Abstract

Accurate and adequate treatment of STIs is a critical component of STI-control activities to reduce transmission and sequelaes. On the other hand, chronic shortage in skilled staff and laboratory equipment in many countries necessitate the use of clinical skills more in order to diagnose and differentiate STIs. For these places, the WHO has recommended and produced a protocol of it syndromic approach management of STIs in place of treatment by -etiology. Since 1997 the Indonesia Ministry of Health has been conducting national training on this method. However, the syndromic approach for vaginal discharge is known to be problematic since differentiation among cervicitis, vaginitis, and even normal condition is difficult. The main objective of this study is to determine the sensitivity, specificity and positive predictive value of the syndromic approach management of women with signs and/or symptoms of abnormal vaginal discharge. The sample population were women with high risk sexual behaviors in East Java and North Sulawesi provinces. The laboratory tests using DNA hybridization probe technique (the PACE 2 test, Gen-Probe, San Diego, Calif.) for Neisseria gonorrhoeae and Chlamydia trachomatis were used as gold standard. In addition, we also compared the clinical approach widely used by clinicians (mainly at hospitals) with laboratory results. A total of 439 participants was recruited purposively (230 from E. Java and 209 from N.Sulawesi). In E.Java, the sensitivity, specificity, and predictive value of the syndromic management for vaginal discharge are 31%, 83%, and 59%, respectively, and in N.Sulawesi 49%, 56%, and 40%,respectively. The clinical approach did not show better results. In E.Java the sensitivity, specificity, and positive predictive value are 13%, 89%, and 50%, res­pectively, while in N.Sulawesi they are 42%, 61%, and 39%, respectively. As a conclusion, the current form of syndromic management has little use for STI screening among high risk women. Further studies by adding more criteria to the syndromes are needed to improve this method.