Point-of-care testing may improve infection management in women with urogenital infection, according to a study published in Lancet Infectious Diseases.
With an estimated 357 million new curable infections caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Treponema pallidum occuring in 2012, sexually transmitted infections and other urogenital infections are a major disease burden worldwide. When these infections are left untreated, the risk for HIV acquisition and transmission, pregnancy complications, pelvic inflammatory disease, and invasive neonatal infections increases significantly.
The diagnosis of genital infection occurs by patient-reported symptom in resource-poor countries, and using guidelines based on the World Health Organization (WHO), treatment is directed at all potential causative organisms. However, syndromic and presumptive approaches miss all asymptomatic infections. Researchers, therefore, designed a study to evaluate women’s improvement of sexual and reproductive health (WISH), and created algorithms focused on point-of-care testing, as point-of-care testing has been successful for HIV, syphilis, and pregnancy. Researchers aimed to compare the performance of the WISH algorithms and the WHO guidelines with gold standard testing.
WHO algorithms are based on 4 main syndromes in women, including vaginal discharge without lower abdominal pain, lower abdominal pain with or without vaginal discharge, genital ulcers with or without inguinal buboes, and inguinal buboes without genital ulcers. WISH algorithms focus on point-of-care testing and are based on 5 syndromes, which include no/mild symptoms, symptoms of vulvovaginal candidiasis, substantial vaginal discharge without symptoms of vulvovaginal candidiasis and no lower abdominal pain or pain during sex, lower abdominal pain or pain during sex with or without vaginal discharge, and genital ulcer disease with or without buboes, buboes without genital ulcer disease, or genital warts.
In total, 705 women from Kigali, Rwanda, age ³18 years with or without urogenital symptoms who were at risk of acquiring sexually transmitted infections were enrolled in the study and completed a study visit. Each participant underwent a face-to-face interview at the study visit during which they were asked questions about current urogenital symptoms. At first, women were asked without prompting (spontaneous reporting), and then they were asked questions about 14 specific symptoms (structural reporting).
Gold standard testing and WISH algorithms identified similar prevalence of C trachomatis (8.5%), N gonorrhoeae (7.1%), and T vaginalis (16.1%); however, higher numbers of bacterial vaginosis and vulvovaginal candidiasis infections were identified by WISH algorithms compared with gold standard testing. Further, the WISH algorithms show high specificity and good sensitivity when compared with gold standard testing for C trachomatis (specificity 100%, sensitivity 71%), N gonorrhoeae (specificity 100%, sensitivity 76.0%), and T vaginalis (specificity 97.4%, sensitivity 68.5%); however, WISH algorithms showed low specificity for bacterial vaginosis (specificity 41.2%, sensitivity 95.2%) and moderate specificity and sensitivity for vulvovaginal candidiasis (specificity 69.4%, sensitivity 64.4%) when compared with gold standard testing. The WHO algorithms had poor specificity and moderate sensitivity for all infections compared with gold standard testing.
Overall, the study authors concluded that, “Point-of-care testing for urogenital infections might improve case-finding and infection management and is feasible in resource-poor settings.”
Verwijs MC, Agaba SK, Sumanyi JC, et al. Target point-of-care testing compared with syndromic management of urogenital infections in women (WISH): a cross-sectional screening and diagnostic accuracy study. Lancet Infect Dis. 2019;19:658-669.