THE SENSITIVITY OF A SYNDROMIC MANAGEMENT APPROACH IN DETECTING SEXUALLY-TRANSMITTED DISEASES IN PATIENTS AT A PUBLIC-HEALTH CLINIC IN CAPE-TOWN

Objectives. To evaluate the sensitivity of a syndromic diagnostic proc edure in detecting and treating sexually transmitted diseases (STDs) a nd genital tract infections (GTIs). Methods. All new patients presenti ng at an STD clinic were sampled systematically by gender over a 6-wee k period. After the patient's clinical consultation, the clinical reco rds were reviewed. Thereafter all patients were given a thorough genit al examination by the research physician, and specimens were collected for laboratory investigations. In a retrospective simulation clinicia ns' syndromic diagnoses were validated against the laboratory findings , or for genital ulcer syndrome against the findings of the research p hysician. Results. 170 men and 161 women were included in the sample. Ninety-five per cent of patients were black and the median age was 22 years for women and 26 years for men. In this setting, the Western Cap e syndromic diagnostic procedure achieved reasonable levels of sensiti vity in detecting Neisseria gonorrohoeae and Chlamydia trachomatis in men and women, and in detecting Trichomonas vaginalis and bacterial va ginosis in women. However, it was estimated to be only 36.4% sensitive in detecting genital ulcers in women, and between 0% and 12.3% sensit ive in detecting Candida albicans. With syndromic management 8.2% of m en and 32.9% of women would leave the clinic with at least one infecti on inadequately treated. Conclusions. Despite the introduction of synd romic protocols, it is likely that a proportion of STDs and GTIs are n ot being detected and treated owing to the high prevalence of multiple syndromes and mixed infections, both symptomatic and asymptomatic.