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. 2024 Mar 1;14(1):14-19.
doi: 10.5588/pha.23.0022. eCollection 2024 Mar.

Point-of-care diagnostics for sexually transmitted infections among migrants in Greece

C Tsorou  1   2 , A Williams  3   4 , W van den Boogaard  3 , N Staderini  5 , E Repetto  5   6 , A Terzidis  2 , E Pikoulis  2
Affiliations

Point-of-care diagnostics for sexually transmitted infections among migrants in Greece

C Tsorou et al. Public Health Action. .

Abstract
in English, French

Setting: Sexually transmitted infections (STIs) can impact individuals of any demographic. The most common pathogens causing STIs are Chlamydia trachomatis, Neisseria gonorrhea and Trichomonas vaginalis; these can be treated with specific antibiotics.

Objective: To compare the GeneXpert CT/NG test-and-treat algorithm to the syndromic approach algorithm and their impact on antibiotic prescription for gonorrhoea and chlamydia STIs.

Design: A retrospective observational study on women aged ≥18 years who accessed the Médecins Sans Frontières Day Care Centre in Athens with complaints related to urogenital infections between January 2021 and March 2022. Women with abnormal vaginal discharge, excluding clinically diagnosed candidiasis, were eligible for Xpert CT/NG testing.

Results: Of the 450 women who accessed care, 84 were eligible for Xpert CT/NG testing, and only one was positive for chlamydia, therefore resulting in saving 81 doses of ceftriaxone and azithromycin, and 19 doses of metronidazole. The cost of Xpert CT/NG testing, including treatment was €4,606.37, while full antibiotic treatment would have costed €536.76.

Conclusion: The overall cost of the Xpert CT/NG test-and-treat algorithm was higher than the syndromic approach. However, quality of care should be weighed against the potential benefits of testing and syndromic treatment to determine the best option for each patient; we therefore advocate for decreasing the costs.

Contexte: Les infections sexuellement transmissibles (STI, pour l’anglais « sexually transmitted infections ») touchent tous les individus. Les agents pathogènes les plus courants à l'origine des STI sont Chlamydia trachomatis, Neisseria gonorrhea et Trichomonas vaginalis, et ils peuvent être traités avec des antibiotiques spécifiques.

Objectif: Comparer l'algorithme test-and-treat du GeneXpert CT/NG à l'algorithme de l'approche syndromique et leur impact sur la prescription d'antibiotiques pour les STI à gonorrhée et à chlamydia.

Méthode: Une étude observationnelle rétrospective sur les femmes âgées de ≥18 ans qui ont accédé au centre de soins de jour de Médecins Sans Frontières à Athènes avec des plaintes relatives aux infections urogénitales entre janvier 2021 et mars 2022. Les femmes présentant des pertes vaginales anormales, à l'exclusion des candidoses cliniquement diagnostiquées, étaient éligibles pour le test GeneXpert CT/NG.

Résultats: Sur les 450 femmes qui ont eu accès aux soins, 84 étaient éligibles au test GeneXpert CT/NG et une seule était positive à la chlamydia, ce qui a permis d'économiser 81 doses de ceftriaxone et d'azithromycine, et 19 doses de métronidazole. Le coût du test GeneXpert CT/NG, traitement compris, s'est élevé à €4 606,37, tandis qu'un traitement antibiotique complet aurait coûté €536,76.

Conclusion: Le coût global de l'algorithme GeneXpert CT/NG test-and-treat était plus élevé que celui de l'approche syndromique. Cependant, la qualité des soins doit être mise en balance avec les avantages potentiels des tests et du traitement syndromique afin de déterminer la meilleure option pour chaque patient, et nous plaidons par conséquent en faveur d'une diminution des coûts.

Keywords: Chlamydia Trachomatis; GeneXpert CT/NG test; Neisseria gonorrhoeae; SORT IT; Structured Operational Research and Training Initiative; antimicrobial resistance.

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Figures

FIGURE.
FIGURE.
Decision-making algorithm as per MSF guidelines. Risk factors include new partner or >1 partners in the last 3 months, oral/anal/genital complaint and/or dysouria in a man aged <30 years or a woman aged <25 years, and/or treated STI/genital/urethral/anal discharge present in the partner. STI = sexually transmitted infection; PCR = polymerase chain reaction; CT = C. trachomatis; NG = N. gonorrhoeae; MSF = Médecins Sans Frontières.
See this image and copyright information in PMC

References

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