To Evaluate the Effectiveness of Targeted Versus Syndromic Management in Women with Abnormal Vaginal Discharge

Aim: To compare the effectiveness of Targeted management with syndromic management in achieving a complete cure for abnormal vaginal discharge. Material and Methods:- The study was carried out in patients attending Gynae OPD of SRMS IMS Hospital. It was conducted on 200 women with abnormal vaginal discharge and distributed in 2 groups A and B each consisted of 100 women. Group A underwent laboratory investigations and treatment was started as soon as reports were available. Group B was given syndromic management based on clinical presentation and risk factors. In absence of endocervical discharge and risk factors, treatment for vaginitis only is given. Follow up on 3rd day and after 2 weeks was done. Results: Among 100 women in group A (targeted management) the prevalence of bacterial vaginosis was 43%, Candida 40%, N. gonorrhea 11%, Trichomonas 3% and Chlamydia is 3%. The total response in symtpoms of vaginal discharge in group A was 77% for vaginitis, 71.4% for cervicitis and 60% in vaginitis coexsisting with cervicitis in group A compared to 50%,30% and 35% respectively in group B. Partial response was seen in 18%, 21% and 30% cases of vaginitis,cervicitis and vaginitis with cervicitis in group A compared o 14%, 20%,15% respectively in group B. Vaginal discharge with itching was relieved in 83.6% in group A and 71.4% in group B. Conclusion: Low response to treatment in syndromic management group is due to low sensitivity of clinical examination in diagnosing the nature of vaginal discharge. Hence when laboratory facilities are available, a women with abnormal discharge should be investigated for the specified causative organisms and treatment should be directed accordingly. Clinical Significance: The targeted approach increases sensitivity of treatment. It decreases overuse of drugs, lowers incidence of side-effects and increases compliance of treatment.