Evaluations of clinical signs currently and not currently used in syndromic case management (SCM) of reproductive tract infections (RTIs) among pregnant women in Jamaica

Reproductive tract infections include sexually transmitted infections, endogenous infections caused by overgrowth of organisms that can be present in the genital tract of a healthy woman, and iatrogenic infections. 3 In Jamaica, women in the reproductive age group of 15--44 years old accounts for 95% of all RTIs.2 RTIs among Jamaican women of reproductive age can seriously impact the health of the women and their children.10, 11, 12;The advent of HIV/AIDS has had a significant impact on increasing awareness of the effect of STIs.13,18,16 Health care organizations have reacted with great commitment to STI prevention and treatment as a significant factor in preventing the spread of HIV/AIDS.3,5;The traditional approach for diagnosing and managing infections in most developed countries is by identification of etiological agents by laboratory tests. The SCM approach has been recommended by the World Health Organization (WHO) as a cost-effective method of managing RTIs.14,15 SCM uses groups of symptoms and easily recognized signs in the identification of well defined pathogens that cause RTIs.5 This allows management of the patient's RTI in a single visit by providing treatment even where tests for etiological agents are unavailable.5;In 1997, the use of SCM among pregnant women was evaluated in Jamaica. The results of previous analyses show that SCM algorithm based solely on vaginal discharge has a marginal validity among pregnant women.9 In this study an algorithm with two components was used: a risk assessment portion which contains behavioral risk factors predictive of RTI and a clinical portion which includes clinical assessment of vaginal discharge. During the implementation of this study, several other clinical signs such as cervical erosion, friable cervix, color of discharges were integrated in the algorithm. The validity of these added signs and the other clinical signs used in SCM have not been assessed.;The present study aims to evaluate the validity of the added clinical risk factors together with the current clinical signs used in SCM in diagnosing RTIs among pregnant women in Jamaica. From the results of these analyses, this study aims to develop modified algorithms/s that best suit this specific population.;Keywords: Reproductive tract infections (RTIs), syndromic case management, human immunodeficiency virus.