Validation of diagnostic algorithms for syndromic management of sexually transmitted diseases

s To validate our revised syndromic algorithms of the management of sexually trans mitted diseases and determine their sensitivity, specificity, positive predictiv e value and cost effectiveness Methods Patients with either urethral discharge, vaginal discharge or genital ulcer, wer e selected during their first visits to three urban sexually transmitted disease clinics in Fujian Province, China They were managed syndromically according t o our revised flowcharts The etiology of the syndromes was detected by laborat ory testing The data were analyzed using EPI INFO V6 0 software Results A total of 736 patients were enrolled into the study In male patients with ur ethral discharge, the sensitivities for gonococcal and chlamydial infections wer e 96 7% and 100%, respectively, using the syndromic approach The total positi ve predictive value was 73% In female patients with vaginal discharge, the sen sitivity was 90 8%, specificity 46 9%, positive predictive value 50 9%, and n egative predictive value 89 3% for the diagnosis of gonorrhea and/or chlamydial infection by syndromic approach In patients with genital ulcer, the sensitivi ties were 78 3% and 75 8%, specificities of 83 6% and 42 9%, and positive pr edictive values of 60 0% and 41 0% for the diagnosis of syphilis and genital h erpes, respectively, using the syndromic approach Cost effectiveness analysi s indicated that the average cost of treatment for a patient with urethral disch arge was RMB 46 03 yuan using syndromic management, in comparison with RMB 149 19 yuan by etiological management Conclusions The syndromic management of urethral discharge was relatively effective and suit ed clinical application The specificity and positive predictive value for sy ndromic management of vaginal discharge are not satisfactory The revised flowc hart of genital ulcer syndrome could be suitable for use in clinical settings Further validation and revision are needed for syndromic approaches of vaginal d ischarge and genital ulcer

Gonorrhea in China, 2018

Objective:Gonorrhea is a globally widespread sexually transmitted infection caused by Neisseria gonorrhoeae.This study is aimed to analyze the epidemiological characteristics of gonorrhea cases reported in China in 2018 and provide evidence for strategies making in the gonorrhea prevention and control programme.Methods:Gonorrhea cases were extracted from National Notifiable Disease Report System (NNDRS) covering 31 provinces,autonomous regions,arnd municipalities in the mainland of China.The overall incidence rate was calculated,as were rate per province,sex,age group,and occupation group.ResultS:in 2018,133,156 new cases of gonorrhea were reported in China,corresponding to an incidence rate of 9.59 cases per 100,000 population and having a 36.03% increase from 2014 (7.05 cases per 100,000 population).Zhejiang,Hainan,Guangdong,Fujian provinces,and Shanghai city had a higher reported rate (14.05-28.00 per 100,000 population).Hebei,Tianjin,Tibet,Heilongjiang,and Jilin provinces had a lower rerted rate (1.56-5.19 per 100,000 population).The males had a much higher incidence than the females (15.81 per 100,000 vs.3.08 per 100,000) and a faster rising rate (38.32% vs.27.27%).The highest rate was detected in the aged 25-29 years both of male and female (46.37 and 6.60 per 100,000,respectively),followed by those aged 30-34 years (41.12 and 6.39 per 100,000,respectively).The largest proportion of gonorrhea cases was among the farmers accounting for 27.74%,followed by the unemployed persons (24.67%),business persons (17.02%) and industrial workers (9.50%).Conclusion:In general,gonorrhea has an increasing trend from 2014 and remains a common notifiable disease in China in 2018.Young males who are sexually active are high risk populations for gonococ~ infection.The southeast coastal areas with developed economy have a higher rate of gonorrhea reported.Corresponding strategies on disease prevention and control should be performed on the high risk populations and regions.