Etiology of Vaginal/Cervical Discharge Syndrome: Analysis of Data from a Referral Laboratory in Eastern India

CONTEXT: Sexually transmitted infections (STIs) and reproductive tract infections (RTIs) constitute important public health problem worldwide. Syndromic diagnosis of vaginal/cervical discharge (VCD) is often inaccurate leading to over- or under-treatment. AIMS: This study aimed to ascertain the laboratory-confirmed diagnosis of VCD and their relative frequency in a group of patients presenting to a STI clinic in eastern India and to determine the sensitivity and specificity of clinical diagnosis. SETTINGS AND DESIGN: This was a cross-sectional study. MATERIALS AND METHODS: Data of 5301 consecutive patients with VCD were analyzed for etiological diagnosis and the findings were compared with laboratory data of 3110 asymptomatic cases. STATISTICAL ANALYSIS USED: Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of clinical diagnosis of vaginal discharge syndrome were obtained considering the results of the laboratory diagnosis as gold standard. The strength of agreement was computed using Kappa statistic. RESULTS: Of 5301 cases of VCD, 90.83% had STI/RTIs. The most prevalent infection was trichomoniasis (35.23%), followed by bacterial vaginosis (33.05%) and vulvovaginal candidiasis (19.67%). Sensitivity, specificity, PPV, and NPV of vaginal discharge as an indicator of STI/RTI were 85.5%, 99.0%, 99.3%, and 80%, respectively, with agreement of 90.49% and kappa value of 0.8, indicating “almost perfect” agreement. Many cases with VCD also suffered from other STIs such as herpes simplex virus-2, hepatitis B, human immunodeficiency syndrome, and syphilis and some asymptomatic cases suffered from one or more STIs. CONCLUSIONS: All patients with VCD with high-risk behavior should preferably undergo laboratory evaluation of the VCD syndrome to avoid over- or under-treatment.