{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:57:29Z","timestamp":1792612649957,"version":"4.5.0"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013238","name":"Faculty of Medicine Siriraj Hospital, Mahidol University","doi-asserted-by":"publisher","award":["R016433015, Fund 3"],"award-info":[{"award-number":["R016433015, Fund 3"]}],"id":[{"id":"10.13039\/501100013238","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>In Thailand, sexually transmitted infections (STIs) persist as a significant public health issue, notwithstanding the affordability of treatments. The primary challenge lies in diagnostic methodologies. According to the Thai National Treatment Guidelines for abnormal vaginal discharge, wet preparation using proportion of white blood cell (WBC) counts and epithelial cell (EC) guides presumptive STI treatment. This study investigated the prevalence of common STI pathogens in sexually active women presenting with abnormal vaginal discharge and WBC\u2009&gt;\u2009EC under microscopy; and the cost-minimization analysis of this approach. A cross-sectional study was done during July 2021\u2013March 2023 at the Siriraj Female STI Clinic, Bangkok, Thailand. The eligible participants were non-pregnant Thai women aged 18\u201350 years with the following conditions; being sexually active in prior one year, presenting with abnormal vaginal discharge, having WBC\u2009&gt;\u2009EC under microscopy, and no allergy to cefixime and azithromycin which were the presumptive treatment in the study. The endocervical swabs were sent for molecular diagnosis of STI pathogens (polymerase chain reaction; PCR). Cost-minimization analysis comparing two approaches, PCR and wet preparation, was done. From an initial 199 participants, 186 were eligible. The average age was 31.1\u2009\u00b1\u20099.4 years and their sex debut was at 19.7\u2009\u00b1\u20093.8 years. Around 10% of them, sex partners had STIs. Prevalent STI pathogens included <jats:italic><jats:italic>C. trachomatis<\/jats:italic><\/jats:italic>(20.4%), <jats:italic><jats:italic>N. gonorrhoeae<\/jats:italic><\/jats:italic>(7.0%), <jats:italic><jats:italic>M. genitalium<\/jats:italic><\/jats:italic>(5.9%) and <jats:italic><jats:italic>T. vaginalis<\/jats:italic><\/jats:italic>(3.8%). Presumptive treatment yielded no severe immediate or delayed adverse effects. Using wet preparation as a primary test with presumptive treatment, cost per one case cured was almost three times lower than that of using PCR as a primary test (1250.0 vs 3454.4 Thai Baht). In summary, a quarter of the sexually-active Thai women with abnormal vaginal discharge and WBC\u2009&gt;\u2009EC under microscopy had either <jats:italic><jats:italic>C. trachomatis<\/jats:italic><\/jats:italic> or <jats:italic><jats:italic>N. gonorrhoeae<\/jats:italic><\/jats:italic>. The use of wet preparation-guided presumptive STI treatment is practical and cost-saving, compared with the PCR approach. <jats:bold>Trial registration<\/jats:bold>: Thai Clinical Trial Registry (TCTR20210702001, 2 July 2021).<\/jats:p>","DOI":"10.1371\/journal.pone.0331668","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T17:25:51Z","timestamp":1757352351000},"page":"e0331668","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence of common bacterial STI pathogens and the microscopic diagnostic approach to abnormal vaginal discharge in a tertiary care hospital in Bangkok, Thailand"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0153-2231","authenticated-orcid":true,"given":"Chenchit","family":"Pichailuck","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piyachat","family":"Sakunborrirak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossaphorn","family":"Kittiyaowamarn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chanon","family":"Neungton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pareeda","family":"Taunwaena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natnaree","family":"Girdthep","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rungnapa","family":"Luengprasit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pochamana","family":"Phisalprapa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7182-0733","authenticated-orcid":true,"given":"Chayanis","family":"Kositamongkol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"issue":"3","key":"pone.0331668.ref001","first-page":"182","article-title":"Characteristics of clients at the Siriraj Female STD Clinic during 2011-2015","volume":"11","author":"C Chayachinda","year":"2018","journal-title":"Siriraj Med Bull"},{"issue":"4","key":"pone.0331668.ref002","first-page":"222","article-title":"The Thai 2022 Sexually Transmitted Infections Treatment Guideline: Abnormal Vaginal Discharge","volume":"30","author":"C Chayachinda","year":"2022","journal-title":"Thai J Obstet Gynaecol"},{"key":"pone.0331668.ref003","unstructured":"World Health Organization. Sexually transmitted infections (STIs). https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/sexually-transmitted-infections-(stis). 