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. 2023 Oct 20;18(1):28-34.
doi: 10.21010/Ajidv18i1.5. eCollection 2024.

AN ESSENTIAL TOOL TO BE OPTIMIZED: SYNDROMIC MANAGEMENT OF VAGINAL DISCHARGE IN HAITI

-Sturgis Morgan  1 , -Buckman Victoria  1 , -Diawara Samiya  1 , Fiquita St Paul F  1 , Adrien Marlene M  1 , Zhao Xixi  2 , Mehta Supriya  3 , Towbin Jennifer  4 , Crane Stephanie  4
Affiliations

AN ESSENTIAL TOOL TO BE OPTIMIZED: SYNDROMIC MANAGEMENT OF VAGINAL DISCHARGE IN HAITI

-Sturgis Morgan et al. Afr J Infect Dis. .

Abstract

Background: Haiti, like many low-income countries in crisis, has limited resources for etiologic diagnosis of vaginal discharge. As such, we sought to characterize variability in diagnoses of women presenting with vaginal discharge syndrome, with the goal to improve standardization of syndromic management.

Materials and methods: Participants aged 18 years and older endorsing vaginitis, or dysuria were recruited at Jerusalem Clinic over two, one-week periods in April 2018 and July 2019. We calculated Spearman rank correlations among history, exam findings, and diagnoses based on clinical presentation, to understand presentation groupings and their management.

Results: Among 98 women, median age was 33.5 years, and most frequent symptoms were: vaginal discharge (97%), vaginal itch (73%), and/or suprapubic pain (68%). Most common physical exam findings were vaginal discharge (86%), suprapubic/lower quadrant tenderness (29%), cervical motion tenderness (24%), and cervical erythema (20%). Most symptoms and physical exam findings were weakly correlated with each other. Nearly one-third (31%) were diagnosed with normal physiologic vaginal discharge or no diagnosis, followed by Bacterial vaginosis (31%), vulvovaginal candidiasis (15%), cervicitis/PID (13%), and STI (7%). No reported symptoms strongly differentiated diagnostic categories. Diagnoses varied considerably by exam findings.

Conclusions: The weak correlations between symptoms, exam findings, and diagnoses could represent variability in assessment. In the absence of reliable and accessible laboratory testing, the importance of standardizing syndromic management becomes increasingly relevant. Results from our study support the utility of speculum examination and more standardized documentation of physical exam findings. Next steps include the development of local algorithms to promote standardization of treatment of vaginal discharge syndrome.

Keywords: Haiti; community health; syndromic management; vaginal discharge syndrome.

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Figures

Figure 1
Figure 1
Spearman Correlations of Symptoms, Physical Exam Findings, and Diagnoses.
Figure 2
Figure 2
Distribution of Diagnoses by (A) Reported Symptoms and (B) Physical Exam Findings.
See this image and copyright information in PMC

References

    1. Bristow CC, Desgrottes T, Cutler L. The aetiology of vaginal symptoms in rural Haiti. International Journal of STD & AIDS. 2014;25(9):669–75. doi:10.1177/0956462413516300. Epub 2013 Dec 18. PMID:24352116;PMCID:PMC4712119. - PMC - PubMed
    1. Community Empowerment Global Health Partnerships:Jerusalem, Haiti. Accessed via: https://community-empowerment.org/haiti#:~:text=In%20the%20aftermath%20o... .
    1. Guidelines for the management of symptomatic sexually transmitted infections. Geneva: World Health Organization; 2021. Licence:CC BY-NC-SA 3.0 IGO. - PubMed
    1. Peebles K, Velloza J, Balkus JE. High Global Burden and Costs of Bacterial Vaginosis:A Systematic Review and Meta-Analysis. Sexually Transmitted Diseases. 2019;2019;46(5):304–311. doi:10.1097/OLQ.0000000000000972. - PubMed
    1. Unemo M, Ross J, Serwin AB. European guideline for the diagnosis and treatment of gonorrhoea in adults [published online ahead of print, 2020 Oct 29] International Journal of STD & AIDS. 20202020:956462420949126. doi:10.1177/0956462420949126. - PubMed

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