EC Gynaecology

Introduction: Sexually transmitted infections (STIs) and reproductive tract infections (RTIs) are major global health challenges, particularly for women of reproductive age. In India, a high number of new STI cases contribute to complications like infertility, pelvic inflammatory disease (PID), and increased HIV susceptibility. While syndromic management has been widely used in resource-limited settings, it lacks specificity, leading to over-treatment and antimicrobial resistance. In contrast, etiological diagnosis—identifying the specific pathogen through laboratory tests—could improve treatment outcomes by providing more targeted therapies.

Aim: This study aimed to evaluate the clinical outcomes of women diagnosed with STIs and RTIs treated with etiological diagnosis and compare them to those treated using syndromic management. The study also sought to assess the impact of targeted treatment on symptom resolution, recurrence, and long-term reproductive health.

Methods: A prospective observational study was conducted at ESIC Medical College, Bengaluru, with 337 women aged 18 - 45 years presenting with STI/RTI symptoms. Participants were diagnosed using microbiological tests, including PCR, NAATs, Gram staining, and cultures. Based on the diagnoses, they received pathogen-specific treatments. In the comparison group, women were treated with the syndromic approach. Outcomes were tracked for three months, focusing on symptom resolution, recurrence, and complications.

Results: Women treated with pathogen-specific therapies showed significantly better clinical outcomes, including higher rates of symptom resolution, fewer recurrences, and a lower incidence of complications. The most common pathogens identified were Candida albicans (13.4%), Trichomonas vaginalis (3.6%), and Chlamydia trachomatis (1.5%). The syndromic approach showed higher rates of symptom persistence and recurrence. The etiological diagnosis group had more targeted treatments, which reduced antibiotic overuse and the risk of antimicrobial resistance.

Conclusion: The study supports the transition from syndromic management to etiological diagnosis for STIs and RTIs, showing that microbiological testing leads to more effective treatment, better patient outcomes, and reduced complications. It highlights the importance of integrating laboratory diagnostics into routine STI/RTI management to enhance treatment precision and reduce public health burdens.

Keywords: Sexually Transmitted Infections; Reproductive Tract Infections; Syndromic Management; Microbiological Diagnostics; Microbial Pathogens

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