Laboratory diagnosis of sexually transmitted infections in women with genital discharge in Madagascar: implications for primary care
Women seeking care in Madagascar for genital discharge (n =1066) 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 a...
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Published in | International journal of STD & AIDS Vol. 13; no. 9; pp. 606 - 611 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
London, England
SAGE Publications
01.09.2002
Royal Society of Medicine Press Sage Publications Ltd |
Subjects | |
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Abstract | Women seeking care in Madagascar for genital discharge (n =1066) 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. |
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AbstractList | 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. Women seeking care in Madagascar for genital discharge ( n =1066) 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. |
Author | RATSIMBAZAFY, N DALLABETTA, G ANDRIAMIADANA, J RANDRIANASOLO, D BEHETS, F. M-T F COHEN, M. S RASAMILALAO, D |
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Keywords | DISCHARGE ANTIMICROBIAL SUSCEPTIBILITY DIAGNOSIS PRIMARY CARE CERVICAL INFECTIONS Performance evaluation Human Vaginal diseases Method Female genital diseases Infection Sensitivity Specificity Leukorrhea Sexually transmitted disease Female Cervicitis Diagnosis Woman Uterine cervix diseases Comparative study |
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Snippet | Women seeking care in Madagascar for genital discharge (n =1066) were evaluated for syphilis seroreactivity; bacterial vaginosis (BV) and trichomoniasis.... Women seeking care in Madagascar for genital discharge (n = 1,066) were evaluated for syphilis seroreactivity; bacterial vaginosis (BV) and trichomoniasis.... Women seeking care in Madagascar for genital discharge ( n =1066) were evaluated for syphilis seroreactivity; bacterial vaginosis (BV) and trichomoniasis.... Women seeking care in Madagascar for genital discharge (n = 1066) were evaluated for syphilis seroreactivity; bacterial vaginosis (BV) and trichomoniasis.... |
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SubjectTerms | AIDS/HIV Animals Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Bacterial diseases Bacterial diseases of the genital system Biological and medical sciences Chlamydia trachomatis - isolation & purification Clinical Laboratory Techniques Culture Media Female Fluorescent Antibody Technique, Direct Human bacterial diseases Humans Infectious diseases Ligase Chain Reaction Madagascar Medical sciences Microbial Sensitivity Tests Neisseria gonorrhoeae - drug effects Neisseria gonorrhoeae - isolation & purification Predictive Value of Tests Primary Health Care - methods Sensitivity and Specificity Sexually Transmitted Diseases - diagnosis Sexually Transmitted Diseases - drug therapy Sexually Transmitted Diseases - etiology Treponema pallidum - isolation & purification Trichomonas - isolation & purification Tropical medicine Urine - microbiology Urine - parasitology Vaginal Discharge - drug therapy Vaginal Discharge - etiology |
Title | Laboratory diagnosis of sexually transmitted infections in women with genital discharge in Madagascar: implications for primary care |
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