5147.0: Wednesday, November 15, 2000 - Board 10

Abstract #3031

Syndromic Management of STDs: What Works and What Doesn't

Douglas H. Huber, MD, MSc, Medical Services, Pathfinder International, 9 Galen Street, Suite 217, Watertown, MA 02472, 617-924-7200, DHUBER@PATHFIND.ORG

Syndromic management of STDs was introduced as a simplified approach to diagnose and treat common STDs that infect 333 million people annually. The approach is useful for managing some STDs, and it fails badly for others. Pathfinder International's current practice is presented for four syndromes applied in family planning/reprductive health (FP/RH) settings:

* Urethritis in men is an expanded concept from simple urethral discharge, since either discharge or burning during urination are adequate symptoms for treatment of both gonorrhea and chlamydia. Sensitivity and specificity are relatively high, such that there is growing confidence in letting lower level providers use syndromic management and provide treatment.

* Genital Ulcer Disease (GUD) is relatively easy for providers to diagnose through visual assessment. Treatment for syphilis or chancroid works well. Providers can usually distinguish herpes, which responds less well.

* Lower abdominal pain requires the most extensive history in order to rule out causes other than pelvic inflammatory disease. Examination is important, and decisions are similar to standard clinical management.

* Vaginal discharge is the most problemmatic syndrome because the symptoms are common and the sydrome is neither sensitive nor specific for gonorrhea and chlamydia. Contacting partners on the basis of a very weak STD diagnosis can put women at risk of physical violence. The vaginal discharge syndrome is more useful to manage vaginitis, with only carefully selected clients at high STD risk treated for gonorrhea and chlamydia with partner management.

Syndromic management is not always simple or effective; however, for urethritis in men, this method works well.

Learning Objectives: At the end of this session the participant will be able to: 1. Describe the correct use of four algorithms for managing STD syndromes 2. Identify the strengths and weaknesses of four syndromic approaches 3. Develop a cost-effective approach for managing urethritis in men

Keywords: STD,

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA