What question did this study set out to answer?

The study aims to assess how point-of-care testing for gonorrhoea and chlamydia influences overtreatment and undertreatment in women with vaginal discharge syndrome.

February 8, 2026

Reduction in overtreatment of gonorrhoea and chlamydia through point-of-care testing compared with syndromic management for vaginal discharge: a modelling study for Zimbabwe

Puntos clave

The study aims to assess how point-of-care testing for gonorrhoea and chlamydia influences overtreatment and undertreatment in women with vaginal discharge syndrome.
Developed an agent-based model based on sexual networks stratified by age and risk.
Modeled the co-circulation of gonorrhoea, chlamydia, trichomoniasis, HIV, and bacterial vaginosis.
Estimated treatment rates and disease burden under varying guidelines for syndromic management.
70%-80% of women treated for gonorrhoea and chlamydia currently do not have these infections.
With point-of-care testing, overtreatment could drop to less than 5%.
If only half of women are treated, the test could enable over 500,000 additional correct treatments for gonorrhoea and 1.5 million for chlamydia and trichomoniasis by 2040.

Resumen

Background Zimbabwe’s national guidelines for sexually transmitted infection (STI) management recommend that high-risk women presenting with vaginal discharge syndrome (VDS) are prescribed antibiotics for gonorrhoea ( Neisseria gonorrhoeae (NG)), chlamydia ( Chlamydia trachomatis (CT)), trichomoniasis ( Trichomonas vaginalis (TV)) and bacterial vaginosis (BV). The performance of this approach depends on its clinical interpretation and implementation. Here, we investigate the potential relative impact of an NG/CT/TV point-of-care (POC) test on undertreatment, overtreatment and disease burden in the context of different implementations of syndromic management of women with VDS. Methods We created an agent-based model with an age- and risk-stratified sexual network and modelled co-circulation of NG, CT and TV along with HIV and BV. We estimated symptomatic proportions and care-seeking rates under three different scenarios around the implementation of treatment guidelines, corresponding to all, most or half of women being treated for NG+CT upon presentation with VDS. For each implementation scenario, we estimated disease burden and over/undertreatment rates assuming continuation of the standard of care with/without a POC NG/CT/TV test available over 2027–2040. Results Under a treat-all interpretation of the syndromic management guidelines, we estimate that 70%–80% of antibiotics for NG/CT would currently be given to women without these infections. Overtreatment would fall to less than 5% if a sensitive POC test for NG/CT/TV were available. However, if the implementation of the guidelines implies that only half of women seeking care for VDS are treated, then a POC test would also reduce undertreatment and disease burden, with >500 000 additional women correctly treated for NG and ~1.5 million correctly treated for CT and TV, and 24%/15% reductions in the number of women with NG/CT by 2040. Conclusion Improved data on the functioning of syndromic management in practice would help refine the estimates of the health impact and the overall value proposition of a highly sensitive POC diagnostic for NG/CT/TV. However, even without such data, our analysis demonstrates the potential for such a diagnostic to reduce overtreatment by >90% relative to plausible assumptions regarding the standard of care.

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