Prevalence of reproductive tract and sexually transmitted infections among symptomatic and asymptomatic women, validity of syndromic management, in urban and periurban low to mid socioeconomic neighbourhoods of North Delhi: an observational study

TL;DR

This study examines the prevalence of reproductive tract and sexually transmitted infections in women in Delhi, finding that many infections are asymptomatic and the syndromic approach has limited accuracy.

Contribution

The study provides recent data on infection prevalence in India and evaluates the effectiveness of syndromic management for diagnosing RTIs/STIs.

Findings

Bacterial vaginosis and Candida albicans were the most prevalent infections.

The syndromic approach had low sensitivity (62%) and specificity (45%) for diagnosing RTIs/STIs.

Younger age was associated with a higher risk of having a lab-confirmed STI/RTI.

Abstract

Reproductive tract infections (RTIs) including sexually transmitted infections (STIs) result in major reproductive health morbidity worldwide. There is a paucity of recent data on laboratory-confirmed prevalence in India of the curable pathogens responsible, Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), Bacterial vaginosis (BV) and Candida albicans (CA), with a significant proportion being asymptomatic. This study aims to determine the diagnostic accuracy of the syndromic approach and the prevalence of symptomatic and asymptomatic infections.

An observational study was conducted with 440 married, reproductive age women in low-income and middle-income neighbourhoods of Delhi. Vaginal swabs were collected irrespective of symptoms. Nucleic acid amplification technique was used for NG, TV and CT, gram stain for CA and Nugent’s criteria for BV.

Statistical analysis was done using STATA V.16.1. Categorical variables were analysed using the binomial exact method. Sensitivity, specificity, positive and negative predictive value, and likelihood ratios were calculated for the syndromic approach. Logistic regression was performed to assess associated factors.

262 of 440 women had a positive laboratory test. BV was 37%, CA 12.7%, CT, NG and TV were <1%. 56% of asymptomatic women had a laboratory confirmed RTI. Sensitivity and specificity of syndromic approach were 62% and 45%. Every 1-year increase in age of women was associated with an 8% reduction in the odds of having a lab-confirmed STI/RTI (OR=0.92).

BV and CA were most prevalent infections. A syndromic approach had low sensitivity and specificity; young age was a risk factor.

CTRI/2020/03/023954.

Figures