Regional STD Teaching, Training and Research Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India.
Int J Infect Dis. 2009 Nov;13(6):e352-9. doi: 10.1016/j.ijid.2008.11.021. Epub 2009 Feb 23.
The adequacy of the World Health Organization's syndromic approach for the diagnosis and management of sexually transmitted diseases (STDs), especially at primary health centers (PHCs) and at other levels, is still debatable in different settings in India and requires validation.
A cross-sectional study was carried out in women attending the peripheral government clinics of Delhi in order to (1) enumerate their self-reported reproductive tract infection (RTI)/sexually transmitted infection (STI) symptoms; (2) assess their clinical status; (3) determine the syndromic diagnosis of RTI/STI in symptomatic women and etiological diagnosis in both symptomatic and asymptomatic women; and (4) compare the level of agreement between self-reporting of morbidity and syndromic and etiological diagnosis.
The study was conducted over 26 months in 4090 women attending peripheral government healthcare centers, both rural and urban, in four zones of Delhi. They were recruited into four different study groups: group I, non-pregnant, reporting with symptoms of RTI/STI; group II, with a bad obstetric history or infertility; group III, pregnant women in any trimester attending the antenatal clinic; and group IV, the control group. Gynecological examination, followed by the collection of genital specimens and blood, were performed after informed and written consent was obtained. Every symptomatic patient was managed on the basis of algorithms of the syndromic approach as recommended by the National AIDS Control Organisation (NACO), India. All specimens were transported to the STD Reference Laboratory, Safdarjung Hospital, New Delhi and processed by standard methods to diagnose the various STDs. Laboratory reports were sent to the clinicians and appropriate treatment was instituted. Data were analyzed by applying statistical methods.
Overall, self-reporting of morbidity was 65.0%. However, the percentage of women with some STD-related syndrome was 71.4%. The rural women were observed to have significantly more STD syndromes than their urban counterparts. The etiological diagnosis could be established in only 32.2% of cases.
This study highlights the wide variation between self-reporting of morbidity and syndromic- and etiology-based diagnosis in women from both rural and urban settings. This has implications for the syndromic approach to STI case management. These observations call for a review of the diagnostic policy for RTIs/STIs by national authorities in order to avoid the overuse of antimicrobials. The study also highlights the need for the introduction and/or strengthening of facilities for simple diagnostic tests for RTIs/STIs, especially at the peripheral healthcare level.
在印度不同地区，世界卫生组织（WHO）的综合征方法在诊断和管理性传播疾病（STD）方面的充分性，尤其是在基层医疗中心（PHC）和其他层面，仍存在争议，需要进行验证。
本横断面研究在德里周边政府诊所就诊的女性中进行，目的是：（1）列举她们自述的生殖道感染（RTI）/性传播感染（STI）症状；（2）评估她们的临床状况；（3）确定有症状女性的 RTI/STI 综合征诊断和有症状及无症状女性的病因诊断；（4）比较发病率的自我报告与综合征和病因诊断之间的一致性水平。
这项研究在德里四个区的农村和城市的 4090 名就诊于周边政府保健中心的女性中进行，历时 26 个月。她们被招募进入四个不同的研究组：第 I 组为非妊娠、自述 RTI/STI 症状的女性；第 II 组为有不良产科病史或不孕的女性；第 III 组为任何孕期的产前门诊孕妇；第 IV 组为对照组。在获得知情和书面同意后，对所有女性进行妇科检查，并采集生殖道标本和血液。每个有症状的患者都根据印度国家艾滋病控制组织（NACO）推荐的综合征方法算法进行管理。所有标本均运送到新德里萨夫达容医院的 STD 参考实验室，采用标准方法进行处理，以诊断各种 STD。实验室报告发送给临床医生，并进行适当的治疗。数据采用统计方法进行分析。
总体而言，发病率的自我报告率为 65.0%。然而，有某种 STD 相关综合征的女性比例为 71.4%。农村女性的 STD 综合征发生率明显高于城市女性。仅能确定 32.2%的病例的病因诊断。
本研究强调了来自城乡背景的女性中发病率的自我报告与综合征和病因诊断之间的广泛差异。这对性传播感染病例管理的综合征方法具有影响。这些观察结果呼吁国家当局审查 RTIs/STIs 的诊断政策，以避免过度使用抗生素。该研究还强调需要引入和/或加强基层医疗保健水平的 RTIs/STIs 简单诊断检测设施。
