Urethral Discharge Syndrome Research Articles

Utility, acceptability and applicability of a nucleic acid amplification test in comparison with a syndromic approach in the management of sexually transmitted diseases at Mulago National Referral Hospital in Uganda (ASTRHA): protocol for an open-label, randomised controlled trial

IntroductionSexually transmitted diseases (STDs) are a major cause of long-term disability. Urethral discharge syndrome (UDS), abnormal vaginal discharge (AVD) and genital ulcer disease (GUD) are very common in low-income and...

Aetiological molecular identification of sexually transmitted infections that cause urethral discharge syndrome and genital ulcer disease in Brazilian men: a nationwide study

BackgroundLittle is known about the aetiology of urethral discharge syndrome (UDS) and genital ulcer disease (GUD) in Brazil due to limited access to laboratory tests and treatment based mainly on...

Antibiotic overuse, poor antimicrobial stewardship, and low specificity of syndromic case management in a cross section of men with urethral discharge syndrome in Kampala, Uganda.

High prevalence of sexually transmitted infections (STIs) combined with poor antimicrobial stewardship are drivers of STI antimicrobial resistance (AMR) especially in resource-limited settings where syndromic case management (SCM) is the norm. We characterized patterns of antibiotic use prior to clinic attendance and study enrollment in Ugandan men with urethral discharge syndrome (UDS), evaluated in-clinic prescribing, and the performance characteristics of SCM. Participants were recruited from government clinics participating in an existing gonococcal surveillance program in Kampala, Uganda. Questionnaires including antimicrobial use prior to attendance, prior episodes of UDS, penile swabs, and blood samples were collected. Bivariable and multivariable logistic regression models were used to estimate odds ratios (OR) for preselected factors likely to be associated with antibiotic use. In-clinic antibiotic treatment data were extracted from clinical notes, and the performance of SCM against laboratory-based STI diagnoses was evaluated. Between October 2019 and November 2020, 100(40%) of 250 men with UDS reported taking antibiotics in the 14days prior to attending the clinic. Of these 210(84%) had at least one curable STI and 20% had a reactive point-of-care HIV test. Multivariable analysis demonstrated significant associations between recent antimicrobial use and duration of UDS symptoms <6 days (OR 2.98(95%CI 1.07,8.36), p = 0.038), and sex with women only (OR 0.08(95%CI 0.01,0.82),p = 0.038). The sensitivity of SCM ranged from 80.0% to 94.4%; specificity was low between 5.6% and 33.1%. The positive predictive value of SCM ranged from 2.4(95%CI 0.7,6.0) for trichomoniasis to 63.4(95%CI 56.5,69.9) for gonorrhea. Pre-enrollment antibiotic use was common in this population at high risk of STI and HIV. Combined with the poor specificity of SCM for male UDS, extensive antibiotic use is a likely driver of STI-AMR in Ugandan men. Interventions to improve antimicrobial stewardship and deliver affordable diagnostics to augment SCM and decrease overtreatment of STI syndromes are required.

Clinical Review of Urethral and Vaginal Discharge Syndrome: A Comprehensive Case Series from Primary Care Centers in Bahrain

Background: This case series presents a comprehensive clinical review of twelve cases exhibiting symptoms of urethral and vaginal discharge syndrome in men and women attending primary care centers in Bahrain. The cases encompassed a diverse range of clinical manifestations, including dysuria, frequency, pyuria, urethral pruritus, malodorous urine, vulval itching, purulent vaginal discharge, abnormal vaginal bleeding, dyspareunia, lower abdominal pain, anorectal pain, and anal skin lesions. The individuals included in the case series engaged in various types of sexual activities, ranging from heterosexual intercourse, unsafe sexual behavior, a history of sexual abuse, to homosexual activity. This study aims to provide a scientifically rigorous analysis of these cases, highlighting the clinical presentation, potential risk factors, and implications for diagnosis and management of urethral and vaginal discharge syndrome in the primary care setting in Bahrain. Methods: The clinical evaluation of the patients encompassed a comprehensive assessment of their medical history, physical examination, and laboratory investigations. Urethral and vaginal swabs were collected for culture and sensitivity testing, urine analysis, microscopy, and imaging studies were performed. The most frequently identified etiological agents in this study were Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Candida yeasts infection. This study provides valuable insights into the clinical management of urethral and vaginal discharge syndrome, aiding in accurate identification and appropriate treatment of patients with similar symptoms. Results: Management of the patients involved a combination of antibiotic therapy, antifungal medications, and symptomatic relief measures. Safe sexual behaviors were highlighted as a preventive measure against sexually transmitted infections, which were identified as the primary causative agents of urethral and vaginal discharge syndrome. These findings have significant implications for primary care providers, offering valuable insights into the clinical presentation, diagnosis, and management of these conditions, particularly in primary care.

