A pilot study of the frequency of genital tract infection in symptomatic women and the use of rapid diagnostic tests in two groups of women from Bogotá, Colombia, 2008
DOI:
https://doi.org/10.18597/rcog.268Keywords:
vaginitis, vulvovaginal candidiasis, bacterial vaginosis, sexually transmitted disease, cervicitis, diagnosis, rapid diagnostic test, syndromic managementAbstract
Objectives: describing the frequency and etiology of genital tract infections in two selected groups of women.
Methodology: this was a cross-sectional study which included females having symptoms of vaginal discharge or itching who consulted during 2007-2008 at three sites in Bogotá, Colombia. They were aged 14 to 49. The following exclusion criteria were used: females having severe medical conditions, a history of hysterectomy, being pregnant, presenting menstrual discharge, having no history of sexual activity or those who reported having received antibiotic therapy during the previous 14 days. Sequential sampling. Syndromic diagnosis was stablished according to the World Health Organization guidelines. Definitive diagnosis was made by PCR (Polymerase Chain Reaction) for C. trachomatis, culturing for N. gonorrhoeae and Candida, treponemal tests for syphilis, direct exam for Trichomonas vaginalis, nugent’s test for bacterial vaginosis and serological detection for human immunodeficiency virus (HIV). Sensitivity and specificity of the rapid diagnostic tests used were determined against the “gold standard” diagnostic test for each infection.
Results: one hundred and thirty-one females were included. Bacterial vaginosis was present in 46% of the patients, followed by candidiasis in 16%. Syphilis was the most frequently diagnosed sexually-transmitted infection in 7% of cases and C. trachomatis in 6%. Trichomonas vaginalis was observed in two patients but no cases of N. gonorrhoeae were identified. The most frequent syndromic diagnosis was vaginitis. The rapid diagnostic tests had close to 100% specificity; sensitivity varied from 90% for syphilis, to 81% for bacterial vaginosis and 60% for Candida. The frequency of positive cases for Chlamydia and gonorrhoeae was too low to assess the rapid tests’ diagnostic precision.
Conclusions: genital tract infections in the symptomatic women studied here were mainly endogenous. The overall frequency of sexually transmitted infection in these selected populations was 16%. Rapid diagnostic tests may be used at the point-of-care. Additional research is urgently needed; a larger sample should be used for accurately assessing rapid tests’ diagnostic precision.
Author Biographies
Edith Ángel-Müller
María Patricia González
Lilian Núñez
Jorge Pacheco
Jorge E. Tolosa
Luz Amparo Díaz
Elkin Osorio
Ariel Ruiz-Parra
Hernando Gaitán-Duarte
References
WHO. Global prevalence and incidence of selected curable sexually transmitted infections: overviews and estimates. WHO/HIV_AIDS/2001.02. Geneva: WHO, 2001.2.
Da Ros CT, Schmitt Cda S. Global epidemiology of sexually transmitted diseases. Asian J Androl 2008;10:110-4.
Gwatkin D, Guillot M. The burden of disease among the global poor. Current situation, future trends, and implications for strategy. Washington, D.C.: The World Bank; 2000.
Centers for Disease Control and Prevention, Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep 2006;55:1-93.
Denney JM, Culhane JF. Bacterial vaginosis: a problematic infection from both a perinatal and neonatal perspective. Semin Fetal neonatal Med 2009;14:200-3.
Larsson PG, Bergström M, Forsum U, Jacobsson B, Strand A, Wölner-Hanssen P. Bacterial vaginosis. Transmission, role in genital tract infection and pregnancy outcome: an enigma. APMIS 2005;113:233-45.
Rottingen J, Cameron DW, Garnett GP. A systematic review of the epidemiologic interactions between classic sexually transmitted diseases and HIV. Sex Transm Dis 2001;28:579-95.
Laga M, Manoka A, Kivuvu M, Malele B, Tuliza M, nzila n, et al. non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS 1993;7:95-102.
Sewankambo N, Gray RH, Wawer MJ, Paxton L, Mcnaim D, Wabwire-Mangen F, et al. HIV and HIV-2 J infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Lancet 1997;350:546-50.
Hashemi FB, Ghassemi M, Roebuck KA, Spear GT. Activation of human immunodeficiency virus type 1 expression by Gardnerella vaginalis. J Infect Dis 1999;179:924-30.
Cohen MS, Hoffman IF, Royce RA, Kazembe P, Dyer JR, Daly CC, et al. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. AIDSCAP Malawi Research Group. Lancet 1997;349:1868-73.
Jackson DJ, Rakwar JP, Bwayo JJ, Kreiss JK, Moses S. Urethral Trichomonas vaginalis infection and HIV-1 transmission. Lancet 1997;350:1076.
Wöhrl S, Geusau A. Clinical update: syphilis in adults. Lancet 2007;369:1912-4.
UnAIDS/WHO. Sexually transmitted diseases: policies and principles for prevention and care. UnAIDS Best Practice Collection. Key Material. Geneva: UnAIDS/ WHO, 1999.
