Syndromic approach to sexually transmitted infections in Tunisian women: bacteriological validation

Syndromic surveillance of female sexually transmitted infections in primary care: a descriptive study in Monastir, Tunisia, 2007─2017

BACKGROUND

Sexually Transmitted Infections (STIs) are a public health problem, especially for reproductive-age women. The aim of this study was to determine the incidence and trend of STIs during 11 years in Tunisia (2007-17).

METHODS

We conducted a descriptive study including all women with curable STIs (chlamydia, gonorrhea, syphilis and trichomoniasis) diagnosed with the syndromic approach in all basic health care centers of the Governorate of Monastir (Tunisia) from 2007 to 2017. Syndromes included, Pelvic Pain (PP), Vaginal Discharge (VD) and Genital Ulceration (GU).

RESULTS

We analyzed 40,388 episodes of curable STIs with a crude incidence rate and age standardized incidence rate of 1393 (95% Confidence Interval (CI); 1348-1438) / 100,000 Person Year (PY) and 1328 (95%CI; 1284-1372) /100,000 PY respectively. The incidence rate showed a positive trend over 11 years for all age groups and syndromes. VD was the most common syndrome with a crude incidence rate of 1170/100,000 PY. For all syndromes, women aged 20 to 39 were the most affected age group (p < 0.001).

CONCLUSION

In conclusion, the incidence rate of STIs episodes among women diagnosed with the syndromic approach was high, consistent with the global evidence. Focusing on reviewing STIs surveillance system in low and middle-income countries could allow the achievement of the ending of STIs epidemics by 2030.

Syndromic Diagnosis in Evaluation of Women with Symptoms of Vaginitis

PURPOSE OF REVIEW

This review aims to determine the effectiveness of the use of syndrome diagnosis in the evaluation of vaginitis and to make suggestions based on the review findings.

RECENT FINDINGS

Vaginal discharge as the main symptom of vaginitis is unspecific. A randomized study of symptom-based diagnosis and treatment of vaginitis in the USA favored symptoms used for treatment; however, this was only a pilot study. Hence, a population-based study is necessary to validate these findings. Most of the study that assessed treatment of vaginitis in pregnancy reported low diagnostic sensitivity and specificity for bacterial vaginosis and vaginal candidiasis and a wide range for trichomonas vaginalis reflecting ineffectiveness of syndrome-based treatment in pregnancy. A systematic review of the web for relevant literature was made, and appropriate articles were extracted and reviewed. Sensitivity, specificity, and positive values were used, where applicable to determine effectiveness. Forty-three full articles and abstracts were reviewed. Studies that validated or applied WHO algorithm for treatment of vaginitis reported high sensitivity (91.5-100%) but moderate to low specificity (0-27.5%) among women with vaginal symptoms. Studies that focused on symptoms for diagnosis of the three main etiologic agents of vaginitis reported low sensitivity and specificity, while such studies in pregnancy reported sensitivity and specificity ranging from 35.4 to 54% for TV, 11 to 100% for BV, and 0 to 56.2% for trichomonas vaginalis, bacterial vaginosis, and vaginal candidiasis, respectively. Studies that added point of care test reported higher sensitivity and specificity and positive predictive value. The use of WHO syndrome-based algorithm or its modification for treatment of vaginitis though moderately effective has the potential for overtreatment and physician error. Point of care testing and laboratory investigation are essential for productive intervention especially in pregnancy.

Are the fatty acids responsible for the higher effect of oil and alcoholic extract of Nigella sativa over its aqueous extract on Trichomonas vaginalis trophozoites?

Trichomoniasis, the disease caused by the flagellate protozoan Trichomonas vaginalis is the sexually transmitted infection with the largest annual incidence. Metronidazole is the drug of choice recommended for the treatment of human trichomoniasis but it can lead to drug resistance and many other adverse effects. So, it is necessary for new alternatives for the treatment of this infection. Medicinal plants or herbs could be good alternative regimens to be inexpensive, effective and safe to use. In the present study, the therapeutic potential of Nigella sativa aqueous and alcoholic extracts as well as seeds oil was examined. Different concentrations of these plant preparations were incubated in vitro with cultivated T. vaginalis trophozoites and its effect on growth was compared with metronidazole under the same conditions. Both the alcoholic extract and oil proved to be valuable agents as efficient as metronidazole in treating T. vaginalis infection. The remarkable effect of N. sativa oil may be attributed to the fact that the active principles extracted from N. sativa seeds are mostly from its essential oil (omega 3, 6, 9 as well as 7 fatty acids). However, further experimental and clinical investigations are needed to evaluate and standardize the doses of these natural products to be safe and efficient.

The Effect of Commiphora molmol (Myrrh) in Treatment of Trichomoniasis vaginalis infection

BACKGROUND

Trichomoniasis vaginalis is now an important worldwide health problem. Metronidazole has so far been used in treatment, but the metronidazole-resistant strains and unpleasant adverse effects have been de-veloped. Myrrh is one of the oldest known medicinal plants used by the ancient Egyptians for medical purposes and for mummification. Commiphora molmol (Myrrh) proved safe for male reproductive organ which is the main habitat of T. vaginalis and this study aims to evaluate the efficacy of the herbal against T. vaginalis in females.

METHODS

In the present study, 33 metronidazole-resistant T. vaginalis females were treated with a combined course of metronidazole and tinidazole. Those still resistant to the combined treatment were given C. molmol. Also, natural plant extract purified from pomegranate (Punica granatum, Roman) was in-vitro investigated for its efficacy against T. vaginalis on Diamond media.

RESULTS

The anti-T. vaginalis activity of both P. granatum (in-vitro) and C. molmol (in-vivo) extracts gave promis-ing results.

CONCLUSION

The anti-T. vaginalis activity of P. granatum and C. molmol showed promising results indicating to sources of new anti-Ttrichomonas agents.