indicates that 12% of female clients and 6% of male clients attend the out - patient departments for complaints related to sti / rti . according to dlhs-3
. early diagnosis and treatment of these infections can prevent serious complications and long term sequelae affecting the quality of life .
main barriers to the health seeking behavior among women are illiteracy , ignorance , low socioeconomic status , cultural norms and lack of privacy at the health care facilities .
this results in poor availability of data on reproductive tract infections among symptomatic and asymptomatic women . in order to respond to situation of high prevalence and need for effective treatment for rti/ sti , especially in countries with limited resources ,
syndromic diagnostic approach was recommended by who and was adopted by naco , india at the primary health center level .
the approach of using simple laboratory tests in conjunction with syndromic approach is called enhanced syndromic management which can enhance the effectiveness i.e increase sensitivity , specificity and predictive values , and contribute to the epidemiological data in programming decision making .
there are very few community based prevalence studies with laboratory support on reproductive tract infections / sexually transmitted infections studies among ever married women aged 15 - 49 years in rural india . to address this issue ,
this study was carried out among ever married rural women aged 15 - 49 years with the objective to assess the consistency of syndromic diagnosis with laboratory diagnosis .
a community - based , cross - sectional study was undertaken in rural field practice area of osmania medical college , patancheru , medak district , andhra pradesh between march 2010 and february 2011 .
three subcenters under the rural health center with population of 19,081 , women population of age group 15 - 49 years ( 5002 ) , of this 25% were chosen ie 1250 women .
prevalence was taken as 50% , precision error as 10% 4pq / l2=400 approval for the study was obtained from osmania medical college ethics committee , hyderabad and informed consent was taken from participants .
inclusion criteria : ever married women of reproductive age group 15 - 49 years living in the particular village at the time of data collection .
exclusion criteria : women with missed periods , undergone hysterectomy and unmarried women . at rural health center ,
convergence meeting was conducted which included medical officers , auxillary nurse midwives , health supervisors , asha workers , anganwadi workers and other staff .
household survey was conducted with the help of asha workers , postgraduate students and assistant professors using interview schedule to collect demographic data .
the participants were informed that they would be tested for rtis and stis and that they would be offered free treatment if found to be infected .
informed consent was obtained in all cases . before being recruited the purpose of the study was explained to eligible women in their homes and to close family members , e.g. husbands , mothers - in - law .
each woman who agreed to participate attended clinic ( sub center building or gram panchayat office or primary school or rural health centre ) and was interviewed in private about her socio demographic and reproductive history , current and past clinical symptoms affecting the reproductive tract , treatment - seeking behavior , and sexual behavior .
two gynecologists conducted a comprehensive physical examination that included a speculum - based examination of the cervix and vagina and bimanual examination .
of the 751 women agreed to come for the study , only 536 women turned up to the camps , of whom 96 refused for examination and 33 were excluded due to menstruation and missed periods ; so a total of 407 were taken up for the study .
criteria for clinical diagnosis were standardized [ table 1 ] and findings recorded . during per speculum examination , papnicolaou smear , 3 vaginal , 3 cervical swabs , and a 5 ml blood sample were taken for mirobiological investigations as per standard operating procedures ( sop ) manual of regional std reference laboratory , safdarjung hospital , new delhi and naco guidelines [ table 2 ] and the samples were transported to regional sti center at osmania general hospital on the same day by the technician .
criteria for diagnosis as per naco guidelines criteria for laboratory diagnosis done using ms excel 2007 and epiinfo version 3.5.6 .
three subcenters under the rural health center with population of 19,081 , women population of age group 15 - 49 years ( 5002 ) , of this 25% were chosen ie 1250 women .
approval for the study was obtained from osmania medical college ethics committee , hyderabad and informed consent was taken from participants .
inclusion criteria : ever married women of reproductive age group 15 - 49 years living in the particular village at the time of data collection .
exclusion criteria : women with missed periods , undergone hysterectomy and unmarried women . at rural health center ,
convergence meeting was conducted which included medical officers , auxillary nurse midwives , health supervisors , asha workers , anganwadi workers and other staff .
and they were assessed on awareness on reproductive tract infections . and the study aims and objectives with inclusion and exclusion criteria were explained .
household survey was conducted with the help of asha workers , postgraduate students and assistant professors using interview schedule to collect demographic data .
the participants were informed that they would be tested for rtis and stis and that they would be offered free treatment if found to be infected .
informed consent was obtained in all cases . before being recruited the purpose of the study was explained to eligible women in their homes and to close family members , e.g. husbands , mothers - in - law .
each woman who agreed to participate attended clinic ( sub center building or gram panchayat office or primary school or rural health centre ) and was interviewed in private about her socio demographic and reproductive history , current and past clinical symptoms affecting the reproductive tract , treatment - seeking behavior , and sexual behavior .
two gynecologists conducted a comprehensive physical examination that included a speculum - based examination of the cervix and vagina and bimanual examination .
of the 751 women agreed to come for the study , only 536 women turned up to the camps , of whom 96 refused for examination and 33 were excluded due to menstruation and missed periods ; so a total of 407 were taken up for the study .
