A Study on Sexually Transmitted Infections Using Syndromic Approach among Patients Attending Suraksha Clinic at a Tertiary Care Hospital of West Bengal

Introduction : A proper understanding of different aspects of Sexually Transmitted Infections (STIs) in different regions of a country like India is very essential for STI control. Objectives : To assess pattern of STIs using Syndromic approach among patients attending at Suraksha Clinic and to find out treatment seeking behaviour among them. Material and Method : A cross-sectional study was conducted at a Tertiary Care Hospital of West Bengal. This retrospective study was done selecting all patients who attended the Clinic for first time from 1st May, 2020 to 30th April, 2021. Relevant records were reviewed. Descriptive statistics and chi-square test were used. Observations : In present study Suraksha Clinic attendees were mainly comprised of female (95.8%); while 65.8% and 64.2% of patients were suffering from Lower abdominal pain and Cervicovaginal discharge respectively. Nearly one-third of them (37.9%) were suffering from more than one disease. About one-fourth of patients (28.2%) accessed the STI/RTI/Suraksha Clinic directly. The treatment seeking behaviour was significantly associated with gender and education of patients. Conclusions : This Tertiary Care Hospital based study highlighted higher prevalence of certain STIs among attendees to Suraksha Clinic as well as lower proportion of male and directly walk-in patient

Prevalence of Sexually Transmitted Infections and its Associated factors among women living with HIV/AIDS

Background: Sexually transmitted infections (STIs) are significant public health problem in India. Studies have shown a considerably higher prevalence of STIs among females as well as in high-risk groups. Thus, we conducted this study to estimate the prevalence of STIs and to find out its associated factors among women living with HIV/AIDS. Material & Methods: A cross-sectional study was conducted at the ART centre, Aligarh. A total of 170 HIV positive women were approached with study tools comprising of pre-structured proforma. NACO STIs Syndromes were used to estimate STIs. Data was analyzed using the SPSS version 20.0, keeping significance at p<0.05. Results: We found the self-reported prevalence of STIs in HIV positive women to be 18.2% (31/170) at the time of interview and 49.4% (84/170) ever since the diagnosis of HIV. Most of the HIV women were presently having vaginal/cervical or urethral discharge syndrome (93.5%) and genital ulcer syndrome (16.1%). STIs were significantly associated with uneducated females and with irregular use of condoms. Conclusion: This study found the prevalence of STIs to be still higher among HIV positive women, in spite of years of targeted interventions reducing it. A proper action and further researches are required to explore and manage variables associating STIs for reducing its prevalence

Syndromic approach to identify cases of vaginal discharge: a cross-sectional study among females of Shaheed Nagar, Bhopal, Madhya Pradesh

Background: Management of Sexually Transmitted Infections (STIs) is important in controlling STIs and to break the chain of infection and transmission.Syndromic case management is a standardized evidence-based approach which utilizes clinical management algorithms and flowcharts that are handy and can be consistently used across health care providers. The objectives of the study were to identify cases of vaginal discharge in Shaheed Nagar, Bhopal and to provide them treatment following syndromic approach.Methods: Prospective cross-sectional study carried out over a period of three months among reproductive age group females (15-45 years) in Shaheed Nagar, Bhopal. Purposive sampling by conducting door- to- door survey until 150 women fulfilling study criteria was interviewed. A pre-designed questionnaire used for data collection. Educational intervention given to all participants. 37 participants identified with vaginal discharge syndrome and were assisted by study team to gynecological OPD for obtaining treatment based on syndromic approach. Data entered in MS Excel 2007 and statistical analysis carried out using epi-info 7.2. Proportions and percentages were calculated. Chi-square was used to find out association between prevalence of vaginal discharge and qualitative variables. P value <0.05 considered statistically significant.Results: Prevalence of vaginal discharge was 24.67%. The most common presenting complaint was general weakness (52%). The most common diagnosis was cervicitis (8.67%) followed by vaginitis (4.67%). Statistically significant correlation was found between presence of disease (STI) and use of intra- uterine device (IUD), non-use of sanitary pads, marital status, occupation and socio- economic class.Conclusions: Abnormal vaginal discharge can both be the cause as well as the effect of pelvic inflammatory disease.

Study on reproductive tract infection among the female patients attending the gynecology OPD in a teaching hospitals of Gujarat- India.

