P2.061 Accuracy of Syndromic Diagnosis (SD) For Vaginal Dyscharge and Cervicitis in Women of Reproductive Age in Bogota, Colombia

Abstract

Objective Determine the diagnostic accuracy of the symptoms and signs used in the syndromic diagnosis of low genital tract infections (LGTIs) in symptomatic women. Materials and Methods: A diagnostic validity study of sexually active women (14–49 years old) consulting with symptoms of LGTI at three outpatient facilities in Bogota, Colombia were recruited in 2010. Exclusion criteria: hysterectomy, pregnancy or antibiotics in the 7 previous days. Symptoms and signs and syndromic diagnosis were evaluated by a physician for two syndromes: Vaginal discharge caused by Bacterial vaginosis (BV) Candida albicans (CA) and Trichomonas vaginalis (TV) and Cervicitis caused by N. gonorrhoeae (NG), and C trachomatis (CT). Those were compared against PCR for CT and NG; Nugent’s criteria for BV; wet smear for TV and blood agar culture for CA. Sensitivity, specificity, LR (+), LR (-) for each syndrome and its symptoms and signs were calculated Results 1372 subjects were evaluated. The prevalence of NG and CT was 1.3% (18/1372) and 9.1% (125/1372); for BV, TV and CA infection was 39.9% (548/1372), 0.8% (11/1372) and 11.1% (152/1372). Sensitivity and Specificity are for syndromic approach for cervicitis 13.3%(CI 95 8.2–20) and 90.9% (CI95 89.1–92.4) respectively. Vaginal discharge is the sign with the most sensitivity for cervicitis and BV, TV and CA infections: 93% and 78%, respectively. In cervicitis, the most specific sign is mucopurulent cervical discharge (91.8%) and for BV, TV and CA infections is erythema valvular (68%). Conclusions SD for vaginal discharge syndrome has a high sensitivity and a low specificity resulting in a high rate of unnecessary antibiotic treatment (64.9%). SD for cervicitis, has a low sensitivity and high specificity resulting in a high % of false negatives and lack of needed antibiotic treatment in 86.7%. SD alone is an ineffective strategy for LGTIs. Funded by COLCIENCIAS (Colombia) Grant: 621 2009