2023."},{"key":"pone.0331668.ref004","unstructured":"HIV INFO HUB. Rate of five main STIs reported case in Thailand, 2009\u20132022. 2023. Available from: https:\/\/hivhub.ddc.moph.go.th\/epidemic.php"},{"issue":"2","key":"pone.0331668.ref005","first-page":"228","article-title":"Reproductive outcomes of patients being hospitalised with pelvic inflammatory disease","volume":"37","author":"C Chayachinda","year":"2017","journal-title":"J Obstet Gynaecol"},{"issue":"2","key":"pone.0331668.ref006","first-page":"96","article-title":"The prevalence of bacterial vaginosis in asymptomatic pregnant women during early third trimester and the pregnancy complications","volume":"25","author":"S Tachawatcharapunya","year":"2017","journal-title":"Thai J Obstet Gynaecol"},{"issue":"3","key":"pone.0331668.ref007","first-page":"579","article-title":"Predicting chlamydial and gonococcal cervical infection: implications for management of cervicitis","volume":"100","author":"JM Marrazzo","year":"2002","journal-title":"Obstet Gynecol"},{"issue":"3","key":"pone.0331668.ref008","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1136\/sextrans-2015-052332","article-title":"Cervicitis aetiology and case definition: a study in Australian women attending sexually transmitted infection clinics","volume":"92","author":"MJ Lusk","year":"2016","journal-title":"Sex Transm Infect"},{"key":"pone.0331668.ref009","first-page":"1","article-title":"A retrospective study of relationship between white blood cell counts in cervical discharge and Chlamydial cervicitis among young adults: is the simple microscopy an alternative method for diagnosing the disease?","volume":"52","author":"S Arunothong","year":"2013","journal-title":"Biomedical Sciences and Clinical Medicine"},{"issue":"4","key":"pone.0331668.ref010","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr7004a1","article-title":"Sexually Transmitted Infections Treatment Guidelines, 2021","volume":"70","author":"KA Workowski","year":"2021","journal-title":"MMWR Recomm Rep"},{"issue":"4","key":"pone.0331668.ref011","first-page":"271","article-title":"Effect of on-line vs on-site class on medical students\u2019 competency in vaginal wet mount","volume":"16","author":"D Tuangrattanasirikun","year":"2023","journal-title":"Siriraj Med Bull"},{"issue":"4","key":"pone.0331668.ref012","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1097\/LGT.0000000000000412","article-title":"International Society for the Study of Vulvovaginal Disease Recommendations Regarding Female Cosmetic Genital Surgery","volume":"22","author":"P Vieira-Baptista","year":"2018","journal-title":"J Low Genit Tract Dis"},{"issue":"11","key":"pone.0331668.ref013","doi-asserted-by":"crossref","first-page":"1845","DOI":"10.1111\/jdv.15146","article-title":"Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum in men and women? - a position statement from the European STI Guidelines Editorial Board","volume":"32","author":"P Horner","year":"2018","journal-title":"J Eur Acad Dermatol Venereol"},{"issue":"1","key":"pone.0331668.ref014","doi-asserted-by":"crossref","DOI":"10.1093\/lambio\/ovac002","article-title":"Comparison of Seegene AnyPlexTM II STI-7e with standard-of-care diagnostic methods for the detection of Mycoplasma genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis","volume":"76","author":"K Bodiybadu","year":"2023","journal-title":"Lett Appl Microbiol"},{"issue":"5","key":"pone.0331668.ref015","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1016\/S1473-3099(21)00625-3","article-title":"Efficacy of ertapenem, gentamicin, fosfomycin, and ceftriaxone for the treatment of anogenital gonorrhoea (NABOGO): a randomised, non-inferiority trial","volume":"22","author":"HJC de Vries","year":"2022","journal-title":"Lancet Infect Dis"},{"issue":"26","key":"pone.0331668.ref016","doi-asserted-by":"crossref","first-page":"2512","DOI":"10.1056\/NEJMoa1502599","article-title":"Azithromycin versus Doxycycline for Urogenital Chlamydia trachomatis Infection","volume":"373","author":"WM Geisler","year":"2015","journal-title":"N Engl J Med"},{"key":"pone.0331668.ref017","unstructured":"Riewpaiboon A. Standard cost lists for Health Technology Assessment. http:\/\/costingmenu.hitap.net\/"},{"key":"pone.0331668.ref018","unstructured":"Drug and Medical Supply Information Center M of PH. Drug and Medical Supply Information Center. https:\/\/dmsic.moph.go.th\/index\/drugsearch\/1"},{"key":"pone.0331668.ref019","doi-asserted-by":"crossref","first-page":"8236575","DOI":"10.1155\/2018\/8236575","article-title":"The Role of Polymorphonuclear Leukocyte Counts from Urethra, Cervix, and Vaginal Wet Mount in Diagnosis of Nongonococcal Lower Genital Tract Infection","volume":"2018","author":"I Randjelovic","year":"2018","journal-title":"Infect Dis Obstet