Skip to main content
Top
Published in: The Journal of Obstetrics and Gynecology of India 1/2016

01-10-2016 | Original Article

Study to Evaluate Targeted Management and Syndromic Management in Women Presenting with Abnormal Vaginal Discharge

Authors: Veena Meena, Charu Lata Bansal

Published in: The Journal of Obstetrics and Gynecology of India | Special Issue 1/2016

Login to get access

Abstract

Introduction

Vaginal discharge is a commonest complaint among women in reproductive age group. Infective vaginal discharge can be broadly categorized into vaginitis or mucopurulent cervicitis. Vaginitis is predominantly caused by bacterial vaginosis, vaginal candidiasis, vaginal trichomoniasis, etc. Mucopurulent cervicitis is due to chlamydia or gonococcal infection. The targeted management is based on identification of causative organism and targeting the therapy against it, while syndromic management is based on high risk factors’s presence.

Aims and Objectives

To study the effect of targeted management as compared to syndromic management in achieving a complete cure for abnormal vaginal discharge and to study the microbial flora of women presenting with abnormal vaginal discharge.

Method

The study is a randomized control trial conducted at tertiary health care on 200 women who presented with abnormal vaginal discharge, distributed in two groups A and B each consisted of 100 women. Group A underwent laboratory investigations, and treatment was started as soon as reports were available. Group B was given syndromic management based on high risk factors’s presence. Both groups were followed up after 2 weeks.

Results

The prevalence of various organisms in vaginal discharge was candidiasis 39 %, bacterial vaginosis 28 %, trichomoniasis 5 %, N. gonorrhoeae 5 % and chlamydia 2 % among the 100 women in group A. Response to treatment for vaginitis was 76.3 % in group A, whereas it was 41 % in group B. With cervicitis, 71.4 % women responded to treatment in targeted group as compared to 54 % in syndromic management group.

