Department of Reproductive Health and Research (RHR), World Health Organization
Sexually transmitted and other reproductive tract infections
A guide to essential practice
Management of STIs/RTIs
Syndromic management of STI/RTI
Many STIs/RTIs can be identified and treated on the basis of characteristic symptoms and signs. Symptoms and signs can be grouped together into syndromes —upper respiratory infection, gastroenteritis and vaginal discharge are examples of common syndromes. It is often difficult to know exactly what organism is causing the syndrome, however, and treatment may need to cover several possible infections.
Syndromic management refers to the approach of treating STI/RTI symptoms and signs based on the organisms most commonly responsible for each syndrome. A more definite or etiological diagnosis may be possible in some settings with sophisticated laboratory facilities, but this is often problematic. Laboratory tests require resources, add to the cost of treatment, may require clients to make extra visits to the clinic and almost always result in delays in treatment. For these reasons, syndromic management guidelines are widely used for syndromes such as lower abdominal pain, urethral discharge and genital ulcer (Table 8.1), even in developed countries with advanced laboratory facilities.
WHO has developed simple flowcharts (also called algorithms) to guide health care providers in using the syndromic approach to manage seven syndromes. Five of these algorithms (for vaginal discharge, lower abdominal pain, genital ulcer, inguinal bubo and urethral discharge) are included in this chapter, adapted where needed for application in reproductive health settings. Additional algorithms dealing with STI/RTI in pregnancy are given in Chapter 9. The syndromic approach is widely used to manage STIs/RTIs. The algorithms may change from country to country depending on the prevalence of disease, the cost of drugs, and microbial resistance patterns.
Table 8.1. The syndromic approach—strengths and limitations
Infections of the male and female reproductive tract and their consequences:
Preventing STIs/RTIs and their complications
STI/RTI education and counselling
Promoting prevention of STI/RTI and use of services
STI/RTI Assessment during Routine Family Planning Visits
STI/RTI Assessment in pregnancy, childbirth and the postpartum period
Management of symptomatic STIs/RTIs
STI/RTI complications related to pregnancy, miscarriage, induced abortion, and the postpartum period
Annex 1. Clinical skills needed for STI/RTI
Annex 2. Disinfection and universal precautions
Annex 3. Laboratory tests for RTI
Annex 4. Medications