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Evaluating diagnostic indicators of urogenital Schistosoma haematobium infection in young women: A cross sectional study in rural South Africa

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Galappaththi-Arachchige, Hashini Nilushika, Holmen, Sigve, Koukounari, Artemis, Kleppa, Elisabeth, Pillay, Pavitra, Sebitloane, Motshedisi, Ndhlovu, Patricia, van Lieshout, Lisette, Vennervald, Birgitte Jyding, Gundersen, Svein Gunnar, Taylor, Myra and Kjetland, Eyrun Floerecke (2018) 'Evaluating diagnostic indicators of urogenital Schistosoma haematobium infection in young women: A cross sectional study in rural South Africa'. PLoS ONE, Vol 13, Issue 2, e0191459.

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Abstract

Background
Urine microscopy is the standard diagnostic method for urogenital S. haematobium infection. However, this may lead to under-diagnosis of urogenital schistosomiasis, as the disease may present itself with genital symptoms in the absence of ova in the urine. Currently there is no single reliable and affordable diagnostic method to diagnose the full spectrum of urogenital S. haematobium infection. In this study we explore the classic indicators in the diagnosis of urogenital S. haematobium infection, with focus on young women.

Methods
In a cross-sectional study of 1237 sexually active young women in rural South Africa, we assessed four diagnostic indicators of urogenital S. haematobium infection: microscopy of urine, polymerase chain reaction (PCR) of cervicovaginal lavage (CVL), urogenital symptoms, and sandy patches detected clinically in combination with computerised image analysis of photocolposcopic images. We estimated the accuracy of these diagnostic indicators through the following analyses: 1) cross tabulation (assumed empirical gold standard) of the tests against the combined findings of sandy patches and/or computerized image analysis and 2) a latent class model of the four indicators without assuming any gold standard.

Results
The empirical approach showed that urine microscopy had a sensitivity of 34.7% and specificity of 75.2% while the latent class analysis approach (LCA) suggested a sensitivity of 81.0% and specificity of 85.6%. The empirical approach and LCA showed that Schistosoma PCR in CVL had low sensitivity (14.1% and 52.4%, respectively) and high specificity (93.0% and 98.0, respectively). Using LCA, the presence of sandy patches showed a sensitivity of 81.6 and specificity of 42.4%. The empirical approach and LCA showed that urogenital symptoms had a high sensitivity (89.4% and 100.0%, respectively), whereas specificity was low (10.6% and 12.3%, respectively).

Conclusion
All the diagnostic indicators used in the study had limited accuracy. Using urine microscopy or Schistosoma PCR in CVL would only confirm a fraction of the sandy patches found by colposcopic examination.

Item Type: Article
Subjects: QX Parasitology > Helminths. Annelida > QX 355 Schistosoma
QY Clinical Pathology > Diagnostic Tests > QY 185 Urinalysis
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 810 Schistosomiasis
WJ Urogenital System > WJ 20 Research (General)
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pone.0191459
SWORD Depositor: JISC Pubrouter
Depositing User: JISC Pubrouter
Date Deposited: 22 Feb 2018 10:48
Last Modified: 22 Feb 2018 10:48
URI: https://archive.lstmed.ac.uk/id/eprint/8246

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