SynthesisPloS one2016
The Performance of the Vaginal Discharge Syndromic Management in Treating Vaginal and Cervical Infection: A Systematic Review and Meta-Analysis.
Synthesis in PloS one, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 2 syntheses or guidelines pooled it, 83 citations in OpenAlex.
- Risk scores for predicting HIV incidence among adult heterosexual populations in sub-Saharan Africa: a systematic review and meta-analysis.Journal of the International AIDS Society · 2022Pooled it
- Diagnosing sexually transmitted infections in resource-constrained settings: challenges and ways forward.Journal of the International AIDS Society · 2019Pooled it
- Youth-Friendly Sexual Health Services and Peer Support for Improved Sexual and Reproductive Health Outcomes Among Adolescents and Young Adults in South Africa: Results of a Factorial Randomized Controlled Trial.Sexually transmitted diseases · 2025Trial
- Prevalence of five treatable sexually transmitted infections among women in Lower River region of The Gambia.BMC infectious diseases · 2023Trial
- When context matters: Multilevel determinants of self-reported sexually transmitted infections symptoms among men engaged in transactional sex in 26 Sub-Saharan African countries.BMC public health · 2026Article
- Epidemiology and management of bacterial vaginosis in Dakar, Senegal.BMC women's health · 2026Observational
- Stakeholder perspectives on integrating doxycycline postexposure prophylaxis into Kenyan HIV PrEP programmes.Sexually transmitted infections · 2025Article
- Syndromic management of sexually transmitted infections among female sex workers in Lomé (Togo), 2023.PloS one · 2025Article
- Article
- Prevalence of sexually transmitted infections (STIs), associations with sociodemographic and behavioural factors, and assessment of the syndromic management of vaginal discharge in women with urogenital complaints in Mozambique.Frontiers in reproductive health · 2024Article
- Second trimester vaginalFrontiers in global women's health · 2024Article
- AN ESSENTIAL TOOL TO BE OPTIMIZED: SYNDROMIC MANAGEMENT OF VAGINAL DISCHARGE IN HAITI.African journal of infectious diseases · 2024Article
- High prevalence and incidence of gonorrhoea and chlamydia in young women eligible for HIV pre-exposure prophylaxis in South Africa and Zimbabwe: results from the HPTN 082 trial.Sexually transmitted infections · 2023Article
- Challenges and Solutions to STI Control in the Era of HIV and STI Prophylaxis.Current HIV/AIDS reports · 2023Review
- Prevalence, Associated Factors, and Appropriateness of Empirical Treatment of Trichomoniasis, Bacterial Vaginosis, and Vulvovaginal Candidiasis among Women with Vaginitis.Microbiology spectrum · 2023Article
- Review
- Importance of Candida infection and fluconazole resistance in women with vaginal discharge syndrome in Namibia.Antimicrobial resistance and infection control · 2022Article
- STI prevalence, incidence, and partner notification among women in a periconception HIV prevention program in Uganda.International journal of STD & AIDS · 2022Article
- Cross-sectional assessment of determinants of STIs among men who have sex with men and transgender women in Kigali, Rwanda.Sexually transmitted infections · 2022Article
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 4 institutions in 4 countries.
Funding
Abstract
backgroundThis review aimed to synthesize and analyze the diagnostic accuracy and the likelihood of providing correct treatment of the syndromic approach Vaginal Discharge Flowchart in managing cervical infections caused by Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT), and vaginal infections caused by Trichomonas vaginalis (TV) and Bacterial vaginosis (BV) and Candida albicans. This review will inform updating the WHO 2003 guidelines on Vaginal Discharge syndromic case management.
methodsA systematic review was conducted on published studies from 01-01-2000 to 30-03-2015 in multiple databases. Studies evaluating the diagnostic accuracy and validation of the WHO Vaginal Discharge Flowchart were included. Validation parameters including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and the 95% confidence intervals for the different types of the flowchart were taken as outcomes, re-calculated, and analysed using a fixed model meta-analysis for data pooling. The level of agreement between the index and reference test were determined by the Cohen's Kappa co-efficiency test. Each individual study was assessed on quality using the QUADAS-2 tool.
findingsThe search yielded 2,845 studies of which 16 met the eligibility criteria for final analysis. The diagnostic performance to identify cervical infections was low and resulted in a high proportion of over and missed treatment. The four flowcharts had a sensitivity between 27.37% in history and risk assessment and 90.13% with microscopy, with the inverse in specificity rates. The treatment performances between the flowcharts were inconsistent. The same applies to the use of vaginal discharge flowchart for treating vaginal infections. For vaginal infections the vaginal discharge flowchart had a good performance in flowchart 3 with 91.68% of sensitivity; 99.97% specificity; 99.93% PPV and 0.02% who missed their treatment and 8.32% of women who were over treated by the vaginal discharge flowchart.
conclusionThe vaginal discharge flowchart should focus on management of vaginal infection. It could be used as an intermediate approach for cervical infections for sex workers until a point of care test is available in resource poor settings.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.