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doi: 10.1136/sextrans-2013-051184.0401
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Poster presentations
ConclusionIn patients with STIs/HIV, when using syndromic
approach nearly half of the male patients had uretharal discharge
syndrome and over half of female patients had vaginal discharge
syndrome. Etiologically, genital warts due to HPV were the most
common cause.
P2.137
IntroductionVaginal discharge constitutes an important symptom in women attending gynaecology outpatient clinics. Some of
these cases are due to sexually transmitted organisms such as N.
gonorrheae, C. trachomatis and T. vaginalis and can lead to poor
reproductive health and co-infection with HIV. The control of these
infections can lead to substantial reduction in the transmission of
HIV. Given the high cost of diagnosis, National Aids Control Organisation advocates syndromic management of patients with genitourinary complaints and treatment with drugs that target the most
frequent etiological agents. However, it can lead to emergence of
antibiotic resistant strains due to overtreatment. Therefore, we
tried to find out prevalence of these three pathogens in cases of
symptomatic vaginal discharge and to determine the number of
patients who were over-treated following syndromic approach.
Methods 320 non-pregnant women (16 60 years) attending the
gynaecology outpatient clinic of VMMC & Safdarjung Hospital,
New Delhi, with complaint of vaginal discharge and clinically suspected to be infected by N. gonorrhoeae, C. trachomatis & T. Vaginali were recruited. Endocervical swabs were used for detection of
these organisms by PCR.
Results Of the 320 subjects 24 (7.5%) were positive for C. trachomatis, 19 (5.9%) for N. gonorrhoeae & 13 (4.6%) for T. vaginalis.
Furthermore, 8(2.5%) patients had co-infection of C. trachomatis &
N. gonorrhoeae, 07(2.1%) had co-infection of C. trachomatis & T.
vaginalis, 07(2.1%) had N. gonorrheae & T. vaginalis and 06 (1.8%)
cases had C. trachomatis, N. gonorrheae & T. vaginalis. Infection
was found in 49/320 patients with infection rate of 15.3%. Since all
the patients (320) were treated the overtreatment rate was 84.6%.
Conclusion Cost-effective technology for simultaneous detection
of these pathogens is urgently required in developing countries so
that all clinically suspicious cases of vaginal discharge are given
treatment only after confirmed diagnosis.
P2.138
Objectives Although congenital syphilis is a completely preventable disease, its incidence in Bulgaria has experienced an increase in
the recent 15 years.
Methods A 25-day male newborn with a wide spectrum of clinical
features of congenital syphilis is presented.
Results The child was hospitalised in a quite bad condition with
fever, interstitial pneumonia, swollen and painful knee and tarsal
joints, reduced active movement of the left schoulder, and erythemo-bullous rush of the palms and soles (palmoplantar pemphigus). The bone radiogram showed features of osteochondritis and
periostitis of the femurs. The laboratory studies revealed
A130
P2.139
Background Syndromic management of vaginal discharge is common in both developed and developing countries. No systematic
review has evaluated the performance of the WHO syndromic management algorithms as a case-management tool for symptomatic
women. Our evaluation will inform health care professionals
whether these algorithms have sufficient discriminatory power in
identifying patients who would benefit from treatment for cervical
infections.
Methods We conducted a systematic review and meta-analysis of
diagnostic studies on syndromic management of vaginal discharge.
We searched Medline, Embase and Global Health databases; we also
searched relevant lists of references. We included the studies that
reported their findings in sufficient detail to allow data abstraction
for symptomatic women. Sensitivity, specificity and diagnostic OR
(DOR) were used to evaluate the algorithms. ROC curves were
pooled using the HSROC random effects model.
Findings We screened 896 abstracts for eligibility and included 101
articles for a full text review; 17 studies were included in the analysis. HSROC overall summary statistics were: sensitivity 0.58 (0.42
0.73), specificity 0.70 (0.610.78), DOR 3.25 (2.224.76) and
sensitivity 0.81 (0.710.87), specificity 0.46 (0.400.52), DOR 3.71
(2.425.67) for the WHO algorithms without and with speculum
examination respectively. For the algorithms that were modified to
include local risk factors the overall sensitivity was 0.75 (0.510.90),
specificity 0.58 (0.350.77) and DOR 4.18 (2.846.15) for the algorithms without speculum exam; sensitivity 0.70 (0.410.89), specificity 0.64 (0.420.82), DOR 4.24 (2.557.54) for the algorithms
with speculum exam; and sensitivity 0.91 (0.680.98), specificity
0.54 (0.310.75), DOR 11.97 (4.9330.0) for the algorithms with
microscopy.
Interpretation Overall, diagnostic algorithms for the management of vaginal discharge had poor to moderate performance in
symptomatic women. Incorporating locally-identified risk factors
resulted in small improvement in the performance of the algorithms, however, considerable number of women were overtreated
due to low specificity.
P2.140