title: Vaginal discharge: aetiological agents and evaluation of syndromic management in Lagos.
abstract: BACKGROUND
  The WHO introduced the syndromic management to help in the control of STIs in resource-poor settings. This needs to be adapted to local settings taking into consideration the prevalence of the various organisms causing STIs. This has given rise to a need to validate the algorithm. The study aimed to correlate the syndromic management treatment algorithm for vaginal discharge with the aetiological diagnosis based on laboratory investigations. Specifically, the sensitivity, specificity and positive predictive values of the syndromic management against a gold standard laboratory diagnosis were evaluated.
  
  
  METHODS
  A total of 195 consecutive patients presenting to the study sites with vaginal discharge were enrolled in the study. Information on sociodemographic data was obtained with the aid of questionnaires. Samples were taken and examined for candida, trichomonas, bacterial vaginosis (BV), chlamydia and gonorrheal infections, after speculum and vaginal examinations.
  
  
  RESULTS
  The sensitivity and positive predictive values (PPV) of the syndromic management in detecting vaginal infections performed better than corresponding values for cervicitis. The algorithm for cervicitis improved on addition of speculum examination (36% and 32.1% for sensitivity and PPV respectively).
  
  
  CONCLUSIONS
  The study shows that the syndromic diagnosis for vaginal discharge fares better for vaginitis, especially with addition of speculum examination. The application of syndromic diagnosis for cervicitis resulted in omission of patients who had evidence of cervical infections by bacteriologic examination.
authors.affiliation: College of Medicine, University of Nigeria, Enugu Campus, Nigeria. chyonyekonwu@yahoo.co.uk
authors.forename: C L
authors.initials: CL
authors.lastname: Onyekonwu
authors.forename: Y M
authors.initials: YM
authors.lastname: Olumide
authors.forename: F A
authors.initials: FA
authors.lastname: Oresanya
authors.forename: G C
authors.initials: GC
authors.lastname: Onyekonwu
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000465:Algorithms; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002181:Candidiasis, Vulvovaginal / Q000175:diagnosis / Q000188:drug therapy; D019468:Disease Management; D005260:Female; D006801:Humans; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D009761:Nystatin / Q000627:therapeutic use; D010808:Physical Examination; D015995:Prevalence; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014247:Trichomonas Vaginitis / Q000175:diagnosis / Q000188:drug therapy; D002575:Uterine Cervicitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D019522:Vaginal Discharge / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D009761:Nystatin