How effective is syndromic management of STDs? A review of current studies
How effective is syndromic management of STDs? A review of current studies
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DOI：
10.1097/00007435-200008000-00002
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发表时间：
2000-08-01
影响因子：
3.1
通讯作者：
Raghunathan, P
中科院分区：
文献类型：
--
作者：
Pettifor, A;Walsh, J;Raghunathan, P
背景：对综合征管理准确性的研究表明，根据性别、感染地点、危险群体、生物体等因素，结果差异很大。目的：综述目前关于性传播疾病综合征管理的知识，并对不同综合征管理算法的优缺点提出建议。研究设计：作者选取了有关性传播疾病综合征管理的文章和摘要。评估尿道分泌物、生殖器溃疡疾病和阴道分泌物算法的有效性主要基于已发表的敏感性和特异性数据。结果：总体而言，男性尿道分泌物和生殖器溃疡疾病的诊断和治疗算法具有较高的敏感性或治愈率（尿道分泌物87-99%；生殖器溃疡疾病68-98%）。在出现阴道分泌物症状的妇女中，这些算法对阴道分泌物的敏感性为73%至93%，在没有症状的妇女中为29%至86%。阴道分泌物不是宫颈感染的有效指标，因此不是检测宫颈感染妇女的独立有效的筛查工具，特别是在低风险或无症状人群中。结合风险评分可以提高宫颈感染检测算法的准确性。结论：尿道分泌物和生殖器溃疡疾病的检测算法对性传播疾病有较好的检测效果，目前的阴道分泌物检测算法对女性淋病和衣原体的检测效果不高；风险评分可以提高其疗效，但必须量身定制以反映社区风险。如果不关注性病综合征管理的定性方面，这些方法可能比上述研究更不准确。仍然迫切需要开发一种负担得起的、快速和有效的诊断技术，以改善资源贫乏地区的性病检测。
Background: Studies of the accuracy of syndromic management have demonstrated widely varying results depending upon gender, location of infection, risk group, organisms, among other factors.Goal: To review current knowledge about syndromic management of sexually transmitted diseases (STDs) and to make recommendations about the strengths and weaknesses of different syndromic management algorithms.Study Design: The authors identified articles and abstracts about the syndromic management of STDs. Evaluation of the effectiveness of algorithms for urethral discharge, genital ulcer disease, and vaginal discharge was based primarily on published sensitivity and specificity data.Results: Overall, algorithms for the diagnosis and treatment of urethral discharge and genital ulcer disease in men had high sensitivities or cure rates (urethral discharge, 87-99%; genital ulcer disease, 68-98%). The sensitivities for the algorithms for vaginal discharge ranged from 73% to 93% among women presenting with symptoms of vaginal discharge, and from 29% to 86% among women not presenting with symptoms. Vaginal discharge was not found to be an effective indicator of cervical infection and, therefore, is not an independently effective screening tool to detect women with cervical infection, especially in low-risk or asymptomatic populations. Incorporating risk scores can improve the accuracy of algorithms to detect cervical infection.Conclusions: Algorithms for urethral discharge and genital ulcer disease can be effective in STDs, The current algorithms for vaginal discharge are not highly effective in detecting gonorrhea and chlamydia in women; risk scores can improve their efficacy, but must be tailored to reflect community risks, Without attention to the qualitative aspects of STD syndromic management, these methods will likely have even less accuracy than the studies reviewed above. There remains an urgent need for the development of an affordable, rapid, and effective diagnostic technique that will improve STD detection in resource-poor settings.