{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T14:21:44Z","timestamp":1793283704648,"version":"4.5.0"},"reference-count":22,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2025,12,9]]},"abstract":"\n Background<\/jats:title>\n \n Zimbabwe\u2019s national guidelines for sexually transmitted infection (STI) management recommend that high-risk women presenting with vaginal discharge syndrome (VDS) are prescribed antibiotics for gonorrhoea (\n Neisseria gonorrhoeae<\/jats:italic>\n (NG)), chlamydia (\n Chlamydia trachomatis<\/jats:italic>\n (CT)), trichomoniasis (\n Trichomonas vaginalis<\/jats:italic>\n (TV)) and bacterial vaginosis (BV). The performance of this approach depends on its clinical interpretation and implementation. Here, we investigate the potential relative impact of an NG\/CT\/TV point-of-care (POC) test on undertreatment, overtreatment and disease burden in the context of different implementations of syndromic management of women with VDS.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We created an agent-based model with an age- and risk-stratified sexual network and modelled co-circulation of NG, CT and TV along with HIV and BV. We estimated symptomatic proportions and care-seeking rates under three different scenarios around the implementation of treatment guidelines, corresponding to all, most or half of women being treated for NG+CT upon presentation with VDS. For each implementation scenario, we estimated disease burden and over\/undertreatment rates assuming continuation of the standard of care with\/without a POC NG\/CT\/TV test available over 2027\u20132040.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Under a treat-all interpretation of the syndromic management guidelines, we estimate that 70%\u201380% of antibiotics for NG\/CT would currently be given to women without these infections. Overtreatment would fall to less than 5% if a sensitive POC test for NG\/CT\/TV were available. However, if the implementation of the guidelines implies that only half of women seeking care for VDS are treated, then a POC test would also reduce undertreatment and disease burden, with >500\u2009000 additional women correctly treated for NG and ~1.5\u2009million correctly treated for CT and TV, and 24%\/15% reductions in the number of women with NG\/CT by 2040.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Improved data on the functioning of syndromic management in practice would help refine the estimates of the health impact and the overall value proposition of a highly sensitive POC diagnostic for NG\/CT\/TV. However, even without such data, our analysis demonstrates the potential for such a diagnostic to reduce overtreatment by >90% relative to plausible assumptions regarding the standard of care.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/sextrans-2025-056646","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T18:20:32Z","timestamp":1770315632000},"page":"sextrans-2025-056646","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Reduction in overtreatment of gonorrhoea and chlamydia through point-of-care testing compared with syndromic management for vaginal discharge: a modelling study for Zimbabwe"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5482-9584","authenticated-orcid":false,"given":"Robyn M","family":"Stuart","sequence":"first","affiliation":[{"name":"Gates Foundation, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori M","family":"Newman","sequence":"additional","affiliation":[{"name":"Gates Foundation, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Griffins","family":"Manguro","sequence":"additional","affiliation":[{"name":"Gates Foundation, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chido","family":"Dziva Chikwari","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, MRC International Statistics & Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Biomedical Research and Training Institute, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7585-4743","authenticated-orcid":false,"given":"Michael","family":"Marks","sequence":"additional","affiliation":[{"name":"Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Hospital for Tropical Diseases, University College London Hospital, London, UK"},{"name":"Division of Infection and Immunity, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5955-0815","authenticated-orcid":false,"given":"Remco P H","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Klein","sequence":"additional","affiliation":[{"name":"Gates Foundation, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Snyder","sequence":"additional","affiliation":[{"name":"Gates Foundation, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cliff","family":"Kerr","sequence":"additional","affiliation":[{"name":"Gates Foundation, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darcy W","family":"Rao","sequence":"additional","affiliation":[{"name":"Gates Foundation, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"2026020510202384000_sextrans-2025-056646v1.1","unstructured":"World Health Organisation . 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