Background: Clinical diagnosis of sexually transmitted infections (STIs) may result in misdiagnosis of certain infections. Syndromic approaches are currently the standard practice for STI assessment in Jamaica.
Methods: In order to assess potentially missed STIs, we compared clinically-diagnosed STIs to laboratory-confirmed gonorrhea (GC), chlamydia (CG), and trichomonas (Tvag) using data and specimens previously collected for the Sino-Implant Study (SIS) in Jamaica. SIS was a clinical trial that randomized 414 women to receive a levonorgestrel implant at either baseline or three months post-enrollment, in order to evaluate unprotected sex after implant initiation. Available vaginal swab samples (N=254) were tested for GC, CT, and Tvag by Aptima Combo 2 assay for CT/NG and Aptima Trichomonas vaginalis assay (Hologic, San Diego, CA). Clinically-diagnosed STIs were categorized as cervicitis or vaginitis, excluding herpes simplex virus, human papilloma virus and yeast infection, and were determined from medical records by assessing clinical impressions and prescriptions. Log-binomial regression models fit with generalized estimating equations were used to estimate associations of clinically-diagnosed STIs with laboratory-confirmed diagnoses and demographic and behavioral characteristics.
Results: Overall, 195 (76.8%) women had a laboratory-confirmed STI (CT, GC or Tvag) while only 65 (25.6%) women had clinically-diagnosed cervicitis and/or vaginitis during the study period. Clinical diagnosis missed 79.7% of cases of laboratory-confirmed STI: 85% of GC, 78.8% of CT, and 80.0% of Tvag. Hormonal contraception in the month prior to the study visit was associated with clinical diagnosis of cervicitis and/or vaginitis at any time point (PR: 1.65, 95% CI: 1.07, 2.54). Younger age was significantly associated with missed infections (PR: 0.98 per year increase, CI: 0.97, 1.00).
Conclusion: The prevalence of laboratory-confirmed STIs was much higher than what was captured by clinical diagnosis among the study participants. GC, CT, and Tvag were not accurately detected by this approach, particularly among younger women. Increased laboratory capacity for STI surveillance and refinement of the syndromic approach are needed.
M. Snead, None
J. R. Papp, None
C. Phillips, None
N. Medley-Singh, None
E. Costenbader, None
T. Hylton-Kong, None
A. Kourtis, None