12 September 2023

If it’s on two legs, call it chicken, if it’s on four legs, call it cow, so man could well be called chicken, and a four-legged chair could be labelled cow! Such prescriptive approaches in patient care assume that patients’ storylines always follow a specific, precise and predictable pattern. This is the approach applied in the syndromic guidelines commonly used to treat genital infections in many resource-constrained settings.

From published reports of a wanting performance of the syndromic approach in management of sexually transmitted infections (STI), inconsistencies in practice and low adherence by health workers, Gloria Omosa-Manyonyi and colleagues set out to assess and improve the performance of the algorithm used to treat women with abnormal vaginal discharge. These researchers, from the Department of Internal Medicine, Radboud Center for Infectious Diseases, published their findings in BMC Infectious Diseases, on 22nd August 2023.

The team studied over 800 women at health facilities in Nairobi, Kenya. The women’s ‘sehemu za siri’ (private parts) complaints exhibited by the women were diverse and were led by genital discharge (‘uchafu’=dirt) and the irresistible itch; and these complaints ‘kept coming back’ despite treatment. ‘Unblindfolded’, the researchers identified the perpetrators, thanks to the laboratory tests; the magnitude and varieties of infections in these women was remarkable with genital thrush/Candidiasis leading, and STI well represented; interesting also was the assortment of culprits within individual women. Sadly, by the ‘blindfolded’ conventional treatment approach, many women received treatment that was not necessary, while others missed to receive the required treatment! With optimism, the team constructed an alternative flowchart. Although this reduced the number of unnecessary treatments, it was still an ‘opaque’ approach hence not good enough.

To improve this situation, simple and quick real-time tests are required to reveal the real cause of the genital symptoms in women, for accurate treatment.

Read the publication here

Omosa-Manyonyi GA-O, de Kam M, Tostmann A, Masido MA, Nyagah N, Obimbo MM, Van der Ven JAM, Ten Oever J. Evaluation and optimization of the syndromic management of female genital tract infections in Nairobi, Kenya. 

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