981. Are self-reported STI symptoms an accurate measure of disease?  A comparison of STI symptom reporting versus etiological diagnosis among three different high-risk populations – men who have sex with men, female sex workers, persons living with HIV/AIDS – in El Salvador, 2008
Session: Poster Abstract Session: Clinical Studies of Bacterial Infection
Saturday, October 22, 2011
Room: Poster Hall B1
  • 11_227210-A_PTR_ShahN_IDSA.pdf (120.2 kB)
  • Background: Treatment of sexually transmitted infections (STIs) can help prevent the spread of HIV.  However, resource-limited countries have limited laboratory capability and rely on syndromic management to diagnose STIs.  El Salvador, which has the highest rates of HIV and STIs in Central America, uses syndromic management.  Currently, data to validate syndromic management as a STI control strategy in El Salvador are limited.

    Methods: From March–September 2008, men who have sex with men (MSM), female sex workers (FSW) and people living with HIV/AIDS (PLWHA) were recruited for a STI surveillance study.  Participants provided information on demographics, sexual behaviors, STI history, and service utilization.   Biological specimens were collected and tested for genital inflammatory infections (gonorrhea, chlamydia, Mycoplasma genitalium, Trichomonas vaginalis) and ulcerative infections (syphilis and HSV-2).  Z-scores were calculated to compare the sensitivity, specificity, and positive predictive value (PPV) of self-reported STI symptoms to laboratory-confirmed STIs among different populations.

    Results: Prevalence of ulcerative infections was 48.8% among MSM, 82.2% among FSW, and 84.6% among PLWHA.  Prevalence of inflammatory infections was higher in women (FSW 75.2%; female PLWHA 52.7%) than men (MSM 11.9%; male PLWHA 9.0%).  Most participants (82.0% to 96.7%) reported no ulcerative symptoms.  Sensitivity and PPV of inflammatory symptoms were poor among female PLWHA (52% and 52%, respectively), male PLWHA (28% and 15%, respectively) and MSM (17% and 14%, respectively). Sensitivity of inflammatory symptoms among FSW was 75%.  Specificity (88% - 96%) and PPV (63% - 92%) of ulcerative symptoms were high among all populations.  Significant differences were seen when comparing sensitivity, specificity, and PPV between FSW and female PLWHA (p<0.01), FSW and MSM (p<0.01), and male and female PLWHA (p<0.01).

    Conclusion: The high proportion of asymptomatic individuals with laboratory-confirmed STIs are missed STI treatment opportunities.  Self-reporting is not an effective STI control strategy for these high-risk study populations.  Prevention programs should focus on STI symptoms recognition and routine screening for high-risk populations.

    Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

    Neha Shah, MD MPH1, Evelyn Kim, PhD1, Flor de Maria Hernández Ayala2, Maria Elena Guardado Escobar3, Ana Isabel Nieto Gomez3, Andrea Kim, PhD1 and Gabriela Paz-Bailey2,4, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)Training Programs in Epidemiology and Public Health Interventions Network, Decatur, GA, (3)Ministry of Public Health, San Salvador, El Salvador, (4)Universidad de Valle de Guatemala, Guatemala, Guatemala


    N. Shah, None

    E. Kim, None

    F. D. M. Hernández Ayala, None

    M. E. Guardado Escobar, None

    A. I. Nieto Gomez, None

    A. Kim, None

    G. Paz-Bailey, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.