Evaluation of syndromic algorithms for managing sexually transmitted infections among pregnant women in Kenya
View File(s)
- Author(s)
- Details
-
Jillian C. Pintye, RN; Alison Drake; Jennifer Unger, MD; Daniel Matemo, MLS; John Kinuthia, MMed; R. Scott McClelland, MD; Grace John-Stewart, MD
- Sigma Affiliation
- Psi at-Large
Visitor Statistics
Visits vs Downloads
Visitors - World Map
Top Visiting Countries
Country | Visits |
---|
Top Visiting Cities
City | Visits |
---|
Visits (last 6 months)
Downloads (last 6 months)
Popular Works for Pintye, Jillian C. by View
Title | Page Views |
---|
Popular Works for Pintye, Jillian C. by Download
Title | Downloads |
---|
View Citations
Citations
Session presented on Thursday, July 21, 2016:
Purpose: Women with Trichomonas vaginalis (TV), Chlamydia trachomatis (CT) or Neisseria gonorrhoeae (GC) during pregnancy have increased risk for adverse obstetric outcomes. Laboratory testing for these sexually transmitted infections (STIs) is often unavailable in resource-limited settings, and pregnant women are managed using syndromic algorithms developed by the World Health Organization (WHO). These algorithms begin with a patient's report of relevant symptoms which triggers a subsequent clinical assessment of signs to inform recommended treatment that will broadly cover likely STIs. We evaluated the diagnostic validity of WHO syndromic algorithms for TV, GC and CT in a pregnant cohort in Kenya.
Methods: We used baseline data from a prospective study of peripartum HIV acquisition that enrolled HIV-uninfected pregnant women at two antenatal care clinics in Western Kenya; women with HIV infection detected at enrollment or during follow-up were excluded. All women were interviewed, underwent pelvic examinations by study clinicians and had vaginal and cervical swabs collected for TV, CT, and GC assessment. Laboratory testing for STI diagnosis included wet mount microscopy for TV and nucleic acid amplification tests (NAAT) for GC and CT. In addition, symptomatic women were treated for TV, CT and GC according to WHO and Kenyan national syndromic management guidelines for women with abnormal vaginal discharge and/or vaginal itching. Laboratory-confirmed diagnosis of TV, CT or GC not covered by syndromic treatment was treated at their subsequent study visit. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of syndromic algorithms were calculated compared to laboratory diagnosis as the gold standard.
Results: Of 1279 HIV-uninfected women in the overall cohort, 1275 (99%) had complete TV, CT and GC assessment at baseline, and were included in the present analysis. Women enrolled at a median of 22 weeks gestation (interquartile range [IQR] 18-26), median age was 22 years (IQR 19-27), and most were married (78%) and self-reported no prior STIs (94%). Prevalence of any STI was 13%. TV, GC and CT were detected in 6%, 3% and 5% of women, respectively. Overall, 20% of women with STIs reported abnormal discharge compared to 9% of women without STIs (p<0.001); there was no difference in report of vaginal itching among women with and without STIs (12% vs 18%, p=0.079). Among women with any STI, symptoms were commonly reported in women with TV (31%), and abnormal vaginal discharge was more frequently reported than vaginal itching (28% vs. 13%, p<0.001). Among women with CT and GC, 23% and 9% reported symptoms, respectively, and there was no difference in frequency of reported abnormal vaginal discharge and vaginal itching. On clinical exam, abnormal vaginal discharge was found in 18% of women and was found more frequently among women with STIs compared to women without STIs (35% vs 16%, p<0.001). Using a gold standard of laboratory diagnosis of STI (TV, CT, or GC), syndromic diagnosis of any STI (TV, CT, or GC) per clinical exam had a sensitivity of 39% (95% confidence interval [CI] 32%-47%), specificity of 78% (95% CI: 75%-80%), PPV of 21% (95% CI: 16%-26%) and NPV of 90% (95% CI: 88%-92%). Among women who reported abnormal vaginal discharge, which represents an entry point for syndromic management, syndromic diagnosis had a sensitivity of 28% (95% CI: 19-37%), specificity of 92% (95% CI: 74-99%), PPV of 94% (95% CI: 79.2-99.2%) and NPV of 23% (95% CI 15-32%). Syndromic diagnosis also had low sensitivity for individual STIs: TV (51%, 95% CI: 39%-62%), CT (41%, 95% CI: 30%-54%) and GC (22%, 95% CI: 9%-40%). Specificity for individual STIs was similar to estimates for any STI: TV (78%, 95% CI: 75%-80%), CT, (77%, 95% CI: 74%-79%) and GC (76%, 95% CI: 73%-78%). Among 163 women with any STI, 100 (61%) would have been missed without laboratory diagnosis.
Conclusion: Among HIV-uninfected pregnant women, STIs were common and syndromic diagnosis had low sensitivity, resulting in missed opportunities for clinical intervention. Novel STI diagnostics are needed to improve Maternal and infant health.
Theme: Leading Global Research: Advancing Practice, Advocacy, and Policy
Items submitted to a conference/event were evaluated/peer-reviewed at the time of abstract submission to the event. No other peer-review was provided prior to submission to the Henderson Repository.
Type | Presentation |
Acquisition | Proxy-submission |
Review Type | Abstract Review Only: Reviewed by Event Host |
Format | Text-based Document |
Evidence Level | N/A |
Research Approach | N/A |
Keywords | Sexually Transmitted Infections; Maternal Child Health; Global Health |
Name | 27th international Nursing Research Congress |
Host | Sigma Theta Tau International |
Location | Cape Town, South Africa |
Date | 2016 |
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
All permission requests should be directed accordingly and not to the Sigma Repository.
All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Related items
Showing items related by title, author, creator and subjects.
-
Third trimester screening for chlamydia and gonorrhea in pregnant teens
Smith, Shauna; Allen, Jennifer; Ilchak, Debra (2016-11-07)Purpose: The purpose of this project was to implement a practice change in a clinic caring for underserved pregnant teens to align with national standard of care guidelines from the Centers for Disease Control and Prevention ... -
Sexually transmitted disease education for adolescents
Osborn, Chastity L. (2015-06-15)An interactive sexually transmitted infection (STI) education tool was developed to assist a non-profit agency, who for the purpose of this paper will be referred to as CCS, in meeting their annual organizational goals ... -
Prevalence of sexually transmitted infections in college students
Zenon, Gracian A.; Favis-Spencer, Lakesha; Lockett, JillianSexually transmitted infections (STIs) are a problem in the college community. Therefore, a pilot literature review was conducted to find the prevalence and preventive methods of STIs in college students. Findings revealed ... -
Knowledge, attitude, and intention to obtain HPV vaccination among undergraduate college students in St. Lucia
Daniel, Esther Shirley; Nelson, Tisha; Mootoo, Gloria Ramdeen (2017-07-03)Purpose: The purpose of this study was to investigate if there were any differences in in the Knowledge, attitude and intention to obtain HPV vaccination among the male and female undergraduates of a selected Community ... -
Standardized care for substance addicted pregnant women increases nurse comfort level
Powell, Mindy M.; Heronema-Garcia, Shannon; Arterberry, Katheryn B.Pregnancy provides the necessity for substance addicted women to seek healthcare, allowing a unique opportunity for healthcare providers to have open communication and offer resources for recovery. Increase nurse comfort ...