# Syndromic management of sexually transmitted infections among female sex workers in Lomé (Togo), 2023

## TL;DR

This study evaluates how well a symptom-based approach works for diagnosing STIs among female sex workers in Lomé, Togo, finding it to be relatively ineffective.

## Contribution

The study provides new evidence on the limited effectiveness of syndromic STI diagnosis in a specific population in Togo.

## Key findings

- The syndromic approach had a positive predictive value of 24.3% for STI diagnosis.
- The prevalence of bacterial STIs (Chlamydia trachomatis and/or Neisseria gonorrhoeae) was 14.3%.
- Only 8.2% of female sex workers had attained higher education.

## Abstract

In Togo, the syndromic approach is used for the diagnosis and management of sexually transmitted infections (STIs). The aim of this study was to evaluate the syndromic approach for diagnosis of STIs among female sex workers (FSW) in Lomé, Togo.

A cross-sectional study was carried out from September to October 2023 among FSW in Lomé (Togo). FSW aged 18 years and above were included. A gynecological examination was performed for syndromic diagnosis, and the Xpert® CT/NG were used to screen vaginal swabs for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). The performance (predictive values) of the syndromic approach to STI diagnosis was evaluated using the Xpert® CT/NG test as the gold standard.

A total of 357 FSW were recruited. The median age of FSW was 32 years (IQR: [26–40 years]) and 8.2% had attained a higher level of education. The prevalence of syndromic STI among FSW was 33.3%. Vaginal swabs were positive for CT (8.4%) and NG (8.7%), with a prevalence of bacterial STIs (CT and/or NG) of 14.3%. The syndromic approach to STI diagnosis demonstrated a positive predictive value of 24.3%.

The prevalence of STIs is relatively high among FSW in Lomé. According to this study, the diagnosis of STIs using the syndromic approach has limited relevance. National STI screening and management policies urgently need to be rethought, incorporating recent technological advances.