Gynecol"},{"issue":"5","key":"pone.0331668.ref020","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1136\/sextrans-2019-054358","article-title":"Call to action for health systems integration of point-of-care testing to mitigate the transmission and burden of sexually transmitted infections","volume":"96","author":"I Toskin","year":"2020","journal-title":"Sex Transm Infect"},{"issue":"1","key":"pone.0331668.ref021","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1038\/s41564-018-0295-3","article-title":"REASSURED diagnostics to inform disease control strategies, strengthen health systems and improve patient outcomes","volume":"4","author":"KJ Land","year":"2019","journal-title":"Nat Microbiol"},{"issue":"2","key":"pone.0331668.ref022","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1586\/14737159.2014.871495","article-title":"Review of use of a new rapid real-time PCR, the Cepheid GeneXpert\u00ae (Xpert) CT\/NG assay, for Chlamydia trachomatis and Neisseria gonorrhoeae: results for patients while in a clinical setting","volume":"14","author":"CA Gaydos","year":"2014","journal-title":"Expert Rev Mol Diagn"},{"issue":"5","key":"pone.0331668.ref023","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1016\/S1473-3099(20)30734-9","article-title":"Performance of a single-use, rapid, point-of-care PCR device for the detection of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis: a cross-sectional study","volume":"21","author":"SR Morris","year":"2021","journal-title":"Lancet Infect Dis"},{"issue":"3","key":"pone.0331668.ref024","doi-asserted-by":"crossref","first-page":"100447","DOI":"10.1016\/j.mcpsp.2024.100447","article-title":"Performance of antigen-based rapid test for Chlamydia trachomatis in comparison with polymerase chain reaction test","volume":"7","author":"MT Ha","year":"2024","journal-title":"Medicina Cl\u00ednica Pr\u00e1ctica"},{"key":"pone.0331668.ref025","doi-asserted-by":"crossref","first-page":"759795","DOI":"10.3389\/fcimb.2021.759795","article-title":"Recent Advances in Presentation, Diagnosis and Treatment for Mixed Vaginitis","volume":"11","author":"W Qi","year":"2021","journal-title":"Front Cell Infect Microbiol"},{"key":"pone.0331668.ref026","first-page":"318","article-title":"Bacterial vaginosis: A comprehensive approach to management in reproductive-aged Thai women","volume":"31","author":"C Chayachinda","year":"2023","journal-title":"Thai J Obstet Gynaecol"},{"issue":"3","key":"pone.0331668.ref027","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/OLQ.0000000000001742","article-title":"Effectiveness of Cefixime for the Treatment of Neisseria gonorrhoeae Infection at 3 Anatomic Sites: A Systematic Review and Meta-Analysis","volume":"50","author":"KJ Yang","year":"2023","journal-title":"Sex Transm Dis"},{"issue":"1","key":"pone.0331668.ref028","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/ijstd.ijstd_103_20","article-title":"Mycoplasma genitalium: A new superbug","volume":"43","author":"JS Raj","year":"2022","journal-title":"Indian J Sex Transm Dis AIDS"},{"issue":"12","key":"pone.0331668.ref029","article-title":"Are Ureaplasma spp. a cause of nongonococcal urethritis? A systematic review and meta-analysis","volume":"9","author":"N Zhang","year":"2014","journal-title":"PLoS One"},{"issue":"6","key":"pone.0331668.ref030","article-title":"Qualitative and Quantitative Detection of Multiple Sexually Transmitted Infection Pathogens Reveals Distinct Associations with Cervicitis and Vaginitis","volume":"10","author":"W-T Kang","year":"2022","journal-title":"Microbiol Spectr"},{"issue":"2","key":"pone.0331668.ref031","doi-asserted-by":"crossref","first-page":"174","DOI":"10.4103\/ijstd.ijstd_75_21","article-title":"Etiology of cervicitis: Are there new agents in play?","volume":"43","author":"S Bansal","year":"2022","journal-title":"Indian J Sex Transm Dis AIDS"},{"issue":"3","key":"pone.0331668.ref032","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.ajog.2020.10.019","article-title":"Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease","volume":"224","author":"J Ravel","year":"2021","journal-title":"Am J Obstet Gynecol"},{"issue":"7","key":"pone.0331668.ref033","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1177\/09564624241239994","article-title":"Effect of mass treatment on the long-term prevalence of gonorrhoea, chlamydia and syphilis-a systematic review","volume":"35","author":"T Vanbaelen","year":"2024","journal-title":"Int J STD AIDS"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331668","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T17:25:57Z","timestamp":1757352357000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331668"}},"subtitle":[],"editor":[{"given":"Caroline","family":"Watts","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,9,8]]},"references-count":33,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0331668","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,8]]}}}