Resource-limited countries have limited laboratory capability and rely on syndromic management to diagnose sexually transmitted infections (STIs). We aimed to estimate the sensitivity, specificity and positive predictive value (PPV) of STI syndromic management when used as a screening method within a study setting. Men who have sex with men (MSM), female sex workers (FSWs) and people living with HIV/AIDS (PLWHA) participated in a behavioural surveillance study. Data were obtained on demographics, sexual behaviours, STI history and service utilisation. Biological specimens were tested for genital inflammatory infections (Neisseria gonorrhoeae [GC], Chlamydia trachomatis [CT], Mycoplasma genitalium [MG], Trichomonas vaginalis [TV]) and genital ulcerative infection (syphilis and Herpes simplex virus-2). There was a high prevalence of Herpes simplex virus-2 (MSM 48.1%, FSW 82.0% and PLWHA 84.4%). Most participants reported no ulcerative symptoms and the majority of men reported no inflammatory symptoms. Sensitivity and PPV were poor for inflammatory infections among PLWHA and MSM. Sensitivity in FSWs for inflammatory infections was 75%. For ulcerative infections, sensitivity was poor, but specificity and PPV were high. Reliance on self-reported symptoms may not be an effective screening strategy for these populations. STI prevention studies should focus on symptom recognition and consider routine screening and referral for high-risk populations.
WhiteRGOrrothKKGlynnJR. Treating curable sexually transmitted infections to prevent HIV in Africa: still an effective control strategy?J Acquir Immune Defic Syndr2008; 47: 346–353.
2.
NgBButlerLHorvathT. Population-based biomedical sexually transmitted infection control interventions for reducing HIV infection. Cochrane Database Syst Rev2011; 3.
3.
SanganiPRutherfordGWilkinsonD. Population-based interventions for reducing sexually transmitted infections, including HIV infection. Cochrane Database Syst Rev2004; 2.
4.
GrosskurthHGrayRHayesR. Control of sexually transmitted diseases for HIV-1 prevention: understanding the implications of the Mwanza and Rakai trials. Lancet2000; 355: 1981–1987.
5.
WawerMJSewankamboNKSerwaddaD. Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomised community trial. Lancet1999; 353: 525–535.
6.
MayaudPMabeyD. Approaches to the control of sexually transmitted infections in developing countries: old problems and modern challenges. Sex Transm Infect2004; 80: 174–182.
7.
The World Organization. Global prevalence and incidence of selected curable sexually transmitted infection, Geneva: World Health Organization, 2001.
8.
Pan American Health Organization. Regional HIV/STI plan for the health sector: 2006–2015, Washington, DC: Pan American Health Organization, 2005.
9.
The World Organization. Guidelines for the management of sexually transmitted infections, Geneva: World Health Organization, 2003.
10.
PettiforAWalshJWilkinsV. How effective is syndromic management of STDs?: a review of current studies. Sex Transm Dis2000; 27: 371–385.
11.
ClarkJLLescanoAGKondaKA. Syndromic management and STI control in urban Peru. PLoS ONE2009; 4: e7201–e7201.
12.
KrishnaRSumathiMManjuB. Comparative study of syndromic and etiological diagnosis of reproductive tract infections/sexually transmitted infections in women in Delhi. Int J Infect Dis2009; 13: e352–e359.
13.
DallabettaGGerbaseAHolmesK. Problems, solutions, and challenges in syndromic management of sexually transmitted diseases. Sex Transm Infect1998; 74: 1S–11S.
14.
VishwanathSTalwarVPrasadR. Syndromic management of vaginal discharge among women in a reproductive health clinic in India. Sex Transm Infect2000; 76: 303–306.
15.
TeodoraWMesolaVManalastaR. Syndromic approach to detection of gonococcal and chlamydia infections among female sex workers in two Phillippine cities. Sex Transm Infect1998; 74: 118S–122S.
16.
GuimarãesHCastroRTávora TaviraL. Assessing therapeutic management of vaginal and urethral symptoms in an anonymous HIV testing centre in Luanda, Angola. J Infect Dev Ctries2013; 7: 720–725.
17.
GarcíaPJCárcamoCPChiappeM. Sexually transmitted and reproductive tract infections in symptomatic clients of pharmacies in Lima, Peru. Sex Transm Infect2007; 83: 142–146.
18.
JudsonF. Gonorrhea. Med Clin North Am1990; 74: 1353–1366.
19.
AlaryMLowndesCMMukenge-TshibakaL. Sexually transmitted infections in male clients of female sex workers in Benin: risk factors and reassessment of the leucocyte esterase dipstick for screening of urethral infections. Sex Transm Infect2003; 79: 388–392.
