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Diagnosis & treatment of STIs

• Over 30 different organisms can cause STIs

• Many infections have similar symptoms & signs

• Accurate treatment requires accurate diagnosis

• For most STIs, accurate diagnosis requires laboratory tests

• In developing countries, laboratory tests are often not available

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Diagnosis & treatment of STIs

STI diagnosis where lab tests not available:

the syndromic approach

to STI case management

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The syndromic approach

• Developed by WHO

• Does not require laboratory tests

• Tested in many countries since 1970’s

• Reviewed, adapted & improved many times

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The syndromic approach

• STIs grouped into 7 main categories, according to symptoms and signs

• Each category is called a “syndrome”

• Each syndrome easily recognized on history & examination

• Treatment covers the most common organisms potentially responsible for the syndrome

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© Teaching-aids at low cost

© Teaching-aids at low cost

© Teaching-aids at low cost

© Teaching-aids at low cost

© Teaching-aids at low cost

© Teaching-aids at low cost

© Teaching-aids at low cost

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©Teaching-aids at low cost

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The syndromic approach to STIs

Principles of syndromic management:

• Recognize the syndrome

• The syndrome could be caused by one or more of a number of organisms

• Treat with a combination of drugs

• Drugs should cover the common organisms potentially responsible for the syndrome

• Organisms must be sensitive to the drugs

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Syndromic approach - advantages

• No laboratory tests needed: – reduces costs– patient does not have to wait for results

• Works well for urethral discharge & genital ulcers

• Simple to use

• Can be used at all levels of the health system

• Promotes standardization

• Facilitates training

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Syndromic approach - challenges

• Many STIs are asymptomatic

• Vaginal discharge is not necessarily the result of an STI

• Vaginitis vs cervicitis - overtreat vs undertreat

• Overuse of drugs: costs, side effects, resistance

• Lack of acceptance by clinicians

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The syndromic approach to STIs

In spite of its limitations,

the syndromic approach is at present

the most realistic option for

the management of STIs in resource-poor settings.

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STIs in conflict settings

Syndromic approach included in:

• MISP

• Sphere

• IASC Guidelines for HIV/AIDS Interventions in Emergency Settings

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Addressing the problem of STIs

• STIs are a common health problem

• STIs have serious consequences

• The management of STIs is challenging

SO……..

• What can individuals do about STIs?

• What can health services do about STIs?

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What can individuals do to reduce the spread of STIs?

1. Protect yourself - ABC

2. Prevent transmission to partners:

- get STIs treated without delay

- use condoms or abstain until STI is cured

- urge partners to get treatment