Background: Reproductive tract infections (RTIs) often go unnoticed and sexually active young women are particularly susceptible to sexually transmitted Infections (STIs). STIs are among the top five disease categories and about one third of STIs globally occur among people younger than 25 years of age. Present study was carried out to know the socio demographic profile of women suffering from RTI/STI. Sensitivity and specificity of syndromic approach was also found. Aims & Objective: (1) To know the socio-demographic profile of female patients attending the gynecology OPD with complaints of RTIs. (2) To find out the sensitivity and specificity of various diagnostic tests used for diagnosing RTIs. Material and Methods: A cross sectional study was carried out among 150 female patients who have attended the Gynecology OPD with complains suggesting Reproductive Tract Infection (RTI) during March-September 2005. After taking Medical and Obstetric History, vaginal and cervical specimens were collected during pelvic examination for laboratory investigation to confirm the diagnosis of genital tract infection. 5 ml blood was drawn in sterile vacutainer for serology. Various laboratory tests were carried out to confirm the diagnosis of RTI. Results: Out of 150 females patients of reproductive tract infection, 68 (45.3%) were less than 25 yrs. Mean age of the study population was 27.37 ± 5.52 yrs. Majority (133, 88.7%) of the females were housewives. The most common symptom reported was vaginal discharge (147, 98%), followed by lower abdominal pain (114, 76%) Findings of present study revealed that sensitivity of Homogenous white discharge (compared with gram stain) to detect the Bacterial vaginosis was 69.4%. Similarly correlation of Green Yellow frothy (GYF) discharge with culture examination for detection of trichomoniasis revealed, sensitivity of 68.8% and specificity of 99%, which means that all the cases labelled as “not having GYF discharge” also tested negative for trichomoniasis by culture. Sensitivity of curdy white discharge in detecting candidiasis was 69.1% and specificity was 99.1%. Conclusion: Young married women are more prone to Reproductive Tract Infection (RTI). Abnormal vaginal discharge is the most common presenting feature among the sufferers of RTI/STI. Syndromic approach is highly specific in diagnosing RTI.

Utility of pH test & Whiff test in syndromic approach of abnormal vaginal discharge.

Background & objective: In India, National AIDS Control Organization (NACO) introduced syndromic approach to treat patients with abnormal vaginal discharge without a need for laboratory tests. Simple tools like pH test and Whiff test can be done without high expertise, microscope and even speculum. This can improve diagnostic value of syndromic approach of abnormal vaginal discharge. The present study was conducted to evaluate sensitivity and specificity of pH test and Whiff test in diagnosis of abnormal vaginal discharge, considering microscopic diagnosis as gold standard. Methods: This prospective hospital-based study included 564 women with abnormal vaginal discharge. All women were subjected to gynaecological examination, pH test and Whiff test. The findings were compared with microscopic examination. Statistical analysis was done by calculating proportions, percentage, sensitivity and specificity. Results: Vaginitis was diagnosed in 301 (53.37%) women. Bacterial vaginosis (BV) was the commonest type of vaginitis (39.01%). Cervical erosion was the second most common cause (17.91%) and physiological discharge was the third (14.36%). pH > 4.5 and positive Whiff test had sensitivity of 94.09 per cent and specificity 87.5 per cent in diagnosing BV. Similarly pH < 4.5 and positive or negative Whiff test had sensitivity of 83.72 per cent in diagnosing candidiasis. Interpretation &conclusion: pH test and Whiff test can improve diagnostic value of speculum examination where microscope facilities are not available.

Comparison of Ofloxacin & Ornidazole with Probiotic versus Doxycycline & Metronidazole for the Outpatient Treatment of Pelvic Inflammatory Disease

The aim of the study was to compare the efficacy and cost effectiveness of ofloxacin, ornidazole, serratiopeptidase and Saccharomyces Boulardii combination with traditional doxycycline and metronidazole combination with serratiopeptidase in the outpatient management of pelvic inflammatory disease. A total of one hundred and ninety three women presenting with symptoms of pelvic inflammatory disease (PID) confirmed to be a case of PID on clinical examination were randomized to one of the two treatments. No investigations were performed to cut the cost and to avoid loss of follow up. A total of 98 women (Group I) were prescribed ofloxacin (400mg), ornidazole (500mg), Serratiopeptidase (10mg), Lactic acid bacillus 60 million spores and Saccharomyces Boulardii 2 million spores once a day for 10 days while a total of ninety five women (group II) were given a 10 day course of doxycycline (100 mg BD) with metronidazole (400mg TDS) along with 10mg of serratiopeptidase once daily. All women were seen after 2 weeks for relief of symptoms and possible side effects. The results were then analyzed. It was found that although the efficacy of both drug regimens was similar. The incidence of gastrointestinal side-effects mainly were less in group I. This was probably due to the addition of probiotic Saccharomyces Boulardii and lactic acid bacillus. The once daily administration led to better compliance in the first group.