20.
CreswellJGuardadoMELeeJ. HIV and STI control in El Salvador: results from an integrated behavioural survey among men who have sex with men. Sex Transm Infect2012; 88: 633–638.
21.
JacobsonJOCreswellJGuardadoME. Coverage of HIV prevention components among people with long-standing diagnosed HIV infection in El Salvador. Sex Transm Dis2012; 39: 694–700.
22.
MurilloWLorenzana de RiveraIAlbertJ. Prevalence of transmitted HIV-1 drug resistance among female sex workers and men who have sex with men in El Salvador, Central America. J Med Virol2012; 84: 1514–1521.
23.
Paz-BaileyGShahNCreswellJ. Risk behaviors and STI prevalence among people with HIV in El Salvador. Open AIDS J2012; 6: 205–212.
24.
SotoRGheeAENunezCA. Sentinel surveillance of sexually transmitted infections/HIV and risk behaviors in vulnerable populations in 5 Central American Countries. J Acquir Immune Defic Syndr2007; 46: 101–111.
25.
HeckathornD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl1997; 44: 174–199.
26.
HeckathornD. Respondent-driven sampling II: deriving valid population estimates from chain-referral samples of hidden populations. Soc Probl2002; 49: 11–34.
27.
Centers for Disease Control and Prevention. HIV prevention through early detection and treatment of other sexually transmitted diseases -- United States recommendations of the advisory committee for HIV and STD prevention, Atlanta: CDC, 1998, pp. 1–24.
28.
LewisDAPillayCMohlamonyaneO. The burden of asymptomatic sexually transmitted infections among men in Carletonville, South Africa: implications for syndromic management. Sex Transm Infect2008; 84: 371–376.
29.
GarcíaPJHolmesKKCárcamoCP. Prevention of sexually transmitted infections in urban communities (Peru PREVEN): a multicomponent community-randomised controlled trial. Lancet2012; 379: 1120–1128.
30.
SteenRChersichMGerbaseA. Periodic presumptive treatment of curable sexually transmitted infections among sex workers: a systematic review. AIDS2012; 26: 437–445.
31.
SteenRChersichMde VlasSJ. Periodic presumptive treatment of curable sexually transmitted infections among sex workers: recent experience with implementation. Curr Opin Infect Dis2012; 25: 100–106.
32.
DesaiVKosambiyaJThakorH. Prevalence of sexually transmitted infections and performance of STI syndrome against aetiological diagnosis, in female sex workers of red light area in Surat, India. Sex Transm Infect2003; 79: 111–115.
33.
TannCMpairweHMorisonL. Lack of effectiveness of syndromic management in targeting vaginal infections in pregnancy in Entebbe, Uganda. Sex Transm Infect2006; 82: 283–289.
34.
GrosskurthHMayaudPMoshaF. Asymptomatic gonorrhoea and chlamydial infection in rural Tanzanian men. BMJ1996; 312: 277–280.
35.
The World Bank. Reducing HIV/AIDS vulnerability in Central America. El Salvador: HIV/AIDS situation and response to the epidemic. Global HIV/AIDS program of the world bank's human development network, Washington, DC: The International Bank for Reconstruction and Development/The World Bank, 2007.
36.
Ministerio de Salud Pública y Asistencia Social. Guía para el Personal de Salud en el Abordaje de Trabajadoras(es) del Sexo, San Salvador: Ministerio de Salud Pública y Asistencia Social, 2007.
37.
RyanCACourtoisBNHawesSE. Risk assessment, symptoms, and signs as predictors of vulvovaginal and cervical infections in an urban US STD clinic: implications for use of STD algorithms. Sex Transm Infect1998; 74(Suppl 1): S59–76.
38.
ChessonHCollinsDKoskiK. Formulas for estimating the costs averted by sexually transmitted infection (STI) prevention programs in the United States. Cost Eff Resour Alloc2008; 6: 10–10.
39.
Redwood-CampbellLPlumbJ. The syndromic approach to treatment of sexually transmitted diseases in low-income countries: issues, challenges, and future directions. J Obstet Gynaecol Can2002; 24: 417–424.
40.
KirkcaldyRDBolanGAWasserheitJN. Cephalosporin-resistant gonorrhea in North America. JAMA2013; 309: 185–187.
41.
DillonJ-ARTreckerMAThakurSD. Two decades of the gonococcal antimicrobial surveillance program in South America and the Caribbean: challenges and opportunities. Sex Transm Infect2013; 89: iv36–iv41.
