The Syndromic versus Laboratory Diagnosis of Sexually Transmitted Infections in Resource-Limited Settings

Sexually transmitted infections (STIs) are highly prevalent in sub-Saharan Africa, where there is a severe HIV epidemic. Thus, accurate recognition and diagnosis of STIs are essential for successful HIV prevention programs in the region. Due to lack of trained personnel and adequate laboratory infrastructure in the region, information regarding the profile of STIs relies essentially on self-reported or physician-diagnosed symptoms. The main objective of the study was to assess the effectiveness of the syndromic diagnosis of STIs, which is often used as a proxy for laboratory diagnosis of STIs in sub-Saharan Africa and other resource-limited settings. The study builds on previously collected data from a community-based survey in Northern Tanzania. We found no significant agreements between patient-reported STIs symptoms and laboratory-confirmed STIs tests. The reported STIs symptoms had high specificity (range？=？85–99%) and poor sensitivity (range？=？2–17%). Knowledge gained from our study will have significant public health implications, and can help improve the syndromic diagnosis of STIs. 1. Introduction AIDS is a major public health challenge in sub-Saharan Africa, and the prevalence of other STIs in the region is high [1, 2]. An estimated 22.9 million people infected with HIV live in sub-Saharan Africa, and approximately 1.2 million deaths from AIDS occurred in sub-Saharan Africa [3]. There is compelling evidence that STIs affect the transmission of HIV. STIs facilitate the sexual acquisition and transmission of HIV infection and HIV infection increases the risk of other STIs [4, 5]. Hence, the recognition, treatment, and prevention of STIs to reduce the risk of HIV transmission should be a public health priority, especially in sub-Saharan Africa where antiretroviral therapy may not be readily available. More than two-thirds of patients living with HIV in sub-Saharan Africa have no access to antiretroviral therapy [6]. STIs can be diagnosed in a number of different ways, including laboratory and syndromic diagnosis. Laboratory diagnosis is the most accurate method of making a diagnosis. However, it is expensive and is not feasible in many settings as it requires sophisticated laboratory facilities and qualified personnel who can perform technically demanding procedures. Moreover, laboratory diagnosis of STIs is time-consuming and results often cannot be made available at the same visit, thereby causing a delay in treatment initiation. For these reasons, the syndromic diagnosis of STIs remains the only feasible option in some resource-limited