Conclusion

There is a potential disadvantage of syndromic management because of its total reliability on a subjective clinical assessment.
Literature
1.
2.
go back to reference Amsel R, Totten PA, Speigel CA, et al. Nonspecific vaginitis: diagnostic criteria and microbial and epidemiological association. Am J Med. 1983;74:14–22.CrossRefPubMed Amsel R, Totten PA, Speigel CA, et al. Nonspecific vaginitis: diagnostic criteria and microbial and epidemiological association. Am J Med. 1983;74:14–22.CrossRefPubMed
3.
go back to reference Dunkelberg WE. Diagnosis of haemophilus vaginalis by gram stained smears. Am J Obstet Gynecol. 1965;91:998–1000.CrossRefPubMed Dunkelberg WE. Diagnosis of haemophilus vaginalis by gram stained smears. Am J Obstet Gynecol. 1965;91:998–1000.CrossRefPubMed
5.
go back to reference Briselden AM, Hiller SL. Evaluation of affirm VP microbial identification test for Gardnerella vaginalis and Trichomonas vaginalis. J Clin Microbiol. 1994;32:148–52.PubMedPubMedCentral Briselden AM, Hiller SL. Evaluation of affirm VP microbial identification test for Gardnerella vaginalis and Trichomonas vaginalis. J Clin Microbiol. 1994;32:148–52.PubMedPubMedCentral
6.
go back to reference Chandeying V, Skov S, Kemapunmanus M, et al. Evaluation of two clinical protocols for the management of women with vaginal discharge in southern Thailand. Sex Transm Inf. 1998;74:194–201.CrossRef Chandeying V, Skov S, Kemapunmanus M, et al. Evaluation of two clinical protocols for the management of women with vaginal discharge in southern Thailand. Sex Transm Inf. 1998;74:194–201.CrossRef
7.
go back to reference Thulkar J, Kriplani A, Agarwal N, et al. Aetiology and risk factors of recurrent vaginitis and its association with various contraceptive methods. Indian J Med Res. 2010;131:83–7.PubMed Thulkar J, Kriplani A, Agarwal N, et al. Aetiology and risk factors of recurrent vaginitis and its association with various contraceptive methods. Indian J Med Res. 2010;131:83–7.PubMed
8.
go back to reference Ryan CA, Zidouh A, Manhart LE, et al. Reproductive tract infections in primary health care, family planning and dermatovenerology clinics: evaluation of syndromic management in Moroco. Sex Transm Infect. 1998;74:S95–105.CrossRefPubMed Ryan CA, Zidouh A, Manhart LE, et al. Reproductive tract infections in primary health care, family planning and dermatovenerology clinics: evaluation of syndromic management in Moroco. Sex Transm Infect. 1998;74:S95–105.CrossRefPubMed
9.
go back to reference Rao PS, Devi S, Shriyah A, et al. Diagnosis of bacterial vaginosis in a rural set up: comparison of clinical algorithm, smear scoring and culture by semiquantitative technique. Indian J Med Microbiol. 2004;22(1):47–50.PubMed Rao PS, Devi S, Shriyah A, et al. Diagnosis of bacterial vaginosis in a rural set up: comparison of clinical algorithm, smear scoring and culture by semiquantitative technique. Indian J Med Microbiol. 2004;22(1):47–50.PubMed
10.
go back to reference Sanchez SE, Koutsky LA, Sanchez J, et al. Rapid and inexpensive approaches to managing abnormal vaginal discharge or lower abdominal pain: an evaluation in women attending gynaecology and family planning clinic in Peru. Sex Transm Infect. 1998;74(Supp 1):S85–94.PubMed Sanchez SE, Koutsky LA, Sanchez J, et al. Rapid and inexpensive approaches to managing abnormal vaginal discharge or lower abdominal pain: an evaluation in women attending gynaecology and family planning clinic in Peru. Sex Transm Infect. 1998;74(Supp 1):S85–94.PubMed
11.
go back to reference Sharma AK, Ranjan R, Mehta G. Prevalence and determinants of reproductive infection among women. J Commun Dis. 2004;36(2):93–9.PubMed Sharma AK, Ranjan R, Mehta G. Prevalence and determinants of reproductive infection among women. J Commun Dis. 2004;36(2):93–9.PubMed
12.
go back to reference Rizvi N, Luby S. Vaginal discharge: perceptions and health seeking behaviour among Nepalese women. J Pak Med Assoc. 2004;54(12):620–4.PubMed Rizvi N, Luby S. Vaginal discharge: perceptions and health seeking behaviour among Nepalese women. J Pak Med Assoc. 2004;54(12):620–4.PubMed
13.
go back to reference Barouti E, Farzaeneh F, Sule AA, et al. The pathogenic microorganism in Papanicolaou vaginal smear and correlation with inflammation. J Fam Reprod Health. 2013;7(1):23–7. Barouti E, Farzaeneh F, Sule AA, et al. The pathogenic microorganism in Papanicolaou vaginal smear and correlation with inflammation. J Fam Reprod Health. 2013;7(1):23–7.
14.
go back to reference Moherdaul F, Vuylsteka B, Sizueira LF, et al. Validation of national algorithm for the diagnosis of sexually transmitted diseases in Brazil: results for a multicentric study. Sex Transm Infect. 1998;74:S38–43. Moherdaul F, Vuylsteka B, Sizueira LF, et al. Validation of national algorithm for the diagnosis of sexually transmitted diseases in Brazil: results for a multicentric study. Sex Transm Infect. 1998;74:S38–43.
15.
go back to reference Nugent RP, Krohn MA, Hillier SA, et al. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991;29:297–301.PubMedPubMedCentral Nugent RP, Krohn MA, Hillier SA, et al. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991;29:297–301.PubMedPubMedCentral
16.
go back to reference Tann CJ, Mpairwe H, Morison L, et al. Lack of effectiveness of syndromic management in targeting vaginal infections in pregnancy in Entebbe, Uganda. Sex Transm Infect. 2006;82:285–9.CrossRefPubMedPubMedCentral Tann CJ, Mpairwe H, Morison L, et al. Lack of effectiveness of syndromic management in targeting vaginal infections in pregnancy in Entebbe, Uganda. Sex Transm Infect. 2006;82:285–9.CrossRefPubMedPubMedCentral
Metadata
Title
Study to Evaluate Targeted Management and Syndromic Management in Women Presenting with Abnormal Vaginal Discharge
Authors
Veena Meena
Charu Lata Bansal
Publication date
01-10-2016
Publisher
Springer India
Published in
The Journal of Obstetrics and Gynecology of India / Issue Special Issue 1/2016
Print ISSN: 0971-9202
Electronic ISSN: 0975-6434
DOI
https://doi.org/10.1007/s13224-016-0879-x

Other articles of this Special Issue 1/2016

The Journal of Obstetrics and Gynecology of India 1/2016 Go to the issue