Evidence map›Paper›PMID 29654017›Full record

ArticleBMJ open2018

Assessing prevalence of missed laboratory-confirmed sexually transmitted infections among women in Kingston, Jamaica: results from a secondary analysis of the Sino-Implant clinical trial.

Yasaman Zia, Jeffrey Wiener, Margaret Christine Snead, John Papp, Christi Phillips, Lisa Flowers, Natalie Medley-Singh, Elizabeth C Costenbader, Tina Hylton-Kong, Athena P Kourtis

Registry-linked trialOpen access · goldAbstract read
In one paragraph

Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01684358 (A Randomized Controlled Trial on the Effect of Sino-implant), which is not on this map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
0.2field-weighted citation impact, top 50% of its field
1 · What the graph read from 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.

2 · The registry

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.

NCT01684358 nacompletednot on this map

A Randomized Controlled Trial on the Effect of Sino-implant (II) Use on Condom Use Among Women in Kingston, Jamaica

TypeinterventionalSponsorCenters for Disease Control and PreventionRan2012 to 2014Enrolled414ConditionsWomen Wanting Contraceptive Implant for Pregnancy PreventionArmsSino-implant (II)
3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it, 2 citations in OpenAlex.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 2 countries.

Yasaman ZiaDivision of Reproductive Health, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
Jeffrey WienerDivision of Reproductive Health, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
Margaret Christine SneadDivision of Reproductive Health, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
John PappDivision of Sexually Transmitted Disease Prevention, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
Christi PhillipsDivision of Sexually Transmitted Disease Prevention, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
Lisa FlowersDivision of Reproductive Health, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
Natalie Medley-SinghDepartment of Obstetrics, Gynaecology, and Child Health, University Hospital of the West Indies, Kingston, Jamaica.
Elizabeth C CostenbaderBehavioral, Epidemiological and Clinical Sciences Department, Family Health International (FHI 360), Durham, North Carolina, USA.
Tina Hylton-KongEpidemiology Research and Training Unit, Ministry of Health, Kingston, Jamaica.
Athena P KourtisDivision of Reproductive Health, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
Centers for Disease Control and Prevention · USFamily Health International 360 · USMinistry of Health · JMUniversity of the West Indies · JM

Funding

OSELS CDC HHS U36 OE000002
6 · The paper itself

Abstract

objectivesTo assess potentially missed sexually transmitted infections (STIs), we compared clinically diagnosed STIs to laboratory-confirmed diagnoses of gonorrhoea (GC), chlamydia (CT) and trichomonas (Tvag).

designSecondary analysis of a randomised controlled trial.

settingWe used data and specimens previously collected for the Sino-Implant Study in Kingston, Jamaica.

participantsThe Sino-Implant Study randomised 414 women to receive a levonorgestrel implant at either baseline or 3 months post-enrolment to evaluate unprotected sex after implant initiation. This analysis used 254 available vaginal swab samples. OUTCOME MEASURES: Clinically diagnosed STIs were determined from medical records by assessing clinical impressions and prescriptions. Laboratory-confirmed STIs included GC, CT and Tvag tested by Aptima Combo 2 for CT/GC and Aptima Tvag assays (Hologic, San Diego, California, USA). Log-binomial regression models fit with generalised estimating equations were used to estimate associations of clinically diagnosed STIs with laboratory-confirmed diagnoses and demographic and behavioural characteristics.

resultsOverall, 195 (76.8%) women had laboratory-confirmed STI (CT, GC or Tvag) while only 65 (25.6%) women had clinically diagnosed cervicitis and/or vaginitis during the study period. Clinical diagnosis missed 79.7% of laboratory-confirmed STIs: 85% of GC (n=17/20), 78.8% of CT (n=141/179) and 80.0% of Tvag (n=180/225). Hormonal contraceptive use in the month prior to the study visit was significantly associated with clinical diagnosis at any time point (prevalence ratio (PR): 1.65, 95% CI 1.07 to 2.54). As age increased, clinically missed infections significantly decreased (PR: 0.98 per year increase, 95% CI 0.97 to 1.00).

conclusionsThe prevalence of laboratory-confirmed STIs was much higher than what was captured by clinical diagnosis. GC, CT and Tvag were not accurately detected without lab confirmation. Missed diagnoses decreased with older age. Increased laboratory capacity and refinement of the syndromic approach are needed to protect the health of sexually active Jamaican women. TRIAL REGISTRATION NUMBER: NCT01684358.

Indexed as

Diagnostic ErrorsSexually Transmitted DiseasesChlamydia InfectionsFemaleGonorrheaHIV InfectionsHumansJamaicaPregnancyPrevalenceTrichomonas Infectionsepidemiologyinternational health servicesreproductive medicine

Identifiers

PMID29654017
PMCPMC5905734
OpenAlexW2797957363

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

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.