Mayaud P, Mabey D. Approaches to the control of sexually transmitted infections in developing countries: old problems and modern challenges. Sex Transm Infect 2004;80:174-82.
, World Health Organization. Guidelines for the management of sexually transmitted infections. WHO/ HIV_AIDS/2001.01.
Kamali A, Quigley M, nakiyingi J, Kengeya-Kayondo J, Gopal R, et al. Syndromic management of sexually transmitted infections and behaviour change interventions on transmission of HIV-1 in rural Uganda: a community randomised trial. Lancet 2003;361:645-52.
Grosskurth H, Mosha F, Todd J, Mwijarubi E, Klokke A, Senkoro K, et al. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet 1995;346:530-6.
Htun Y, Morse SA, Dangor Y, Fehler G, Radebe F, Trees DL, et al. Comparison of clinically directed, disease specific, and syndromic protocols for the management of genital ulcer disease in Lesotho. Sex Transm Infect 1998;74:S23-8.
Guías de Promoción de la Salud y prevención de enfermedades en la Salud Pública. Ministerio de la Protección Social Colombia 2007. Visitado 2010 Jul 22. Disponible en: http://mps.minproteccionsocial.gov.co/pars/NewsDetail.asp?ID=17094&IDCompany=39
Vuylsteke B. Current status of syndromic management of sexually transmitted infections in developing countries. Sex Transm Infect 2004;80:333-4.
Dallabetta GA, Gerbase AC, Holmes KK. Problems, solutions, and challenges in syndromic management of sexually transmitted diseases. Sex Transm Infect 1998;74:S1-11.
Redwood-Campbell L, Plumb J. The syndromic approach to treatment of sexually transmitted diseases in low-income countries: issues, challenges, and future directions. J Obstet Gynaecol Can 2002;24:417-24.
Pettifor A, Walsh J, Wilkins V, Raghunathan P. How effective is syndromic management of STDs?: A review of current studies. Sex Transm Dis 2000;27:371-85.
Trollope-Kumar K, Guyatt G. Syndromic approach for treatment of STIs: time for a change. Lancet 2006;367:1380-1.
Rani R, Corbitt G, Killough R, Curless E. Is there any role for rapid tests for Chlamydia trachomatis? Int J STD AIDS 2002;13:22-4.
Gift TL, Pate MS, Hook EW 3rd, Kassler WJ. The rapid test paradox: when fewer cases detected lead to more cases treated: a decision analysis of tests for Chlamydia trachomatis. Sex Transm Dis 1999;26:232-40.
Vickerman P, Watts C, Peeling RW, Mabey D, Alary M. Modelling the cost effectiveness of rapid point of care diagnostic tests for the control of HIV and other sexually transmitted infections among female sex workers. Sex Transm Infect 2006;82:403-12.
Benzaken AS, Galban EG, Antunes W, Dutra JC, Peeling RW, Mabey D, et al. Diagnosis of gonococcal infection in high risk women using a rapid test. Sex Transm Infect 2006;82:26-8.
Tinajeros F, Grossman D, Richmond K, Steele M, Garcia SG, Zegarra L, et al. Diagnostic accuracy of a point-ofcare syphilis test when used among pregnant women in Bolivia. Sex Transm Infect 2006;82:v17-21.
Alvarado-Esquivel C, García-Villanueva A, Castruita-Limones DE, Cardosa-nevárez FJ, Ruiz-Astorga R. Prevalencia de infección por Chlamydia trachomatis en prostitutas registradas de la ciudad de Durango, México. Salud Pública Mex 2000;42:43-7.
Miranda AE, Szwarcwald CL, Peres RL, Page-Shafer K. Prevalence and risk behaviors for chlamydial infection in a population-based study of female adolescents in Brazil. Sex Transm Dis 2004;31:542-6.
Alvis n, Mattar S, Garcia J, Conde E, Díaz A. Sexually transmitted infection in a high-risk group from Monteria, Colombia. Rev Salud Publica 2007;9:86-96.
Sánchez RM, Ruiz-Parra AI, Ostos-Ortiz OL. Prevalencia de Chlamidia trachomatis detectada por reacción en cadena de la polimerasa en un grupo de mujeres jóvenes sintomáticas y asintomáticas en Bogotá, Colombia. Rev Colomb Obstet Ginecol 2006;57:171-81.
Tolosa JE, Chaithongwongwatthana S, Daly S, Maw WW, Gaitán H, Lumbiganon P, et al. The International Infections in Pregnancy (IIP) study: variations in the prevalence of bacterial vaginosis and distribution of morphotypes in vaginal smears among pregnant women. Am J Obstet Gynecol 2006;195:1198-204.
Mayaud P. Infertility in Africa: the role of reproductive tract infections. En: Boerma T, Mgalla Z, eds. Women and infertility in Africa: a multidisciplinary perspective with special reference to Tanzania. Amsterdam: Royal Tropical Institute, KIT Press; 2001.
How to Cite
Downloads
Downloads
Published
Issue
Section
License
Copyright (c) 2015 Revista Colombiana de Obstetricia y Ginecología
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
