1. 1 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

2. 2 Diagnosis & treatment of STIs STI diagnosis where lab tests not available: the syndromic approach to STI case management

3. 3 The syndromic approach Developed by WHO Does not require laboratory tests Tested in many countries since 1970’s Reviewed, adapted & improved many times

4. 4 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

5. © Teaching-aids at low cost

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13. 13 ©Teaching-aids at low cost

14. 14 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

15. 15 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

16. 16 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

17. 17 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.

18. 18 STIs in conflict settings Syndromic approach included in: MISP Sphere IASC Guidelines for HIV/AIDS Interventions in Emergency Settings

19. 19 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?

20. 20 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