{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:54:43Z","timestamp":1792108483574,"version":"4.4.0"},"reference-count":34,"publisher":"BMJ","issue":"12","funder":[{"DOI":"10.13039\/501100000972","name":"Australian Agency for International Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000972","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Partnership in Health Program grant from Esso Highlands Limited, an ExxonMobil subsidiary"},{"name":"Government of Papua New Guinea"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,11,22]]},"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      Papua New Guinea (PNG) has among the highest estimated prevalences of genital\n                      <jats:italic>Chlamydia trachomatis<\/jats:italic>\n                      (CT),\n                      <jats:italic>Neisseria gonorrhoeae<\/jats:italic>\n                      (NG) and\n                      <jats:italic>Trichomonas vaginalis<\/jats:italic>\n                      (TV) of any country in the Asia-Pacific region. Diagnosis and treatment of these infections have relied on the WHO-endorsed syndromic management strategy that uses clinical presentation without laboratory confirmation to make treatment decisions. We evaluated the performance of this strategy in clinical settings in PNG.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Women attending antenatal (ANC), well woman (WWC) and sexual health (SHC) clinics in four provinces were invited to participate, completed a face-to-face interview and clinical examination, and provided genital specimens for laboratory testing. We estimated the performance characteristics of syndromic diagnoses against combined laboratory diagnoses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>1764 women were enrolled (ANC=765; WWC=614; SHC=385). The prevalences of CT, NG and TV were highest among women attending ANC and SHC. Among antenatal women, syndromic diagnosis of sexually transmitted infection had low sensitivity (9%\u201321%) and positive predictive value (PPV) (7%\u201337%), but high specificity (76%\u201389%) and moderate negative predictive value (NPV) (55%\u201386%) for the combined endpoint of laboratory-confirmed CT, NG or TV. Among women attending WWC and SHC, \u2018vaginal discharge syndrome\u2019 had moderate to high sensitivity (72%\u201378%) and NPV (62%\u201394%), but low specificity (26%\u201333%) and PPV (8%\u201338%). \u2018Lower abdominal pain syndrome\u2019 had low sensitivity (26%\u201341%) and PPV (8%\u201323%) but moderate specificity (66%\u201368%) and high NPV (74%\u201393%) among women attending WWC, and moderate-high sensitivity (67%\u201379%) and NPV (62%\u201386%) but low specificity (26%\u201328%) and PPV (14%\u201333%) among SHC attendees.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The performance of syndromic management for the detection and treatment of genital chlamydia, gonorrhoea and trichomonas was poor among women in different clinical settings in PNG. New diagnostic strategies are needed to control these infections and to prevent their adverse health outcomes in PNG and other high-burden countries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-018630","type":"journal-article","created":{"date-parts":[[2017,12,29]],"date-time":"2017-12-29T04:30:16Z","timestamp":1514521816000},"page":"e018630","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":44,"title":["Performance of syndromic management for the detection and treatment of genital\n                    <i>Chlamydia trachomatis<\/i>\n                    ,\n                    <i>Neisseria gonorrhoeae<\/i>\n                    and\n                    <i>Trichomonas vaginalis<\/i>\n                    among women attending antenatal, well woman and sexual health clinics in Papua New Guinea: a cross-sectional study"],"prefix":"10.1136","volume":"7","author":[{"given":"Lisa M","family":"Vallely","sequence":"first","affiliation":[{"name":"Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Toliman","sequence":"additional","affiliation":[{"name":"Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Ryan","sequence":"additional","affiliation":[{"name":"The Macfarlane Burnet Institute for Medical Research and Public Health, Burnet Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glennis","family":"Rai","sequence":"additional","affiliation":[{"name":"School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Papua New Guinea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Wapling","sequence":"additional","affiliation":[{"name":"The Macfarlane Burnet Institute for Medical Research and Public Health, Burnet Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Gabuzzi","sequence":"additional","affiliation":[{"name":"Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce","family":"Allen","sequence":"additional","affiliation":[{"name":"Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Opa","sequence":"additional","affiliation":[{"name":"Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Munnull","sequence":"additional","affiliation":[{"name":"Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petronia","family":"Kaima","sequence":"additional","affiliation":[{"name":"Tininga clinic, Mt Hagen General Hospital, Mount Hagen, Papua New Guinea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benny","family":"Kombuk","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, Mt Hagen General Hospital, Mount Hagen, Papua New Guinea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Kumbia","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, Eastern Highlands Provincial Hospital, Goroka, Papua New 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