Pattern of sexually transmitted infections from a tertiary care hospital, Pokhara: A six-month retrospective study

Background: Sexually transmitted infections (STIs) are major public health problem that have profound effect in reproductive and mental health. STIs have direct impact on sexual and reproductive health through stigmatization, infertility, and cancers and can increase the risk of HIV.2 Unprotected sexual contact with an infected partner is the most important risk factor associated with STI. Pattern of STI varies from region to region depending on socioeconomic status, ethnicity, and educational factor. Aims and Objectives: The aim of the study was to assess pattern of STIs in a tertiary level hospital, Pokhara. Materials and Methods: The following is a hospital-based retrospective study conducted in the Dermatology department of Pokhara academy of health sciences (PoAHS). All patients who attended the STI clinic of dermatology OPD from 2078/05/01 to 2078/11/30 B.S. with clinical manifestations of STI and associated positive serological investigation with their risky sexual behavior, related information was recorded in STI register and was analyzed. HIV cases are enrolled directly to antiretroviral therapy clinic of PoAHS, so HIV cases were not included in the study. Results: Out of 87 STI patients, 71.3% were males and 28.7% were females. The mean age of patient with STI was 31.34+8.4. The most common diagnosis was syphilis 55.2% followed by urethral discharge syndrome 16.1%. STIs were common among married individuals 74.7%. Most common high-risk sexual behavior among patients with STI was multiple sexual partners 79.3%. Conclusion: The study showed that the prevalence of STIs is still high in the society. Lack of awareness, delinquent behavior, and an inconsistent use of condoms during sexual contact may be the major contributing factors.

High level of HIV viral suppression in a cross-sectional study of Ugandan men with urethritis and bacterial STI.

Urethritis associated with non-viral sexually transmitted infections (STI) increases the risk of HIV acquisition and transmission in those living with HIV (LWH) without viral load suppression (VLS). Compared to women, men typically have lower rates of HIV VLS. We assessed the prevalence of VLS and drug resistance mutations in men LWH and urethral discharge syndrome (UDS) in Kampala, Uganda. Men with UDS were recruited in Kampala October 2019-November 2020. Medical, demographic, and behavioural data were collected with biological samples. All reactive HIV results (rapid, sequential algorithm) underwent confirmatory HIV antibody- and HIV incidence-testing, and viral load (VL) measurement. The pol and gp41 regions were sequenced on samples with VLs >1000 cpm, phylogenetic trees were generated, and resistance mutations were investigated. 50 of 250 participants (20%) had reactive HIV rapid tests and 48/50 (96%) were aware of their HIV status and using antiretroviral therapy (ART). The median age was 38 years (IQR 32-45), 27/50 (54%) had engaged in transactional sex, and 30/50 (60%) reported alcohol before sex. VLS was present in 46/50 (92%). There were no major resistance mutations present in any samples analyzed. The prevalence of HIV and VLS was greater in these men than in the general Ugandan adult population. Most men LWH were on ART and thus less likely to transmit HIV despite demonstrating sexual behaviours associated with high-risk of STIs. These data emphasize that high levels of ART coverage and VLS are achievable among men with UDS in urban Kampala.

High burden of untreated syphilis, drug resistant Neisseria gonorrhoeae, and other sexually transmitted infections in men with urethral discharge syndrome in Kampala, Uganda

