STD syndrome management

This eighth chapter of "Control of Sexually Transmitted Diseases (STDs): A Handbook for the Design and Management of Programs" presents the syndromic approach for managing STD patients that is currently well-accepted in primary health care settings in developing countries. It is well-suited to resource-poor settings. This approach includes detection of a set of signs and symptoms associated with a number of well-defined pathogens (i.e. syndrome). Providers use a clinical flowchart to help them in making a relatively quick diagnosis without special skills and sophisticated laboratory tests. Once they have diagnosed a syndrome they can provide treatment for most pathogens responsible for that syndrome. At the national level public health specialists should develop diagnostic and therapeutic algorithms. They need to have background information on local etiologies of STD syndromes including multiple etiologies. They also need to obtain data on validity and cost-effectiveness. The specialists make their decisions on cost-effective treatments based on local or regional antimicrobial susceptibility patterns findings of treatment trials toxicity data and drug cost. Before a flowchart is introduced to the medical community they should assess its feasibility (i.e. whether it is operational acceptable to provider and patient and adaptable). Flowcharts now in use address the most common STD syndromes: urethral discharge symptom in men epididymitis (a complication of untreated urethral syndrome) lower genital tract syndrome pelvic inflammatory disease (a complication of untreated endocervicitis) and genital ulcer syndrome.