The Diagnostic Accuracy of Syndromic Management for Genital Ulcer Disease: A Systematic Review and Meta-Analysis.
The Diagnostic Accuracy of Syndromic Management for Genital Ulcer Disease: A Systematic Review and Meta-Analysis.
复制标题
DOI：
10.3389/fmed.2021.806605
复制
发表时间：
2021
影响因子：
3.9
通讯作者：
Ong JJ
中科院分区：
文献类型：
--
作者：
Loh AJW;Ting EL;Wi TE;Mayaud P;Chow EPF;Santesso N;Falconer J;Ofori-Asenso R;Ong JJ
目的：生殖器溃疡病（GUD）在全球范围内带来了重大的疾病负担。由于获得诊断的机会有限，2001年世界卫生组织（世卫组织）性传播疾病（STI）指南提出了一种综合征管理算法，需要临床决定来确定GUD的管理。我们评估了该算法的诊断准确性。研究方法：我们使用1995年至2021年1月期间发表的8个数据库进行了一项系统性综述（Prospero：CRD 42020153294），这些数据库报告了关于临床诊断准确性的主要数据，以确定GUD的病因。独立评估标题和摘要的合格性，并从全文中提取数据进行敏感性/特异性分析。分层逻辑回归模型用于推导合并的灵敏度和特异性。我们使用GRADE来评估证据的确定性。结果：在24，857篇文献中，151篇全文被检查，29篇纳入分析。大多数来自中等收入国家[（14/29（48%）中下，10/29（34%）中上）]。我们汇总了分子检测用于确认GUD病因的研究：9项研究（12项估计）用于疱疹，4项研究（7项估计）用于梅毒，7项研究（10项估计）用于软下疳。GUD检测疱疹的合并敏感性和特异性分别为43.5% [95%可信区间（CI）：26.2-62.4]和88.0%[95%可信区间（CI）：26.2-62.4]。（95% CI：67.0-96.3）梅毒阳性率为52.8%（95% CI：23.0-80.7）和72.1%（95% CI：28.0-94.5）（中度确定性证据）;软下疳分别为71.9%（95% CI：45.9-88.5）和53.1%（95% CI：36.6-68.9）（中度确定性证据）。结论：需要临床诊断以确定和治疗GUD病因的算法对梅毒和单纯疱疹病毒的敏感性较差，导致大量病例漏诊。迫切需要改善获得负担得起的有效诊断的机会（例如，床旁检测）纳入GUD算法，以更好地指导适当的管理。系统综述注册：PROSPERO，标识符：CRD 42020153294。
Objectives: Genital Ulcer Disease (GUD) carries a significant disease burden globally. With limited access to diagnostics, the 2001 World Health Organization (WHO) sexually transmitted illnesses (STI) guidelines proposed a syndromic management algorithm that required a clinical decision to determine the management of GUD. We assessed the diagnostic accuracy of this algorithm. Methods: We conducted a systematic review (Prospero: CRD42020153294) using eight databases for publications between 1995 and January 2021 that reported primary data on the diagnostic accuracy of clinical diagnosis to identify aetiological agents of GUD. Titles and abstracts were independently assessed for eligibility, and data were extracted from full texts for sensitivity/specificity. A hierarchical logistic regression model was used to derive pooled sensitivity and specificity. We used GRADE to evaluate the certainty of evidence. Results: Of 24,857 articles, 151 full texts were examined and 29 included in the analysis. The majority were from middle-income countries [(14/29 (48%) lower middle, 10/29 (34%) upper middle)]. We pooled studies where molecular testing was using to confirm the aetiology of GUD: 9 studies (12 estimates) for herpes, 4 studies (7 estimates) for syphilis, and 7 studies (10 estimates) for chancroid. The pooled sensitivity and specificity of GUD for the detection of herpes was 43.5% [95% confidence interval (CI): 26.2–62.4], and 88.0% (95% CI: 67.0–96.3), respectively (high certainty evidence); and for syphilis were 52.8% (95% CI: 23.0–80.7), and 72.1% (95% CI: 28.0–94.5) (moderate certainty evidence); and for chancroid were 71.9% (95% CI: 45.9–88.5) and 53.1% (95% CI: 36.6–68.9) (moderate certainty evidence), respectively. Conclusion: Algorithms requiring a clinical diagnosis to determine and treat the aetiology of GUD have poor sensitivities for syphilis and herpes simplex virus, resulting in significant numbers of missed cases. There is an urgent need to improve access to affordable and efficient diagnostics (e.g., point-of-care tests) to be incorporated into GUD algorithms to better guide appropriate management. Systematic Review Registration: PROSPERO, identifier: CRD42020153294.
登录
查看更多内容
影响因子：
5.7
作者：
Gaydos C;Hardick J
通讯作者：
Hardick J
DOI：
10.1136/bmj.b2535
发表时间：
2009-07-21
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Moher D;Liberati A;Tetzlaff J;Altman DG;PRISMA Group
通讯作者：
PRISMA Group
影响因子：
168.9
作者：
Garcia, Patricia J.;Holmes, King K.;Whittington, William L. H.
通讯作者：
Whittington, William L. H.
影响因子：
3.1
作者：
Pettifor, A;Walsh, J;Raghunathan, P
通讯作者：
Raghunathan, P
影响因子：
1.8
作者：
Johnson, Leigh F.;Dorrington, Rob E.;Coetzee, David J.
通讯作者：
Coetzee, David J.