Evaluation of aetiological profiles, treatment appropriateness, and outcomes of syndromic management for reproductive tract infections in women from urban clinics

Background While syndromic management is widely used in low-resource settings due to its cost-effectiveness and ease of patient care, growing concerns of antimicrobial resistance (AMR) and potential overtreatment highlight the need for regular aetiological testing to monitor treatment appropriateness. Aim To evaluate and compare syndromic management for reproductive tract infection for assessing treatment strategies. Methods In a prospective study, 250 sexually active, non-pregnant women aged 18-50 years, presenting with symptoms of lower genital tract infections were recruited as part of a prospective study from urban clinics in Mumbai. Participants underwent clinical and gynaecological examination, and standard syndromic management was provided. Samples were collected prior to treatment for Nugent scoring, Candida culture, and multiplex polymerase chain reaction (PCR) to detect sexually transmitted infections (STIs). Results The mean age of participants was 32.5 ± 6.6 years, with 51.2% (n=128) belonging to the upper-lower socioeconomic class. Vaginal discharge was the most common symptom (42%, n=105). Aetiological analysis identified causative agents in 90% (n=225) of cases, while 10% (n=25) showed no identifiable aetiology. The most prevalent pathogens were Ureaplasma parvum (47.2%) and Candida species (44.4%), followed by those causing bacterial vaginosis (39.2%). Among Candida species, Candida albicans (47.1%) and Candida krusei (45.2%) were most common. In contrast, Chlamydia trachomatis (3.2%) and Mycoplasma genitalium (1.2%) were less prevalent, and Neisseria gonorrhoeae was not detected. Syndromic management led to overtreatment rates exceeding 96% for these low-prevalence pathogens, raising concerns about AMR. Limitations Since this study is bounded to urban community clinics it limits the expansion to rural scene and AMR tests were not conducted due to the fastidious nature of microbes in the study and implementation challenges in resource limiting settings. Conclusion Syndromic management remains feasible in resource-limited settings; however, its limitations in addressing low-prevalence pathogens emphasise the need for periodic aetiological testing to improve diagnostic accuracy and guide appropriate treatment.