Two Approaches to Managing Vaginal Discharge Lead to Overtreatment, Missed Infections and Wasted Funds

Abstract

This study set out to evaluate the efficacy of two approaches used to identify infected Bangladeshi women without having to perform expensive laboratory tests. The first approach conducted a risk assessment for each client by noting the womans personal characteristics and asking about her sexual history and whether her partner had symptoms of an infection. The second approach involved visual inspection of the vagina where speculum examinations were carried out on each client complaining of vaginal discharge. A comparison of the results from these diagnostic procedures was performed. Overall it was concluded that neither of the approaches was adequate for detecting sexually transmitted infections in a low-prevalence situation. Both approaches were found to have overestimated the prevalence of reproductive tract infections classified uninfected women as possibly infected and missed most of the few women who had serious genital infections. Subsequently anywhere from 36% to 87% of recurrent funds expended to treat women on the basis of these approaches were deemed wasted.