Vallely Lisa M, Toliman Pamela, Ryan Claire, Rai Glennis, Wapling Johanna, Gabuzzi Josephine, Allen Joyce, Opa Christine, Munnull Gloria, Kaima Petronia, Kombuk Benny, Kumbia Antonia, Kombati Zure, Law Greg, Kelly-Hanku Angela, Wand Handan, Siba Peter M, Mola Glen D L, Kaldor John M, Vallely Andrew J
Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
The Macfarlane Burnet Institute for Medical Research and Public Health, Burnet Institute, Melbourne, Victoria, Australia.
BMJ Open. 2017 Dec 29;7(12):e018630. doi: 10.1136/bmjopen-2017-018630.
Papua New Guinea (PNG) has among the highest estimated prevalences of genital (CT), (NG) and (TV) of any country in the Asia-Pacific region. Diagnosis and treatment of these infections have relied on the WHO-endorsed syndromic management strategy that uses clinical presentation without laboratory confirmation to make treatment decisions. We evaluated the performance of this strategy in clinical settings in PNG.
Women attending antenatal (ANC), well woman (WWC) and sexual health (SHC) clinics in four provinces were invited to participate, completed a face-to-face interview and clinical examination, and provided genital specimens for laboratory testing. We estimated the performance characteristics of syndromic diagnoses against combined laboratory diagnoses.
1764 women were enrolled (ANC=765; WWC=614; SHC=385). The prevalences of CT, NG and TV were highest among women attending ANC and SHC. Among antenatal women, syndromic diagnosis of sexually transmitted infection had low sensitivity (9%-21%) and positive predictive value (PPV) (7%-37%), but high specificity (76%-89%) and moderate negative predictive value (NPV) (55%-86%) for the combined endpoint of laboratory-confirmed CT, NG or TV. Among women attending WWC and SHC, 'vaginal discharge syndrome' had moderate to high sensitivity (72%-78%) and NPV (62%-94%), but low specificity (26%-33%) and PPV (8%-38%). 'Lower abdominal pain syndrome' had low sensitivity (26%-41%) and PPV (8%-23%) but moderate specificity (66%-68%) and high NPV (74%-93%) among women attending WWC, and moderate-high sensitivity (67%-79%) and NPV (62%-86%) but low specificity (26%-28%) and PPV (14%-33%) among SHC attendees.
The performance of syndromic management for the detection and treatment of genital chlamydia, gonorrhoea and trichomonas was poor among women in different clinical settings in PNG. New diagnostic strategies are needed to control these infections and to prevent their adverse health outcomes in PNG and other high-burden countries.
在亚太地区所有国家中，巴布亚新几内亚（PNG）的生殖沙眼衣原体（CT）、淋病奈瑟菌（NG）和阴道毛滴虫（TV）估计患病率位居前列。这些感染的诊断和治疗一直依赖于世界卫生组织认可的综合征管理策略，该策略根据临床表现而非实验室确诊来做出治疗决策。我们评估了该策略在巴布亚新几内亚临床环境中的表现。
邀请来自四个省份的产前（ANC）、健康女性（WWC）和性健康（SHC）诊所的女性参与，她们完成了面对面访谈和临床检查，并提供了生殖部位标本用于实验室检测。我们根据联合实验室诊断评估了综合征诊断的性能特征。
共纳入1764名女性（ANC = 765名；WWC = 614名；SHC = 385名）。CT、NG和TV的患病率在ANC和SHC诊所的女性中最高。在产前女性中，性传播感染的综合征诊断对于实验室确诊的CT、NG或TV这一联合终点的敏感性较低（9% - 21%）和阳性预测值（PPV）较低（7% - 37%），但特异性较高（76% - 89%），阴性预测值（NPV）中等（55% - 86%）。在WWC和SHC诊所的女性中，“阴道分泌物综合征”的敏感性中等至高（72% - 78%），NPV中等至高（62% - 94%），但特异性较低（26% - 33%），PPV较低（8% - 38%）。“下腹部疼痛综合征”在WWC诊所的女性中敏感性较低（26% - 41%），PPV较低（8% - 23%），但特异性中等（66% - 68%），NPV较高（74% - 93%）；在SHC诊所的女性中敏感性中等至高（67% - 79%），NPV中等至高（62% - 86%），但特异性较低（26% - 28%），PPV较低（14% - 33%）。
在巴布亚新几内亚不同临床环境中的女性中，用于检测和治疗生殖衣原体、淋病和滴虫的综合征管理表现不佳。需要新的诊断策略来控制这些感染，并预防其在巴布亚新几内亚和其他高负担国家造成不良健康后果。
