title: Diagnostic accuracy of self-reported symptomatic assessment versus per speculum/per vaginal examination for the diagnosis of vaginal/cervical discharge and lower abdominal pain syndromes among female sex workers.
abstract: BACKGROUND
  National AIDS Control Organization guidelines on enhanced syndromic case management of sexually transmitted infections (STIs) and reproductive tract infections (RTIs) require per speculum (P/S) and per vaginal (P/V) examinations for diagnosis of STIs. However, it is not known if the addition of P/S and P/V examinations to self-reported symptomatic assessment adds any value for the diagnosis of STI/RTI.
  
  
  OBJECTIVE
  To assess the diagnostic accuracy of P/S and P/V examinations compared with self-reported symptomatic assessment in a cohort of female sex workers (FSWs).
  
  
  METHODS
  We performed a cross-sectional study from August 2009 to June 2010, among 519 FSWs in Surat city, Gujarat, India. Symptomatic assessment for the presence or absence of vaginal/cervical discharge (VCD) or lower abdominal pain (LAP) was done using a self-administered questionnaire. After completion of the questionnaire, all participants underwent P/S and P/V examinations. Summary diagnostic accuracy measures were calculated.
  
  
  RESULTS
  Five hundred and nineteen FSWs between the ages of 18-49 years participated in the study. The median age of participants was 31 years. The prevalence of VCD and LAP syndromes based on vaginal discharge, LAP, or both was 56%, 5,-10%, respectively. The sensitivity of P/S and P/V examinations depending on symptomatic assessment ranged from 47% to 76%. The specificity ranged from 73% to 93%. The positive predictive value ranged from 25% to 83%, and the negative predictive value ranged from 56% to 98%.
  
  
  CONCLUSIONS
  Symptomatic assessment alone is not adequate for the diagnosis of VCD and LAP syndromes and can lead to a significant number of missed cases (36%). A P/S and P/V examinations is critical for assessment of VCD and LAP syndromes and subsequent treatment.
authors.affiliation: Department of Community Medicine, Government Medical College, Surat, Gujarat, India.
authors.forename: Jayendrakumar K
authors.initials: JK
authors.lastname: Kosambiya
authors.affiliation: Department of Community Medicine, GMERS Medical College, Valsad, Gujarat, India.
authors.forename: H G
authors.initials: HG
authors.lastname: Baria
authors.affiliation: Department of Community Medicine, GMERS Medical College, Vadodara, Gujarat, India.
authors.forename: Rohit
authors.initials: R
authors.lastname: Parmar
authors.affiliation: USF Health Program for Comprative Effectiveness Research, Morsani Medical College, University of South Florida, Tampa, Florida, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Mhaskar
authors.affiliation: Department of Pediatrics, Morsani Medical College, University of South Florida, Tampa, Florida, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Emmanuel
authors.affiliation: USF Health Program for Comprative Effectiveness Research, Morsani Medical College, University of South Florida, Tampa, Florida, USA.
authors.forename: Ambuj
authors.initials: A
authors.lastname: Kumar
keywords: Diagnostic accuracy; lower abdominal pain; reproductive tract infections; sexually transmitted infections; vaginal discharge