and diagnostic accuracy study

Verwijs, Marijn C.; Agaba, Stephen; Sumanyi, Jean-Claude; Umulisa, Marie Michele; Mwambarangwe, Lambert; Musengamana, Viateur; Uwineza, Mireille; Cuylaerts, Vicky; Crucitti, Tania; Jespers, Vicky; Wijgert, Janneke van de

doi:10.1016/s1473-3099(18)30724-2

Cited by 46 publications

(63 citation statements)

References 25 publications

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“…Associations between pathobionts detection/levels and unusual vaginal discharge reporting were also inconsistent van de Wijgert et al between studies. In our experience, vaginal symptom-reporting rarely correlates well with the actual presence of a vaginal infection or vaginal dysbiosis (Verwijs et al, 2019b). None of the women in the three studies had severe symptoms, such as those associated with desquamative inflammatory vaginitis, and we could therefore not test the association between pathobionts levels and such symptoms.…”

Section: Pathobionts In the Vaginal Microbiotamentioning

confidence: 79%

Pathobionts in the Vaginal Microbiota: Individual Participant Data Meta-Analysis of Three Sequencing Studies

Wijgert

Verwijs

Gill

et al. 2020

Front. Cell. Infect. Microbiol.

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Having pathobionts was positively associated with young age, non-Dutch origin, hormonal contraceptive use, smoking, antibiotic use in the 14 days prior to sampling, van de Wijgert et al. Pathobionts in the Vaginal MicrobiotaHIV status, and the presence of sexually transmitted pathogens, in at least one but not all studies; inconsistently associated with sexual risk-taking and unusual vaginal discharge reporting; and not associated with vaginal yeasts detection by microscopy. We recommend that future VMB studies quantify common vaginal pathobiont genera.

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Section: Pathobionts In the Vaginal Microbiotamentioning

confidence: 79%

Pathobionts in the Vaginal Microbiota: Individual Participant Data Meta-Analysis of Three Sequencing Studies

Wijgert

Verwijs

Gill

et al. 2020

Front. Cell. Infect. Microbiol.

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“…Another utility study in South Africa in HIV‐negative women presenting for STI care or with symptoms (CT 18.4%, NG 5.2%, TV 3%) resulted in STI testing of symptomatic and asymptomatic women and the same‐day treatment, with expedited partner treatment and reduced reinfection after six months . A study in Rwanda has shown that integrating POCTs for BV, TV (OSOM) and CT/NG (GeneXpert) in women with urogenital symptoms and increased risk of STIs has improved diagnostic accuracy, with moderate sensitivity and high specificity for CT/NG/TV compared with using syndromic management, and has remarkably reduced overtreatment .…”

Section: Resultsmentioning

confidence: 99%

“…A recent study by Verwijs et al. has shown that integrating POCT (CT, NG, TV) in women with urogenital symptoms and for screening resulted in the reduction of NG and CT by half, and of TV by 42% .…”