ObjectivesPrompt diagnosis and treatment of sexually transmitted infections (STIs) are essential to combat the STI epidemic in resource-limited settings. We characterized the burden of 5 curable STIs chlamydia, gonorrhea, trichomoniasis, Mycoplasma genitalium, syphilis, and HIV infection in Ugandan men with urethritis.MethodsParticipants were recruited from a gonococcal surveillance program in Kampala, Uganda. Questionnaires, penile swabs were collected and tested by nucleic acid amplification. Gonococcal isolates were tested for antimicrobial sensitivity. Sequential point-of-care tests on blood samples were used to screen for syphilis and HIV. Bivariable and multivariable multinomial logistic regression models were used to estimate odds ratios for preselected factors likely to be associated with STIs. Adherence to STI treatment guidelines were analyzed.ResultsFrom October 2019 to November 2020, positivity (95% CI) for gonorrhea, chlamydia, trichomoniasis, and Mycoplasma genitalium, were 66.4% (60.1%, 72.2%), 21.7% (16.8%, 27.4%), 2.0% (0.7%, 4.9%), and 12.4% (8.7%, 17.3%) respectively. All Neisseria gonorrhoeae isolates were resistant to ciprofloxacin, penicillin, and tetracycline, but susceptible to extended spectrum cephalosporins and azithromycin. HIV and syphilis prevalence was 20.0% (50/250) and 10.0% (25/250), and the proportion unaware of their infection was 4.0% and 80.0% respectively. Most participants were treated per national guidelines. Multivariable analysis demonstrated significant associations between curable STI coinfections and younger age, transactional sex, but not HIV status, nor condom or alcohol use.ConclusionsSTI coinfections including HIV their associated risk factors, and gonococcal AMR were common in this population. The majority with syphilis were unaware of their infection and were untreated. Transactional sex was associated with STI coinfections, and > 80% of participants received appropriate treatment.

Diagnostic accuracy of the syndromic management of four STIs among individuals seeking treatment at a health centre in Nairobi, Kenya: a cross-sectional study.

Introductionthe syndromic approach to the management of sexually transmitted diseases (STIs) is recommended in areas without adequate laboratory support. We assessed the diagnostic accuracy of this approach in diagnosing Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG) among 18 to 49 year-old individuals seeking treatment for STIs in a health centre in Nairobi, Kenya.Methodsparticipants were recruited between April and June 2019. After providing written informed consent, an interviewer-administered questionnaire was completed. Endocervical swabs from women and urethral swabs from men were collected for STI testing using polymerase chain reaction (PCR). Diagnostic accuracy of reported symptoms was calculated using PCR as the gold standard.Resultsa total of 297 individuals (148 men and 149 women) were recruited. Majority of the participants had at least one reported symptom (130/148; 87.8% men and 145/148; 97.3% women). The most commonly diagnosed STI was NG (85/297; 28.6% 95%CI 23.5%-34.1%). Vaginal discharge syndrome had moderate (44.4%) to high (92.9%) sensitivity, low specificity, low positive predictive value (PPV) (2.4 % to 31.5%) and high negative predictive value (NPV) (68.2% to 95.2%). The lower abdominal pain syndrome had moderate to high sensitivity (40% to 71.4%), low specificity (30.9% to 35.6%), low PPV (9.9% to 15.8%) and high NPV (79.2% to 93.8%). The urethral discharge syndrome had high sensitivity (71.4% to 84.8%); moderate specificity (37.6% to 51.7%); low to moderate PPV (5.4% to 53.8%) and high NPV (83.6% to 96.4%). The kappa scores for the three syndromes were generally poor.Conclusionthese findings support the need for the review of the syndromic management of STIs.

Implementation of a standardised and quality-assured enhanced gonococcal antimicrobial surveillance programme in accordance with WHO protocols in Kampala, Uganda

ObjectivesThe emergence of multidrug-resistant Neisseria gonorrhoeae (NG) is a major global health threat necessitating response and control measures. NG antimicrobial resistance (AMR) surveillance data from sub-Saharan countries is exceedingly limited....

LEVANTAMENTO DA INCIDÊNCIA DE ISTS EM UM MUNICÍPIO DA REGIÃO INTEGRADA DE DESENVOLVIMENTO DO DISTRITO FEDERAL E ENTORNO

Among the objectives of the study are: Knowing the incidence of STIs in the municipality of Luziânia; conduct a survey of the number of patients treated by the Anonymous Testing Center in the municipality of Luziânia; conduct a survey of the main STIs treated by the Anonymous Testing Center in the municipality of Luziânia. The methodology used was field research with a quantitative approach. The results of the study showed that in 2019 the HIV contamination rate is 0.02%, of this percentage 0.009% are women and 0.012% are men. The rate of contamination by Acquired Syphilis is 0.054%, of which 0.023% are women and 0.031% are men. The Congenital Syphilis contamination index 0.015%, of this percentage 0.009% are women and 0.005% are men. The rate of Hepatitis contamination is 0.11%, of which 0.008% are women and 0.003% are men. The Candidiasis contamination rate is 0.005%. The contamination rate of Urethral Discharge Syndrome in Men is 0.007%. The contamination index of Condyloma Acuminado (Anogenital Warts) is 0.001%. After conducting the research, performing the calculations, a low rate of people infected with STIs in the municipality of Luziânia is observed in 2019. It is concluded that results like this are obtained thanks to good primary care, programs like school health also have a great weight in results like that, through programs like these teenagers have access to information, such as the use of condoms, forms of contagion in addition to sexual relations. The sum of all these factors results in low numbers of infected people.

