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Syndromic management of sexually transmissible infections in resource-poor settings: a systematic review with meta-analysis of the abnormal vaginal discharge flowchart for Neisseria gonorrhoea and Chlamydia trachomatis

van Gemert, Caroline, Hellard, Margaret, Bradshaw, Catriona S, Fowkes, Freya JI, Agius, Paul A, Stoove, Mark and Bennett, Catherine M 2018, Syndromic management of sexually transmissible infections in resource-poor settings: a systematic review with meta-analysis of the abnormal vaginal discharge flowchart for Neisseria gonorrhoea and Chlamydia trachomatis, Sexual health, vol. 15, no. 1, pp. 1-12, doi: 10.1071/SH17070.

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Title Syndromic management of sexually transmissible infections in resource-poor settings: a systematic review with meta-analysis of the abnormal vaginal discharge flowchart for Neisseria gonorrhoea and Chlamydia trachomatis
Author(s) van Gemert, Caroline
Hellard, Margaret
Bradshaw, Catriona S
Fowkes, Freya JI
Agius, Paul A
Stoove, Mark
Bennett, Catherine MORCID iD for Bennett, Catherine M orcid.org/0000-0001-9581-1612
Journal name Sexual health
Volume number 15
Issue number 1
Start page 1
End page 12
Total pages 12
Publisher CSIRO Publishing
Place of publication Clayton, Vic.
Publication date 2018
ISSN 1448-5028
Keyword(s) sexually transmissible infections
STIs
abnormal vaginal discharge (AVD)
cervical infection
Neisseria gonorrhoea
Chlamydia trachomatis
World Health Organization
science & technology
life sciences & biomedicine
public, environmental & occupational health
infectious diseases
Summary Background: Syndromic management of sexually transmissible infections is commonly used in resource-poor settings for the management of common STIs; abnormal vaginal discharge (AVD) flowcharts are used to identify and treat cervical infection including Neisseria gonorrhoea and Chlamydia trachomatis. A systematic review and meta-analysis was undertaken to measure the diagnostic test performance of AVD flowcharts, including both World Health Organization (WHO)- and locally-adapted AVD flowcharts.

Methods
: A systematic search of multiple electronic databases was conducted to locate eligible studies published between 1991 and 2014. Flowcharts were categorised into one of 14 types based on: 1) use of WHO guidelines or locally-adapted versions; 2) use of risk assessment, clinical examination or both; and 3) symptomatic entry. Summary diagnostic performance measures calculated included summary sensitivity, summary specificity and diagnostic odds ratio.

Results: Thirty-six studies, including data on 99 flowcharts, were included in the review. Summary sensitivity estimates for WHO flowcharts ranged from 41.2 to 43.6%, and for locally adapted flowcharts from 39.5 to 74.8%. Locally adapted flowcharts performed slightly better than the WHO flowcharts. A difference in performance was not observed between use of risk assessment or clinical examination. The AVD flowchart performed slightly better when it was not restricted to symptomatic women only.

Conclusions: There was considerable variation in the performance of the AVD flowchart but overall it was a poor diagnostic tool regardless of whether risk assessment or clinical examination was included, or whether the flowchart was WHO or locally developed. Many women were treated unnecessarily and many women with cervical infection were not detected. We caution against their continued use for management of cervical infection.
Language eng
DOI 10.1071/SH17070
Field of Research 11 Medical And Health Sciences
16 Studies In Human Society
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2018, CSIRO
Free to Read? Yes
Use Rights Creative Commons Attribution Non-Commercial No-Derivatives licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30110121

Document type: Journal Article
Collections: School of Health and Social Development
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.