The sensitivity of a syndromic management approach in detecting sexually transmitted diseases in patients at a public health clinic in Cape Town.
OBJECTIVE
To evaluate the sensitivity of a syndromic diagnostic procedure in detecting and treating sexually transmitted diseases (STDs) and genital tract infections (GTIs).


METHODS
All new patients presenting at an STD clinic were sampled systematically by gender over a 6-week period. After the patient's clinical consultation, the clinical records were reviewed. Thereafter all patients were given a thorough genital examination by the research physician, and specimens were collected for laboratory investigations. In a retrospective simulation clinicians' syndromic diagnoses were validated against the laboratory findings, or for genital ulcer syndrome against the findings of the research physician.


RESULTS
170 men and 161 women were included in the sample. Ninety-five per cent of patients were black and the median age was 22 years for women and 26 years for men. In this setting, the Western Cape syndromic diagnostic procedure achieved reasonable levels of sensitivity in detecting Neisseria gonorrhoeae and Chlamydia trachomatis in men and women, and in detecting Trichomonas vaginalis and bacterial vaginosis in women. However, it was estimated to be only 36.4% sensitive in detecting genital ulcers in women, and between 0% and 12.3% sensitive in detecting Candida albicans. With syndromic management 8.2% of men and 32.9% of women would leave the clinic with at least one infection inadequately treated.


CONCLUSIONS
Despite the introduction of syndromic protocols, it is likely that a proportion of STDs and GTIs are not being detected and treated owing to the high prevalence of multiple syndromes and mixed infections, both symptomatic and asymptomatic.
Mathews
C
C
Centre for Epidemiological Research, South Africa.
van Rensburg
A
A
Coetzee
N
N
D000328:Adult; D000818:Animals; D002177:Candidiasis / Q000175:diagnosis; D019411:Clinical Laboratory Techniques / Q000191:economics; D002985:Clinical Protocols / Q000592:standards; D003951:Diagnostic Errors; D005260:Female; D005831:Genital Diseases, Female / Q000175:diagnosis; D005832:Genital Diseases, Male / Q000175:diagnosis; D006069:Gonorrhea / Q000175:diagnosis; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology; D013019:South Africa / Q000453:epidemiology; D014247:Trichomonas Vaginitis / Q000175:diagnosis; D014456:Ulcer / Q000175:diagnosis