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Abstract BACKGROUND: As part of the screening procedures for the Carraguard microbicide trial, consenting women underwent pelvic examination. Women with abnormal vaginal discharge are treated syndromically according to the South African Sexually Transmitted Infections guideline. As part of the clinical trial, vaginal swabs are collected for determination of laboratory-diagnosed STIs as opposed to the standard practice of syndromic management of STIs in the public health sector. OBJECTIVE: To determine the relationship between the clinical diagnosis and laboratory diagnosis of STIs. METHODS: Clinical and laboratory findings of 2,000 women who have been screened between 7 October 2004 and 19 October 2005 were reviewed. Pelvic examination was performed and high vaginal swabs were collected and sent to onsite laboratory to be tested for Trichomonas vaginalis using the InPouch Trichomonas vaginalis test and to an outsourced laboratory for PCR testing of Neisseria gonorrhoeae and Chlamydia trachomatis. Laboratory diagnosis of STIs was compared with clinical symptoms of those who were syndromically treated. RESULTS: Of the 2,000 women 302 (15%) had abnormal vaginal discharge on clinical examination and syndromic management was provided; correspondingly laboratory diagnosis showed that 117 women (38.7%) had at least one of the STIs (i.e., Trichomonas vaginalis, Neisseria gonorrhoeae, and Chlamydia trachomatis). The remaining 185 women (61.3%) who had discharge tested negative for the STIs. Of the 2,000 women 282 (14%) did not present clinically with STIs but on laboratory tests showed that they had either one or a combination of the three STIs, and these women had to be called back in for treatment. CONCLUSION: Clinical and laboratory diagnoses do not always correspond. In high HIV-risk areas, it is imperative that STIs are treated in a timely manner to minimize HIV transmission. Poster Session
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