Antimicrobial Resistance of Neisseria Gonorrhoeae in a Newly Implemented Surveillance Program in Uganda: Surveillance Report.

BackgroundNeisseria gonorrhoeae (commonly known as gonorrhea) has developed resistance to all first-line therapy in Southeast Asia. East Africa has historically had absent or rudimentary gonorrhea surveillance programs and, while the existence of antimicrobial-resistant gonorrhea is recognized, the extent of its resistance is largely unknown. In 2016, the World Health Organization’s Enhanced Gonococcal Antimicrobial Surveillance Program (EGASP) was initiated in Uganda to monitor resistance trends.ObjectiveThis study characterizes gonorrhea and antibiotic resistance in a large surveillance program of men with urethral discharge syndrome from Kampala, Uganda.MethodsMen attending sentinel clinics with urethritis provided demographic information, behavior data, and a urethral swab in line with the World Health Organization’s EGASP protocols for culture, identification, and antibiotic-sensitivity testing using 2 methods—disk diffusion (Kirby-Bauer test) and Etest (BioMérieux Inc). A subset of samples underwent detailed antimicrobial resistance testing.ResultsOf 639 samples collected from September 2016 to February 2018, 400 (62.6%) were culture-positive though 414 (64.8%) had microscopic evidence of gonorrhea. The mean age of the men from whom the samples were collected was 26.9 (SD 9.6) years and 7.2% (46/639) reported having HIV. There was high-level resistance to ciprofloxacin, tetracycline, and penicillin (greater than 90%) by Kirby-Bauer disk diffusion and 2.1% (4/188) had reduced azithromycin sensitivity by Etest. Of the early isolates that underwent detailed characterization, 60.3% (70/116) were culture-positive, 94% (66/69) isolates were either ciprofloxacin-resistant or ciprofloxacin-intermediate by Etest, 96% (65/68) were azithromycin-sensitive, and 96% (66/69) were gentamicin-sensitive. Resistance profiles were comparable between methods except for ceftriaxone (disk diffusion: 68/69, 99%; Etest: 67/69, 97%) and for gentamicin (disk diffusion: 2/8, 25%; Etest: 66/69, 96%) sensitivity.ConclusionsThis is the first report from a systematic gonorrhea surveillance program in Uganda. Findings demonstrated resistance or increased minimum inhibitory concentration to all key antigonococcal antibiotics. There was evidence of poor antibiotic stewardship, near-universal resistance to several antibiotics, and emerging resistance to others. Individuals in the population sampled were at exceptionally high risk of STI and HIV infection requiring intervention. Ongoing surveillance efforts to develop interventions to curtail antimicrobial-resistant gonorrhea are needed.

Prevalence of Sexually Transmitted Infections and Risk Factors Among Young People in a Public Health Center in Brazil: A Cross-Sectional Study.

Sexually transmitted infections (STI) significantly affect the health of sexually active people, especially young people, and can cause low sexual dysfunction, low self-esteem, infertility, increased transmission of HIV, and death. We reviewed the medical records of a cross-section of users of a public health services center and verified the prevalence of STI and its associated predictors for male and female individuals 13-24years of age in an interior county of southern Brazil. The records of 1703 adolescents and young adults, stratified by age (13-18 and 19-24years, respectively) and sex, admitted between April 1, 2012, and March 31, 2017, were reviewed in this retrospective study. Epidemiological, clinical, and laboratory data of medical records were analyzed using the chi-square test and odds ratio, with confidence interval of 95% by the Stata® 9.0 program. During the study period, a total of 3448 patients were attended to; of these, 1703 (49.39%) were 13-24years of age, with 86.56% of those 19-24years having at least 1 STI. The prevalence of STI among men and women, respectively, was 35.40% and 47.67% for condylomata, 8.46% and 7.00% for herpes, 26.35% and 18.80% for syphilis, and 20.06% and 6.27% for urethral discharge syndrome. The risk for STI acquisition was the highest in young adults (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.17-2.06, P=.002), female individuals (OR 1.51, 95% CI 1.14-2.00, P=.004), those with multiple sexual partners (OR 1.62, 95% CI 1.22-2.16, P<.001), and those not using or irregularly using prophylactics (OR 1.62, 95% CI 1.22-2.16, P<.001). The findings revealed a significant prevalence of STI among young people in public health service. The predictors associated with STI in these patients were being female, having multiple partners in the last year, and not using or irregularly using prophylactics. These predictors confirm the necessity to implement more aggressive strategies to prevent the occurrence of STI in specific populations with higher disease risk, thereby minimizing costs and damage caused by the infections.

