Clinical and Laboratory Positive Predictive Value of Symptom Management of STI in Iran: A Community-Based Survey

The correct diagnosis of sexually transmitted infections (STIs) is the first step in the monitoring and management of these diseases.

This study was conducted to investigate the clinical and laboratory positive predictive value (PPV) of STI symptom management in Iran.

This cross-sectional study was conducted on 5986 individuals (aged 18 to 50 years) from the general population of Marovdasht (Iran) in several stages: (1) self-reported symptoms of sexually transmitted diseases, (2) evaluation by a doctor, and (3) laboratory examination.

Among the population sample, 686 (17.68%) individuals reported at least one of the predefined symptoms. The clinical-based PPV of syndromes in men and women were 67.74 (62.34 - 73.14) and 85.36 (82.76 - 87.96), respectively. In men and women, the highest PPV was observed for abnormal discharge from the anus 32.35 (25.35 - 39.35) and abnormal secretions from the cervix 59.39 (56.39 - 62.39), respectively. The laboratory-based PPV for men and women was 0 and 5.04 (3.04 - 7.4), respectively.

The clinical and laboratory-based PPV of STI symptoms in the general population is extremely low. Accordingly, a syndromic-based screening or monitoring approach for STIs is not a reliable tool for screening or monitoring in the Iranian general population. We suggest focusing on special (core) groups for monitoring STIs using laboratory-based methods.