Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Sep 25;4(9):e7201.
doi: 10.1371/journal.pone.0007201.

Syndromic management and STI control in urban Peru

Jesse L Clark  1 , Andres G Lescano, Kelika A Konda, Segundo R Leon, Franca R Jones, Jeffrey D Klausner, Thomas J Coates, Carlos F Caceres; NIMH International Collaborative HIV/STD Prevention Trial
Affiliations

Syndromic management and STI control in urban Peru

Jesse L Clark et al. PLoS One. .

Abstract

Background: Syndromic management is an inexpensive and effective method for the treatment of symptomatic sexually transmitted infections (STIs), but its effectiveness as a method of STI control in at-risk populations is questionable. We sought to determine the potential utility of syndromic management as a public health strategy to control STI transmission in high-risk populations in urban Peru.

Methodology: We surveyed 3,285 at-risk men and women from three Peruvian cities from 2003-05. Participants were asked about the presence of genital ulcers, discharge, or dysuria in the preceding six months. Participants reporting symptoms were asked about subsequent health-seeking and partner notification behavior. Urine and vaginal swab samples were tested for Neisseria gonorrhoeae and Chlamydia trachomatis by nucleic acid testing. Serum was tested for syphilis and Herpes Simplex Virus-Type 2 antibodies.

Findings: Recent urogenital discharge or dysuria was reported by 42.1% of participants with gonorrhea or chlamydia versus 28.3% of participants without infection. Genital ulceration was reported by 6.2% of participants with, and 7.4% of participants without, recent syphilis. Many participants reporting symptoms continued sexual activity while symptomatic, and approximately half of all symptomatic participants sought treatment. The positive and negative predictive values of urogenital discharge or genital ulcer disease in detecting STIs that are common in the study population were 14.4% and 81.5% for chlamydia in women and 8.3% and 89.5% for syphilis among gay-identified men.

Conclusions: In our study, STIs among high-risk men and women in urban Peru were frequently asymptomatic and symptomatic participants often remained sexually active without seeking treatment. Additional research is needed to assess the costs and benefits of targeted, laboratory-based STI screening as part of a comprehensive STI control program in developing countries.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Pre-enrollment Treatment Outcomes Among Men and Women with Genital Gonorrhea and/or Chlamydia; Lima, Trujillo and Chiclayo, Peru 2003–05.
Figure 2
Figure 2. Pre-enrollment Treatment Outcomes Among Men and Women with Recent Syphilis (RPR≥1∶8); Lima, Trujillo and Chiclayo, Peru 2003–05.
See this image and copyright information in PMC

References

    1. Liu H, Jamison D, Li X, Ma E, Yin Y, et al. Is syndromic management better than the current approach for treatment of STDs in China? Evaluation of the cost-effectiveness of syndromic management for male STD patients. Sex Transm Dis. 2003;30:327–330. - PubMed
    1. Tsai CH, Lee TC, Chang HL, Tang LH, Chiang CC, et al. The cost-effectiveness of syndromic management for male STD patients with urethral discharge symptoms and genital ulcer disease in Taiwan. Sex Transm Infect 2008 - PubMed
    1. Adams EJ, Garcia PJ, Garnett GP, Edmunds WJ, Holmes KK. The cost-effectiveness of syndromic management in pharmacies in Lima, Peru. Sex Transm Dis. 2003;30:379–387. - PubMed
    1. Ray K, Muralidhar S, Bala M, Kumari M, Salhan S, et al. Comparative study of syndromic and etiological diagnosis of reproductive tract infections/sexually transmitted infections in women in Delhi. Int J Infect Dis 2009 - PubMed
    1. Sanchez J, Volquez C, Totten PA, Campos PE, Ryan C, et al. The etiology and management of genital ulcers in the Dominican Republic and Peru. Sex Transm Dis. 2002;29:559–567. - PubMed

Publication types