Lack of effectiveness of syndromic management in targeting vaginal infections in pregnancy in Entebbe, Uganda
- 1 August 2006
- journal article
- Published by BMJ in Sexually Transmitted Infections
- Vol. 82 (4), 285-289
- https://doi.org/10.1136/sti.2005.014845
Abstract
Objectives: To measure the prevalence of reproductive tract infections (RTIs) during pregnancy in Entebbe, Uganda, and to evaluate the current syndromic diagnosis and management approach in effectively targeting infections, such as bacterial vaginosis (BV) and trichomoniasis, that are associated with low birth weight and prematurity among newborns. Methods: We enrolled 250 antenatal clinic attenders. Vaginal swabs and diagnostic tests were performed for BV, Trichomonas vaginalis (TV), candida, Neisseria gonorrhoeae, Chlamydia trachomatis and for HIV-1 and active (TPHA+/RPR+) syphilis infection. Same day treatment was offered for symptoms according to syndromic management guidelines. The treatment actually provided by healthcare workers was documented. Sensitivity, specificity, positive and negative predictive values were used to assess the effectiveness of syndromic management guidelines and practice. Results: The prevalence of infections were: BV 47.7%, TV 17.3%, candida 60.6%, gonorrhoea 4.3%, chlamydia 5.9%, syphilis 1.6%, and HIV 13.1%. In total, 39.7% of women with BV and 30.2% of those with TV were asymptomatic. The sensitivity of syndromic management as applied by health workers in targeting BV and TV was 50.0% and 66.7%, respectively. This would have increased to 60.3% (BV) and 69.8% (TV) had the algorithm been followed exactly. Conclusions: The prevalence of BV and TV seen in this and other African populations is high. High rates of asymptomatic infection and a tendency of healthcare workers to deviate from management guidelines by following their own personal clinical judgment imply that many vaginal infections remain untreated. Alternative strategies, such as presumptive treatment of BV and TV in pregnancy, should be considered.Keywords
This publication has 24 references indexed in Scilit:
- Bacterial vaginosis as a risk factor for preterm delivery: A meta-analysisAmerican Journal of Obstetrics and Gynecology, 2003
- Antibiotic treatment of bacterial vaginosis in pregnancy: A meta-analysisAmerican Journal of Obstetrics and Gynecology, 2003
- Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a randomised controlled trialThe Lancet, 2003
- Randomized trial of presumptive sexually transmitted disease therapy during pregnancy in Rakai, UgandaAmerican Journal of Obstetrics and Gynecology, 2001
- The epidemiology of trichomoniasis in women in four African citiesAIDS, 2001
- The burden of reproductive-organ disease in rural women in The Gambia, West AfricaThe Lancet, 2001
- Vaginal infection: prophylaxis and perinatal outcome--a review of the literature.2001
- Placental Membrane Inflammation and Risks of Maternal-to-Child Transmission of HIV-1 in UgandaJAIDS Journal of Acquired Immune Deficiency Syndromes, 1999
- Vaginal Lactobacilli, Microbial Flora, and Risk of Human Immunodeficiency Virus Type 1 and Sexually Transmitted Disease AcquisitionThe Journal of Infectious Diseases, 1999
- Sexually transmitted infections in young pregnant women in Bangui, Central African RepublicInternational Journal of STD & AIDS, 1999