Section: Discussionmentioning

confidence: 99%

Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward

Ndowa²,

et al. 2019

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Introduction Sexually transmitted infections (STIs) remain prevalent and are increasing in several populations. Appropriate STI diagnosis is crucial to prevent the transmission and sequelae of untreated infection. We reviewed the diagnostic accuracy of syndromic case management and existing point‐of‐care tests (POCTs), including those in the pipeline, to diagnose STIs in resource‐constrained settings. Methods We prioritized updating the systematic review and meta‐analysis of the diagnostic accuracy of vaginal discharge from 2001 to 2015 to include studies until 2018. We calculated the absolute effects of different vaginal flowcharts and the diagnostic performance of POCTs on important outcomes. We searched the peer‐reviewed literature for previously conducted systematic reviews and articles from 1990 to 2018 on the diagnostic accuracy of syndromic management of vaginal and urethral discharge, genital ulcer and anorectal infections. We conducted literature reviews from 2000 to 2018 on the existing POCTs and those in the pipeline. Results and discussions The diagnostic accuracy of urethral discharge and genital ulcer disease syndromes is relatively adequate. Asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections limit the use of vaginal discharge and anorectal syndromes. The pooled diagnostic accuracy of vaginal syndromic case management for CT/NG is low, resulting in high numbers of overtreatment and missed treatment. The absolute effect of POCTs was reduced overtreatment and missed treatment. Findings of the reviews on syndromic case management underscored the need for low‐cost and accurate POCTs for the identification, first, of CT/NG, and, second, of Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV) and NG and MG resistance/susceptibility testing. Near‐patient POCT molecular assays for CT/NG/TV are commercially available. The prices of these POCTs remain the barrier for uptake in resource‐constrained settings. This is driving the development of lower cost solutions. Conclusions The WHO syndromic case management guidelines should be updated to raise the quality of STI management through the integration of laboratory tests. STI screening strategies are needed to address asymptomatic STIs. POCTs that are accurate, rapid, simple and affordable are urgently needed in resource‐constrained settings to support the uptake of aetiological diagnosis and treatment.

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“…POC testing for urogenital infections might improve case-nding and infection management and is feasible in resource-poor settings. [40] Integration of POC testing can mitigate the transmission and burden of STI. [41] Thirdly, strengthen training of clinicians and scale up STI interventions.…”

Section: Discussionmentioning

confidence: 99%

Availability of laboratory diagnosis of gonorrhoea and its meaning in case reporting in Shandong province, China

Chen¹,

Gan²,

Liu

2020

Preprint

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Abstract Background The aim of this study is to understand the availability of laboratory diagnosis of gonorrhoea in Shandong province and its meaning in case reporting. Methods Two surveys were conducted among hospitals providing clinical services for sexually transmitted infection(STI) in Shandong Province in 2012 and 2018. The availability of laboratory tests for Neisseria gonorrhoeae (NG) and distribution of reported gonorrhea cases were compared among different hospitals provided clinical services for STI in Shandong province. Descriptive analysis and Chi-square were used for statistical analysis. Results Smear, culture and PCR tests for NG were used among 301(74.69%), 123(30.52%), 43(10.67%) hospitals in 2012 and 356(74.48%), 176(36.82%) and 73(15.27%) hospitals in 2018, respectively. Significant differences were observed in the availability of smear among hospitals at different levels (X2 = 12.159, p = 0.000) and with different affiliations(X2 = 4.551, p = 0.033) in 2018. Significant differences were observed in the availability of culture and PCR tests among hospitals at different levels both in 2012 (X2 = 34.532, p = 0.000; X2 = 7.380, p = 0.007) and 2018 (X2 = 49.820, p = 0.000; X2 = 21.658, p = 0.000). The availability of culture and PCR tests for NG among hospitals in 2018 was higher than that in 2012 (X2 = 3.870, p = 0.049; X2 = 4.050, p = 0.044). More hospitals reported gonorrhea cases in 2018 than in 2012 (X2 = 6.768, p = 0.009). A significant difference was observed in distribution of case reporting among hospitals at different levels in 2018 (X2 = 6.975, p = 0.008) and among different types of hospitals both in 2012 (X2 = 52.362, p = 0.000) and 2018 (X2 = 74.478, p = 0.000). Conclusion Poor availability of NG laboratory tests affects case reporting and is a crucial reason leading to high sex ratio and underreporting of gonorrhea cases in Shandong province. Trial registration Not applicable

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Targeted point-of-care testing compared with syndromic management of urogenital infections in women (WISH): a cross-sectional screening and diagnostic accuracy study

Cited by 46 publications

References 25 publications

Pathobionts in the Vaginal Microbiota: Individual Participant Data Meta-Analysis of Three Sequencing Studies

Pathobionts in the Vaginal Microbiota: Individual Participant Data Meta-Analysis of Three Sequencing Studies

Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward

Availability of laboratory diagnosis of gonorrhoea and its meaning in case reporting in Shandong province, China

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