HomeJournal Club "Syndromic management" may be, well, useless (?) for chlamydia and N. gonorrhea in Batswana women
"Syndromic management" may be, well, useless (?) for chlamydia and N. gonorrhea in Batswana women
published 15-10-2007
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This study examined the prevalence of C. trachomatis and N. gonorrhoeae among 703 antenatal care patients in Botswana. The important finding was that most of these women would not have been properly treated if the syndromic approach to STDs were followed, because signs and symptoms of vaginal discharge were not predictive of the infections. In fact, the signs and symptoms were no more useful than simply knowing the socio-demographic factors (such as age and education) alone.
The authors conclude that (1) rapid diagnostic tests are urgently needed if these STIs are to be found and treated and (2) without such tests, resources could be better used elsewhere than in a [futile] attempt to manage these disease by the syndromic approach.
Note that among the 703 women 51 were infected with C. trachomatis and 21 with N gonorrhoea, so the study was not very large. Also, the results in Botswana may not be the same as those in other areas of Africa. Still, the results merit careful examination since the syndromic approach is widely used: perhaps it needs more justification in the case of these two STIs.
"Unfortunately, risk scores do not appear to improve the management of cervical infections in pregnancy substantially. To diagnose and treat asymptomatic cervical infections, and to reduce the massive overtreatment in the syndromic management, specific diagnostic tests are necessary. Screening for cervical infections in pregnant women is an essential public health measure, and rapid tests will hopefully be available in developing countries within a few years. In the temporary absence of such tests, health authorities in sub-Saharan Africa should consider reallocating their resources to other STI measures rather than diagnosing and treating gonorrhoea and chlamydia inadequately in antenatal care."
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