31.4.2 Treatment and management of STI syndromes
The aim of syndromic management is to identify the seven syndromes listed in Table 31.1 and manage them accordingly. While clinical diagnosis is based on identifying just one specific causative agent, syndromic diagnosis leads to immediate treatment for all of the most important possible causative agents. This is important because mixed infections occur frequently in STIs. Besides, syndromic management of STIs can effectively treat cases in settings with limited laboratory capacity like health posts and health centres. This means that, if necessary drugs are available and affordable, syndromic treatment can quickly render the patient non-infectious.
Therefore the key features of syndromic case management of STIs are first that it is problem-oriented, i.e. it responds to the patient’s symptoms; second, it is efficient in identifying the causes of STIs; and third, it does not miss multiple infections caused by different pathogens.
Syndromic management also makes treatment and control services for STIs more accessible to patients as it can be implemented at health centre level. For example, syndromic management offers a good opportunity to provide health education and HIV testing and counselling during any encounter with STI cases.
In managing STI cases using syndromic management, the health worker is guided through logical steps of clinical decision-making. The following four steps are to be followed:
- Assessing patients for symptoms, signs and risk factors.
- Syndromic diagnosis and treatment.
- Education and counselling on HIV testing and safer sex, including condom use, promotion and provision.
- Management of sexual partners, in your case tracing sexual partners.
A patient complains of a discharge from the penis. Upon examination, you notice a discharge from the urethra. What syndrome does the sign and symptoms suggest? What action should be taken, and why?
Urethral discharge syndrome is suggested. It is commonly caused by gonorrhoea and/or chlamydial infection. Not only can these cause serious complications, but also they can facilitate the transmission and acquisition of HIV. It is therefore essential that we treat the patient for both.
A young woman complains of a sore on her vulva. Upon examination you notice an ulcer on the outer labia. What syndrome does the sign and symptoms signify? What are the possible causes?
This indicates the syndrome of genital ulcer. There are two main bacterial causes of genital ulcer: chancroid and syphilis.
31.4.1 Classification of patients into syndromes