Pattern of sexually transmitted infections in a tertiary care hospital: A five-year retrospective study

Introduction: Sexually transmitted infections (STIs) have a profound impact on sexual and reproductive health worldwide and especially in a developing country like Nepal. However, adequate studies are lacking in our context with regards to the pattern analysis of the STIs in community and in the tertiary care hospitals. The aim of this study is to understand the prevalence and pattern of different STIs in Nepal.&#x0D; Methods: This is a retrospective observational study in which the record of all patients who attended the STD OPD of NAMS, Bir Hospital from 2071 to 2075 B.S. (April 2014 – March 2019) have been analyzed.&#x0D; Results: Among the 2658 patients who visited the STD OPD, majority (27.5%) had been diagnosed with syphilis. The second commonest diagnosis was condyloma acuminata accounting for 22.6 % of cases. Urethral discharge syndrome and vaginal discharge syndrome comprised of 20.1% and 17% respectively. Genital herpes constituted 6% of cases whereas genital molluscum contagiosum comprised of 3.4% of cases. Genital ulcer diseases accounted for 2.1% of total cases.&#x0D; Conclusions: There was a high magnitude of STIs found in this study, among which syphilis constituted the major burden. The results of this study also urge further awareness programs regarding the clinical features and importance of early treatment of STIs.

Prevalence of Sexually Transmitted Infections and its Associated factors among women living with HIV/AIDS

Background: Sexually transmitted infections (STIs) are significant public health problem in India. Studies have shown a considerably higher prevalence of STIs among females as well as in high-risk groups. Thus, we conducted this study to estimate the prevalence of STIs and to find out its associated factors among women living with HIV/AIDS. Material &amp; Methods: A cross-sectional study was conducted at the ART centre, Aligarh. A total of 170 HIV positive women were approached with study tools comprising of pre-structured proforma. NACO STIs Syndromes were used to estimate STIs. Data was analyzed using the SPSS version 20.0, keeping significance at p&lt;0.05. Results: We found the self-reported prevalence of STIs in HIV positive women to be 18.2% (31/170) at the time of interview and 49.4% (84/170) ever since the diagnosis of HIV. Most of the HIV women were presently having vaginal/cervical or urethral discharge syndrome (93.5%) and genital ulcer syndrome (16.1%). STIs were significantly associated with uneducated females and with irregular use of condoms. Conclusion: This study found the prevalence of STIs to be still higher among HIV positive women, in spite of years of targeted interventions reducing it. A proper action and further researches are required to explore and manage variables associating STIs for reducing its prevalence

Prevalence and predictors associated with sexually transmitted infections in patients in Southern Brazil

Background: Sexually transmitted infections (STIs) are now a global public health problem with growing socioeconomic burden, not only because of the high number of people infected but also because of their consequences on sexual, reproductive, and maternal-fetal health. The objective of this study was to estimate the prevalence of STIs and associated predictors in patients attending a referral center. Methods & Materials: A cross-sectional, descriptive, and retrospective study of 2,795 patients attending a health referral center in Southern Brazil was performed between 2012 and 2017. Results: The prevalences of condylomata acuminata, syphilis, urethral discharge syndrome, and genital herpes were 31.13%, 24.36%, 9.45%, and 5.15%, respectively. The number of genital herpes cases increased significantly during the study period. It was found that 90.41% of patients attending were heterosexual, 54.39% had more than one partner in the last 12 months, 53.80% reported not using a condom in the last year, and 31.71% reported using a condom irregularly. Conclusion: The population served had a high prevalence of STIs, especially condylomata. The predictors associated with STIs were male sex, heterosexuality, single status, younger than 39 years, sexual initiation between the ages of 13 and 19 years, and not using condoms on a regular basis. Knowledge of the characteristics of the affected population is useful in determining measures of prevention and control of STIs.

