Validation of diagnostic algorithms for syndromic management of sexually transmitted diseases.

Abstract

To validate our revised syndromic algorithms of the management of sexually transmitted diseases and determine their sensitivity, specificity, positive predictive value and cost-effectiveness. Patients with either urethral discharge, vaginal discharge or genital ulcer, were selected during their first visits to three urban sexually transmitted disease clinics in Fujian Province, China. They were managed syndromically according to our revised flowcharts. The etiology of the syndromes was detected by laboratory testing. The data were analyzed using EPI INFO V6.0 software. A total of 736 patients were enrolled into the study. In male patients with urethral discharge, the sensitivities for gonococcal and chlamydial infections were 96.7% and 100%, respectively, using the syndromic approach. The total positive predictive value was 73%. In female patients with vaginal discharge, the sensitivity was 90.8%, specificity 46.9%, positive predictive value 50.9%, and negative predictive value 89.3% for the diagnosis of gonorrhea and/or chlamydial infection by syndromic approach. In patients with genital ulcer, the sensitivities were 78.3% and 75.8%, specificities of 83.6% and 42.9%, and positive predictive values of 60.0% and 41.0% for the diagnosis of syphilis and genital herpes, respectively, using the syndromic approach. Cost-effectiveness analysis indicated that the average cost of treatment for a patient with urethral discharge was RMB 46.03 yuan using syndromic management, in comparison with RMB 149.19 yuan by etiological management. The syndromic management of urethral discharge was relatively effective and suited clinical application. The specificity and positive predictive value for syndromic management of vaginal discharge are not satisfactory. The revised flowchart of genital ulcer syndrome could be suitable for use in clinical settings. Further validation and revision are needed for syndromic approaches of vaginal discharge and genital ulcer.