title: Evaluation of syndromic management of sexually transmitted infections within the Kisumu Incidence Cohort Study.
abstract: While laboratory aetiological diagnosis is considered the gold standard for diagnosis and management of sexually transmitted infections (STIs), syndromic management has been presented as a simplified and affordable approach for STI management in limited resource settings. STI signs and symptoms were collected using staff-administered computer-assisted personal interview and audio computer-assisted self-interview. Participants underwent a medical examination and laboratory testing for common STIs. The performance of syndromic management was assessed on the agreement between interviewing methods as well as accurate diagnosis. We screened 846 participants, of whom 88 (10.4%) received syndromic STI diagnosis while 272 (32.2%) received an aetiological diagnosis. Agreement between syndromic and aetiological diagnoses was very poor (overall kappa = 0.09). The most prevalent STI was herpes simplex virus type 2 and the percentage of persons with any STI was higher among women (48.6%) than men (15.6%, p < 0.0001). Agreement between audio computer-assisted self-interview and computer-assisted personal interview interviewing methods for syndromic diagnosis of STIs ranged from poor to good. Our findings suggest that syndromic management of STIs is not a sufficient tool for STI diagnosis in this setting; development and improvement of STI diagnostic capabilities through laboratory confirmation is needed in resource-limited settings.
authors: Centre for Global Health Research, Kenya Medical Research Institute (KEMRI)/CDC Program, Kisumu, Kenya FOtieno@kemricdc.org.
authors: Fredrick Odhiambo
authors: FO
authors: Otieno
authors: Centre for Global Health Research, Kenya Medical Research Institute (KEMRI)/CDC Program, Kisumu, Kenya.
authors: Richard
authors: R
authors: Ndivo
authors: Centre for Global Health Research, Kenya Medical Research Institute (KEMRI)/CDC Program, Kisumu, Kenya.
authors: Simon
authors: S
authors: Oswago
authors: Centre for Global Health Research, Kenya Medical Research Institute (KEMRI)/CDC Program, Kisumu, Kenya.
authors: Johnson
authors: J
authors: Ondiek
authors: Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA.
authors: Sherri
authors: S
authors: Pals
authors: Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA.
authors: Eleanor
authors: E
authors: McLellan-Lemal
authors: Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA.
authors: Robert T
authors: RT
authors: Chen
authors: Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA.
authors: Wairimu
authors: W
authors: Chege
authors: Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA.
authors: Kristen Mahle
authors: KM
authors: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D019468:Disease Management; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic / Q000379:methods*; D007630:Kenya / Q000453:epidemiology; D008297:Male; D010808:Physical Examination; D015995:Prevalence; D012648:Self Care; D017678:Sex Distribution; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D012959:Socioeconomic Factors
keywords: Kenya; Kisumu; STIs; diagnosis; sexually transmitted infection; syndromic management