Evaluation of syndromic management guidelines for treatment of sexually transmitted infections in South African women

Lisette van der Eem, Jan Henk Dubbink, Helen E Struthers, James A McIntyre, Sander Ouburg, Servaas A Morre, Marleen M Kock, Remco P H Peters

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: To evaluate the performance of three different guidelines for the management of vaginal discharge syndrome (VDS) for women living in a rural setting in South Africa.

METHODS: We conducted a secondary analysis of data from a cross-sectional study in Mopani District, South Africa. The 2015 and 2008 guidelines of the South African Department of Health (DoH) and the most recent WHO guidelines were evaluated for adequate treatment of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis infection.

RESULTS: Of the 489 women included in this analysis, 35% presented with VDS according to the DoH and 30% per WHO definition of VDS. 56% of the women with VDS would be treated adequately for these STI when using the 2015 DoH guideline, whereas 76% (p=0.01) and 64% (p=0.35) would receive adequate treatment with the 2008 DoH and WHO guidelines respectively. Of the symptomatic women who tested negative for all four STI, STI treatment would have been indicated for 36% as per 2015 DoH guideline vs. 69% (p<0.001) per 2008 DoH and 67% (p<0.001) per WHO guidelines.

CONCLUSION: A considerable proportion of symptomatic women infected with these common curable STI would receive adequate treatment when using a syndromic management approach, and significant differences exist between the three guidelines. Many symptomatic women without these STI receive broad-spectrum antibiotics, so new approaches are needed to improve syndromic STI control. This article is protected by copyright. All rights reserved.

Original languageEnglish
Pages (from-to)1138-1146
Number of pages9
JournalTropical Medicine & International Health
Volume21
Issue number9
Early online date28 Jun 2016
DOIs
Publication statusPublished - Sep 2016

Keywords

  • syndromic management
  • sexually transmitted infection
  • vaginal discharge syndrome
  • South Africa
  • low-resource setting
  • VAGINAL DISCHARGE
  • PREGNANT-WOMEN
  • CHLAMYDIA
  • HEALTH
  • POINT
  • HIV
  • PREVALENCE
  • GONORRHEA
  • OUTCOMES
  • BURDEN

Cite this

van der Eem, L., Dubbink, J. H., Struthers, H. E., McIntyre, J. A., Ouburg, S., Morre, S. A., Kock, M. M., & Peters, R. P. H. (2016). Evaluation of syndromic management guidelines for treatment of sexually transmitted infections in South African women. Tropical Medicine & International Health, 21(9), 1138-1146. https://doi.org/10.1111/tmi.12742