Effectiveness of syndromic management for male patients with urethral discharge symptoms in Amazonas, Brazil.

BackgroundUrethral discharge syndrome (UDS) is characterized by the presence of purulent or mucopurulent urethral discharge.The main etiological agents of this syndrome are Neisseria gonorrhoeae and Chlamydia trachomatis.ObjectivesTo evaluate the effectiveness of the syndromic management to resolve symptoms in male urethral discharge syndrome cases in Manaus, Amazonas, Brazil.MethodsRetrospective cohort of male cases of urethral discharge syndrome observed at a clinic for sexually transmitted disease (STD) in 2013. Epidemiological and clinical data, as well as the results of urethral swabs, bacterioscopy, hybrid capture for C.trachomatis, wet-mount examination, and culture for N.gonorrhoeae, were obtained through medical chart reviews.ResultsOf the 800 urethral discharge syndrome cases observed at the STD clinic, 785 (98.1%) presented only urethral discharge syndrome, 633 (79.1%) returned for follow-up, 579 (91.5%) were considered clinically cured on the first visit, 41(6.5 %) were considered cured on the second visit, and 13(2.0%) did not reach clinical cure after two appointments. Regarding the etiological diagnosis, 42.7% of the patients presented a microbiological diagnosis of N.gonorrhoeae, 39.3% of non-gonococcal and non-chlamydia urethritis, 10.7% of C.trachomatis and 7.3% of co-infection with chlamydia and gonococcus. The odds of being considered cured in the first visit were greater in those who were unmarried, with greater schooling, and with an etiological diagnosis of gonorrhea. The diagnosis of non-gonococcal urethritis reduced the chance of cure in the first visit.Study limitationA study conducted at a single center of STD treatment.ConclusionSyndromic management of male urethral discharge syndrome performed in accordance with the Brazilian Ministry of Health STD guidelines was effective in resolving symptoms in the studied population. More studies with microbiological outcomes are needed to ensure the maintenance of the syndromic management.

How Reliable Is Microscopy and Culture for the Diagnosis of Gonorrhea? An 11-Year Experience from INDIA.

Positivity of microscopy and culture was greater (P < 0.0001) in men with urethral discharge syndrome (65.8%) than in women with vaginal/cervical discharge (0.5%), indicating that basic diagnostic tests may not be cost-effective for diagnosis of vaginal/cervical discharge syndrome. Microscopy when compared with culture showed sensitivity, specificity, positive predictive value and negative predictive value of 95.4%, 77.6%, 84.6%, and 95.3%, in men, whereas in women, it was 77.8%, 99.9%, 92.1%, and 99.9%, respectively.

Usefulness and Utility of NACO Regime in the Management of Sexually Transmitted Infections: A Pilot Study.

Introduction:Treatment of sexually transmitted infections (STIs) has been made easy for field workers due to syndromic approach. The etiological agent responsible for different STI syndromes needs to be validated from time to time so as to guide the therapeutic regimen.Aims and Objectives:The aim of this study was to evaluate the etiological agent for STI syndromes and correlate the syndromic diagnosis with etiological diagnosis.Materials and Methods:The study was conducted over 9 months in all patients attending the STI and Gynaecology Outpatient Department. Syndromic diagnosis was done by STI-trained medical officer of respective clinic. Sample was collected for etiological diagnosis and subjected to relevant investigations. Data were analyzed by applying statistical methods.Results:Among 308 patients (male:female = 1:3.5), no syndromic diagnosis could be made in 11 cases (all females and had premalignant changes on Pap smear). In 68 patients (22.08%), no etiological diagnosis could be arrived at (mostly genital ulcer disease [GUD]-herpetic [H] and vaginal discharge). In cervical discharge syndrome, six patients (16.7%) showed gonococcus. In GUD-H syndrome, 37 patients (27.027%) were tested positive. In GUD-nonherpetic syndrome, three patients (33.33%) were syphilis, granuloma inguinale, and chancroid (1 each). In urethral discharge syndrome, etiology could not be found in 33 cases (45.45%). In vaginal discharge syndrome (n = 217), etiologies were overlapping as follows: trichomonas vaginalis (76.04%), bacterial vaginosis (40%), gonococcus (24%), and undiagnosed (6.5%).Conclusion:The present tool for validation of GUD-H can validate only 27% of cases. Overlap of etiologies is mostly common in vaginal discharge syndrome, wherein malignancies and premalignant conditions are overtreated with kits. Validation can be done only in two-third of cases with the available resources. However, syndromic approach provides the opportunity of treating STI without delay.

