Abnormal vaginal discharge among women of reproductive age in sub-Saharan Africa: the need for a paradigm shift from a syndromic approach to specific pathogen identification and directed treatment.
Sub Saharan Africa
Treatment Decision-making
Vaginal discharge
Journal
IJID regions
ISSN: 2772-7076
Titre abrégé: IJID Reg
Pays: England
ID NLM: 9918418183106676
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
received:
15
09
2022
revised:
26
10
2022
accepted:
26
10
2022
entrez:
5
12
2022
pubmed:
6
12
2022
medline:
6
12
2022
Statut:
epublish
Résumé
An abnormal vaginal discharge is a frequent manifestation of reproductive tract infections, including sexually transmitted infections (STIs) and vulvovaginal candidiasis. It is also a manifestation of bacterial vaginosis, which has a prevalence of up to 50% among women of reproductive age. Reproductive tract infections are associated with a range of reproductive health challenges and increase the risk of HIV acquisition. This study was performed to critically review and discuss the current diagnostic and treatment approaches to abnormal vaginal discharge among women of reproductive age in sub-Saharan Africa, and to call for a paradigm shift from the syndromic approach to specific pathogen identification and directed antimicrobial therapy. Young women have the highest incidence of HIV infection in sub-Saharan Africa. Countries in sub-Saharan Africa where the prevalence of both STIs and bacterial vaginosis is very high have been employing a syndromic approach for the treatment of abnormal vaginal discharge since around 1984. However, the syndromic approach has several limitations, with the potential to miss infections, over-diagnose and over-treat STIs, and propagate antimicrobial resistance, which is one of the greatest global health challenges of the 21 The low to middle-income countries of sub-Saharan Africa must innovate and leverage improved diagnostics to capacitate primary health care and other levels for point-of-care diagnostic testing, in order to provide an immediate diagnosis and treatment for women with an abnormal vaginal discharge.
Sections du résumé
Background
UNASSIGNED
An abnormal vaginal discharge is a frequent manifestation of reproductive tract infections, including sexually transmitted infections (STIs) and vulvovaginal candidiasis. It is also a manifestation of bacterial vaginosis, which has a prevalence of up to 50% among women of reproductive age. Reproductive tract infections are associated with a range of reproductive health challenges and increase the risk of HIV acquisition.
Methods
UNASSIGNED
This study was performed to critically review and discuss the current diagnostic and treatment approaches to abnormal vaginal discharge among women of reproductive age in sub-Saharan Africa, and to call for a paradigm shift from the syndromic approach to specific pathogen identification and directed antimicrobial therapy.
Discussion
UNASSIGNED
Young women have the highest incidence of HIV infection in sub-Saharan Africa. Countries in sub-Saharan Africa where the prevalence of both STIs and bacterial vaginosis is very high have been employing a syndromic approach for the treatment of abnormal vaginal discharge since around 1984. However, the syndromic approach has several limitations, with the potential to miss infections, over-diagnose and over-treat STIs, and propagate antimicrobial resistance, which is one of the greatest global health challenges of the 21
Conclusions
UNASSIGNED
The low to middle-income countries of sub-Saharan Africa must innovate and leverage improved diagnostics to capacitate primary health care and other levels for point-of-care diagnostic testing, in order to provide an immediate diagnosis and treatment for women with an abnormal vaginal discharge.
Identifiants
pubmed: 36467508
doi: 10.1016/j.ijregi.2022.10.006
pii: S2772-7076(22)00132-1
pmc: PMC9713322
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
165-168Informations de copyright
© 2022 The Author(s).
Déclaration de conflit d'intérêts
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reportcoed in this paper.
Références
BMC Infect Dis. 2021 Aug 17;21(1):825
pubmed: 34404367
FEMS Microbiol Lett. 1992 Dec 15;100(1-3):345-9
pubmed: 1478469
Int J STD AIDS. 2019 Mar;30(4):404-410
pubmed: 30626282
PLoS One. 2016 Oct 5;11(10):e0163365
pubmed: 27706174
Trop Med Int Health. 1999 Feb;4(2):114-9
pubmed: 10206265
Int J STD AIDS. 2014 Oct;25(12):851-9
pubmed: 24516075
Sex Transm Infect. 2020 May;96(3):220-222
pubmed: 31040250
Int J STD AIDS. 2008 Jun;19(6):381-4
pubmed: 18595875
Obstet Gynecol. 1998 Nov;92(5):757-65
pubmed: 9794664
J Clin Nurs. 2013 Aug;22(15-16):2244-52
pubmed: 23679832
Int J STD AIDS. 2018 Nov;29(13):1258-1272
pubmed: 30049258
Malawi Med J. 2017 Dec;29(4):290-293
pubmed: 29963282
Am J Obstet Gynecol. 2019 Feb;220(2):155-166
pubmed: 30321529
Int J STD AIDS. 2018 Feb;29(2):157-163
pubmed: 28705094
PLoS Med. 2018 Jun 26;15(6):e1002608
pubmed: 29944660
J Med Assoc Thai. 2004 Nov;87(11):1270-4
pubmed: 15825698
Can J Infect Dis Med Microbiol. 2005 Jan;16(1):39-44
pubmed: 18159527
Int J STD AIDS. 2015 Aug;26(9):656-60
pubmed: 25208533
Clin Infect Dis. 2021 May 4;72(9):1538-1543
pubmed: 32350529
PLoS One. 2018 Apr 24;13(4):e0196209
pubmed: 29689080
J Int AIDS Soc. 2019 Aug;22 Suppl 6:e25343
pubmed: 31468679
AIDS. 2008 Jul 31;22(12):1493-501
pubmed: 18614873
Sex Transm Infect. 2004 Jun;80(3):174-82
pubmed: 15169997
J Clin Microbiol. 2013 May;51(5):1505-9
pubmed: 23467604
J Clin Microbiol. 2011 Mar;49(3):866-9
pubmed: 21248097
MMWR Recomm Rep. 2014 Mar 14;63(RR-02):1-19
pubmed: 24622331
Clin Microbiol Infect. 2016 Sep;22(9):815.e5-815.e7
pubmed: 27371346
Ann Intern Med. 2005 Jun 7;142(11):914-25
pubmed: 15941699
J Glob Infect Dis. 2012 Jan;4(1):22-5
pubmed: 22529623
Am J Clin Pathol. 2014 Mar;141(3):397-403
pubmed: 24515768
Sex Transm Infect. 1999 Feb;75(1):3-17
pubmed: 10448335
Sex Transm Infect. 2002 Dec;78(6):413-5
pubmed: 12473800
BMC Public Health. 2013 Feb 16;13:143
pubmed: 23414518
Pathogens. 2020 Jan 31;9(2):
pubmed: 32024032
BMC Microbiol. 2015 Jul 24;15:142
pubmed: 26205172
Health Secur. 2021 Sep-Oct;19(5):498-507
pubmed: 34495744