title: Laboratory diagnosis of sexually transmitted infections in women with genital discharge in Madagascar: implications for primary care.
abstract: Women seeking care in Madagascar for genital discharge (n = 1,066) were evaluated for syphilis seroreactivity; bacterial vaginosis (BV) and trichomoniasis. Chlamydial infection was assessed by ligase chain reaction (LCR) and by direct immunofluorescence (IF); gonorrhoea by direct microscopy, culture and LCR. Leucocytes were determined in endocervical smears and in urine using leucocyte esterase dipstick (LED). Gonococcal isolates were tested for minimal inhibitory concentrations. BV was found in 56%, trichomoniasis in 25%, and syphilis in 6% of the women. LCR detected gonorrhoea in 13% and chlamydial infection in 11% of the women. Detection of Gram(-) intracellular diplococci in endocervical smears, and gonococcal culture were respectively 23% and 57% sensitive and 98% and 100% specific compared to LCR. Chlamydia antigen detection by IF was 75% sensitive and 77% specific compared to LCR. Leucocytes in endocervical smears and LED testing lacked precision to detect gonococcal and chlamydial infections. Of 67 gonococcal strains evaluated, 19% were fully susceptible to penicillin, 33% to tetracycline; all were susceptible to ciprofloxacin, ceftriaxone, and spectinomycin. Patients who present with genital discharge in Madagascar should be treated syndromically for gonococcal and chlamydial infections and screened for syphilis. Gonorrhoea should be treated with ciprofloxacin.
authors.affiliation: Department of Medicine, School of Public Health, University of North Carolina at Chapel Hill, 27599-7400, USA. frieda_behets@unc.edu
authors.forename: F M-T F
authors.initials: FM
authors.lastname: Behets
authors.forename: J
authors.initials: J
authors.lastname: Andriamiadana
authors.forename: D
authors.initials: D
authors.lastname: Randrianasolo
authors.forename: D
authors.initials: D
authors.lastname: Rasamilalao
authors.forename: N
authors.initials: N
authors.lastname: Ratsimbazafy
authors.forename: G
authors.initials: G
authors.lastname: Dallabetta
authors.forename: M S
authors.initials: MS
authors.lastname: Cohen
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D019411:Clinical Laboratory Techniques; D003470:Culture Media; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D022521:Ligase Chain Reaction; D008270:Madagascar; D008826:Microbial Sensitivity Tests; D009344:Neisseria gonorrhoeae / Q000187:drug effects / Q000302:isolation & purification; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000379:methods*; D012680:Sensitivity and Specificity; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D014210:Treponema pallidum / Q000302:isolation & purification; D014244:Trichomonas / Q000302:isolation & purification; D014556:Urine / Q000382:microbiology / Q000469:parasitology; D019522:Vaginal Discharge / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000900:Anti-Bacterial Agents; D003470:Culture Media