Quality of Sexually Transmitted Infection Case Management Services in Gauteng Province, South Africa: An Evaluation of Health Providers' Knowledge, Attitudes, and Practices.

The sexually transmitted infection (STI) clinical encounter is an opportunity to identify current and prevent new HIV and STI infections. We examined knowledge, attitudes, and practices regarding STIs and HIV among public and private providers in a large province in South Africa with a high disease burden. From November 2008 to March 2009, 611 doctors and nurses from 120 public and 52 private clinics serving patients with STIs in Gauteng Province completed an anonymous, self-administered survey. Responses were compared by clinic location, provider type, and level of training. Most respondents were nurses (91%) and female (89%), were from public clinics (91%), and had received formal STI training (67%). Most (88%) correctly identified all of the common STI syndromes (i.e., genital ulcer syndrome, urethral discharge syndrome, and vaginal discharge syndrome). However, almost none correctly identified the most common etiologies for all 3 of these syndromes (0.8%), or the recommended first or alternative treatment regimens for all syndromes (0.8%). Very few (6%) providers correctly answered the 14 basic STI knowledge questions. Providers reporting formal STI training were more likely to identify correctly all 3 STI syndromes (P = 0.034) as well as answer correctly all 14 general STI knowledge questions (P = 0.016) compared with those not reporting STI training. In addition, several providers reported negative attitudes about patients with STI that may have affected their ability to practice optimal STI management. Sexually transmitted infection general knowledge was suboptimal, particularly among providers without STI training. Provider training and brief refresher courses on specific aspects of diagnosis and management may benefit HIV/STI clinical care and prevention in Gauteng Province.

Prevalence and Associated Factors of Sexually Transmitted Infections Based on the Syndromic Approach among HIV Patients in ART Clinic; Ayder Referral Hospital, Northern Ethiopia

Background: Sexually transmitted Infections represent a large burden of disease worldwide with an annual incidence of about 333 million cases. In Ethiopia, studies on Sexually Transmitted Infections (STIs) among HIV patients are very few; therefore, conducting research on STIs in general and among HIV patients in particular is an important input to design policy and strategy aimed at preventing and controlling the infections. Objective: To determine the prevalence and associated factors of sexually transmitted infections among HIV patients in ART clinic; Ayder referral hospital, Tigray, Ethiopia. Methods: Institution based cross sectional study design was conducted among 353 HIV patients in Ayder hospital, ART clinic from July to September 2014. A systematic random sampling technique was used to identify study subjects. Data were collected using structured questionnaire and entered into and analyzed using SPSS 20 for windows. Descriptive analyses were used to estimate the prevalence of STIs and selected characteristics of patients. The effects of predictors on having STIs were analyzed using logistic regression and their effects were depicted using OR adjusted for confounding. P-value less than 0.05 were considered as statistical significant for all tests. Result;: Among total respondents; 150 (42.5%) were male and 203 (57.5%) female HIV patients .The prevalence of sexually transmitted infections based on the syndromic approach was 8.5% with specific prevalence of (4.6%) urethral discharge syndrome,(2.8%) genital ulcer syndrome, none of them scrotal swelling syndrome, (2.5%) lower abdominal pain syndrome,(0.3%)inguinal bubo and (5.5%) had vaginal discharge syndrome. 8 patients (26.7%) had recurrent disease and 28 patients (93.3%) treated without their partners. After multivariable logistic regression analysis, age (AOR=11.3 (95%CI: 1.1-116.5), marital status (AOR=0.031 (95%CI: 0.001-0.93) and having new sexual partner within the last three months (AOR=152.7 (95%CI: 3.7-6274) were significantly associated with STI syndromes p-value<0.05. Conclusion and recommendations: The prevalence of sexually transmitted infections based on the syndromic approach among HIV patients was 8.5% and the factors associated with STIs among HIV patients were: age, marital status and having new sexual partner within the last three months. Moreover, further studies to explore the predictor variables are highly recommended.