title: Simple and inexpensive point-of-care tests improve diagnosis of vaginal infections in resource constrained settings.
abstract: OBJECTIVE
  Bacterial vaginosis (BV) and Trichomonas vaginalis infection (TV) have been associated with adverse birth outcomes and increased risk for HIV. We compare the performance of simple inexpensive point-of-care (POC) tests to laboratory diagnosis and syndromic management of BV and TV in poor settings.
  
  
  METHODS
  Between November 2005 and March 2006, 898 sexually active women attending two reproductive health clinics in Mysore, India were recruited into a cohort study investigating the relationship between vaginal flora and HSV-2 infection. Participants were interviewed and screened for reproductive tract infections. Laboratory tests included serology for HSV-2; cultures for TV, Candida sp., and Neisseria gonorrhoeae; Gram stains; and two POC tests: vaginal pH; and Whiff test.
  
  
  RESULTS
  Of the 898 participants, 411 [45.7%, 95% confidence interval (95% CI): 42.4-49.0%] had any laboratory diagnosed vaginal infection. BV was detected in 165 women (19.1%, 95%CI: 16.5-21.9%) using Nugent score. TV was detected in 76 women (8.5%, 95%CI: 6.7-10.4%) using culture. Among the entire study population, POC correctly detected 82% of laboratory diagnosed BV cases, and 83% of laboratory diagnosed TV infections. Among women with complaints of vulval itching, burning, abnormal vaginal discharge, and/or sores (445/898), POC correctly detected 83% (60 of 72 cases) of laboratory diagnosed BV cases vs. 40% (29 of 72 cases) correctly managed using the syndromic approach (P < 0.001). Similarly, POC would have detected 82% (37 of 45 cases) of TV cases vs. 51% (23 of 45 cases) correctly managed using the syndromic approach (P = 0.001).
  
  
  CONCLUSIONS
  In the absence of laboratory diagnostics, POC is not only inexpensive and practical, but also significantly more sensitive than the syndromic management approach, resulting in less overtreatment. .
authors.affiliation: San Francisco Department of Public Health, San Francisco, CA 94103, USA. purnima.madhivanan@sfdph.org
authors.forename: Purnima
authors.initials: P
authors.lastname: Madhivanan
authors.forename: Karl
authors.initials: K
authors.lastname: Krupp
authors.forename: Jill
authors.initials: J
authors.lastname: Hardin
authors.forename: Chitra
authors.initials: C
authors.lastname: Karat
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Reingold
mesh_terms: D000293:Adolescent; D000328:Adult; D003944:Diagnostic Techniques, Obstetrical and Gynecological; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007194:India / Q000453:epidemiology; D008507:Medically Underserved Area; D009812:Odorants; D019095:Point-of-Care Systems; D011446:Prospective Studies; D011537:Pruritus / Q000382:microbiology / Q000469:parasitology; D014247:Trichomonas Vaginitis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D019522:Vaginal Discharge / Q000382:microbiology / Q000469:parasitology; D014626:Vaginal Smears / Q000379:methods; D016585:Vaginosis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult