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Using laboratory tests:
- Expensive and require client to return to clinic
Using syndromic approach:
- Based on a person’s symptoms and signs
and the local epidemiology
- Works well for ulcers and male urethral discharge;
does not work as well for vaginal discharge syndrome
During treatment, counseling should
emphasize partner notification
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The only way to be certain if someone has an STI is to identify
the disease-causing microbe with laboratory tests. Laboratory
tests are expensive and require a client to return for results
and treatment. Hence, WHO has developed an approach for diagnosing
and treating STIs called syndromic management, which is based
on a person's symptoms and signs in the context of the local
epidemiology of STI infection.
This syndromic management approach works well in some situations
- for example, when treating men with genital ulcers or urethral
discharge for gonorrhea and chlamydial infection. However, the
syndromic approach has not worked well in diagnosing vaginal
discharge. In addition, about three of every four women with
gonorrhea or chlamydia infection have no symptoms in the early
stages, so syndromic management is not helpful in these cases.
In fact, the main causes of vaginal discharge globally are trichomoniasis
and bacterial vaginosis.
Research is under way to determine if various types of risk
assessment tools can be used to make STI diagnosis and treatment
of cervical infections more effective. Findings thus far are
inconclusive, indicating that any risk assessment tool must
be modified to individual countries and regions within countries.
These tools must take into account prevalence rates for various
STIs and cultural factors such as whether women are willing
to report having multiple partners or are likely to know if
their husbands have had multiple partners.
A full STI management program involves training providers,
diagnosing STIs, treating STIs with antibiotics and tracing
of partners for treatment. During treatment, counseling should
emphasize the importance of partner notification and treatment
in order to prevent reinfection. If programs decide they cannot
afford to offer all of these services, they can at least offer
STI/HIV preventive services and develop a referral system for
diagnosis and treatment with another clinic. They can then counsel
youth about the need for treatment and refer them to the other
clinic.
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