Introduction: Reproductive tract infections (RTIs) including sexually transmitted infections (STIs) result in major reproductive health morbidity worldwide. There is a paucity of recent data on laboratory-confirmed prevalence in India of the curable pathogens responsible, Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT),Trichomonas vaginalis (TV), Bacterial vaginosis (BV) and Candida albicans (CA), with a significant proportion being asymptomatic. This study aimed to determine the diagnostic accuracy of the syndromic approach and the prevalence of symptomatic and asymptomatic infections.

Method: An observational study was conducted with 440 married, reproductive age women in low-income and middle-income neighbourhoods of Delhi. Vaginal swabs were collected irrespective of symptoms. Nucleic acid amplification technique was used for NG, TV and CT, gram stain for CA and Nugent’s criteria for BV. Statistical analysis was done using STATA V.16.1. Categorical variables were analysed using the binomial exact method. Sensitivity, specificity, positive and negative predictive value, and likelihood ratios were calculated for the syndromic approach. Logistic regression was performed to assess associated factors.

Result: 262 of 440 women had a positive laboratory test. BV was 37%, CA 12.7%, CT, NG and TV were <1%. 56% of asymptomatic women had a laboratory confirmed RTI. Sensitivity and specificity of syndromic approach were 62% and 45%. Every 1-year increase in age of women was associated with an 8% reduction in the odds of having a lab-confirmed STI/RTI (OR=0.92).

Conclusions: BV and CA were most prevalent infections. A syndromic approach had low sensitivity and specificity; young age was a risk factor.

Neeta Dhabhai is senior clinical research scientist and a post graduate (MD) in obstetrics and gynaecology. She has over 22 years of clinical experience and over 9 years experience of working as a researcher in the domain of maternal and child health and reproductive and sexual health .She is currently a senior research scientist and deputy director in Society for applied Studies (SAS). SAS is a not for profit research organization and a collaborative center of excellence with Indian council of medical research (ICMR)