criteria for clinical diagnosis were standardized [ table 1 ] and findings recorded . during per speculum examination , papnicolaou smear , 3 vaginal , 3 cervical swabs , and a 5 ml blood sample were taken for mirobiological investigations as per standard operating procedures ( sop ) manual of regional std reference laboratory , safdarjung hospital , new delhi and naco guidelines [ table 2 ] and the samples were transported to regional sti center at osmania general hospital on the same day by the technician .
most of them were in the age group of 26 - 30 years comprising 29.2% , education was less than 5 years in 57.2% , most of them belonged to middle class(38% ) followed by lower class(34% ) as per bg prasad 's socioeconomic status classification .
prevalence of reproductive tract infections / sexually transmitted infections by syndromic diagnosis was 61.9% and by laboratory diagnosis was 33.1% [ figure 1 ] . of the syndromes diagnosed , the most common is vaginal discharge syndrome ( 34% ) followed by lower abdominal pain syndrome ( 28% ) .
syndromic vs laboratory diagnosis results by microbiological investigations using gold standard procedures are shown in figure 2 and via papnicalaou smears shown in table 3 .
prevalence of rti / sti by confirmed microbiological investigations prevalence of rti / sti by pap smear for vaginal discharge syndrome , sensitivity was 58.95% and specificity was 55.13% ; and for lower abdominal pain syndrome sensitivity is very low ( 14.49% ) and high specificity 76.63% [ tables 4 and 5 ] .
most of them were in the age group of 26 - 30 years comprising 29.2% , education was less than 5 years in 57.2% , most of them belonged to middle class(38% ) followed by lower class(34% ) as per bg prasad 's socioeconomic status classification .
prevalence of reproductive tract infections / sexually transmitted infections by syndromic diagnosis was 61.9% and by laboratory diagnosis was 33.1% [ figure 1 ] . of the syndromes diagnosed , the most common is vaginal discharge syndrome ( 34% ) followed by lower abdominal pain syndrome ( 28% ) .
syndromic vs laboratory diagnosis results by microbiological investigations using gold standard procedures are shown in figure 2 and via papnicalaou smears shown in table 3 .
prevalence of rti / sti by confirmed microbiological investigations prevalence of rti / sti by pap smear for vaginal discharge syndrome , sensitivity was 58.95% and specificity was 55.13% ; and for lower abdominal pain syndrome sensitivity is very low ( 14.49% ) and high specificity 76.63% [ tables 4 and 5 ] .
the present study found the prevalence of sti / rti by laboratory diagnosis as 33.1% which is similar to that reported by the study done by prasad et al in rural tamil nadu . also , vaginal discharge syndrome is the most common syndromic diagnosis , which is consistent with previous studies.[68 ] the most common infection identified by laboratory diagnosis was bacterial vaginosis ( 14.3% ) which was similar to that ( 17.4% ) reported by the study done by patnaik et al in urban slums of berhampur .
none of them complained of genital ulcers and growths similar to the study by krishna ray et al .
syndromic diagnosis of vaginal discharge syndrome had high sensitivity but low specificity similar to the study conducted in urban slums of delhi by suneela garg et al .
pap smear findings reported inflammatory changes as 33% and low - grade squamous epithelial lesion as 0.25% which was similar to the above study .
the results of this study provide wide variation between syndromic and laboratory diagnosis of reproductive tract infections in rural women , showing that enhanced syndromic management would be more effective .
this study also demonstrated the feasibility of prevalence and early detection of precancerous and cancerous lesions .
 introduction : in developing countries , reproductive tract infections ( rti ) commonly affect the quality of life . 
 many reproductive tract infections including sexually transmitted infections ( sti ) and cervical cancers remain asymptomatic for long periods . 
 syndromic case management ( scm ) is the mainstay in the control of rti / sti , especially at primary level , where laboratory diagnosis is not possible . 
 however , lab diagnosis should be used when it is available.objective:to assess the consistency of syndromic diagnosis with laboratory diagnosis.materials and methods : a total of 407 women were screened . 
 women were categorized according to syndromic diagnosis of rti / sti based on history and clinical examination . 
 microbiological tests and pap smears were done to confirm the diagnosis and compared with syndromic diagnosis.results:microbiologically , 33.14% were positive for at least one organism . 
 bacterial vaginosis was the most common finding ( 14% ) . 
 pap smear showed 32.9% inflammatory changes and 0.25% low - grade squamous intraepithelial lesion . 
 sensitivity and specificity of syndromic diagnosis with laboratory findings : vaginal discharge syndrome with microbiological tests- ( se 58.9 ; sp55.1% ) lower abdominal pain syndrome with microbiological tests-(se 14.4% ; sp76.6%)conclusion : the findings of this study highlight the wide variation of syndromic and laboratory diagnosis . 
INTRODUCTION
MATERIALS AND METHODS
Study setting
Sample size
Ethical considerations
Study population recriutment
Data analysis
RESULTS
Study population characteristics
DISCUSSION
CONCLUSIONS