Validation of the flow charts used in the syndromic management of STI

Abstract

Introduction: Sexually transmitted infections have caused an immense global burden, of disease predominantly in developing countries. The impact is felt in reproductive and child health and lately in the transmission ofHIV. The syndromic flow charts were developed to improve the management of STI in resource poor settings. They are practical, inexpensive and easy to implement and are specific for the local epidemiological pattern of micro organisms causing sexually transmitted infections. Objective: To determine whether the current flow charts in use for the syndromic management of STI in Nairobi are within an acceptable level of efficacy. Methodology: The study was carried out in three City Council clinics in Nairobi, which offer STI treatment using the syndromic flow charts during the months of November and December 2002. Patients treated using the syndromic flow charts thereafter had their diagnosis validated against laboratory tests. Efficacy of the flow charts was assessed using repeat laboratory tests for all-patients who present with initial positive results. All the data collected were analyzed using SPSS. Results: Sensitivities of 90, 53.6, 20, 20 and 40, percent were derived for the flow charts that treat urethritis, vaginitis, PID, GUD and cervicitis respectively. Specificities of27.3, 47.1, 72.5, 87.5 and 72.5% were again calculated for the above syndromic flow charts respectively. The PPV were low at 36, 35.7, 4.3, 5.9 and 8.3%. The most commonly used drugs, norfloxacin and spectinomycin, presented with a sensitivity of 96.2% each against gonococcal isolates. An overall cure rate of70.4% was achieved. Conclusion: The urethral discharge flow chart had a high sensitivity whereas all others had low sensitivity; it however, had a very low specificity in diagnosis and treatment of STI. Generally, the chart is not a perfect diagnostic tool for STI and has to be augmented by other methods. The cure rate achieved was below the acceptable level; though the