Advantages and Disadvantages

Advantages and Disadvantages of Syndromic Management

Advantages

Syndromic management is expedited, patient-centered care that can be implemented on a large scale. It is rapid and convenient for both patient and health care provider. As treatment can be provided at the first visit, there is usually no need for return visits, no risk for further disease spread, and less risk for complications and sequelae. Syndromic management allows health care workers to make a diagnosis without sophisticated laboratory tests, and it is theoretically more cost effective than the etiologic or clinical diagnosis. It requires minimum training and can be used by a broad range of health care workers as the flowcharts are simple and easy to follow. The syndromic approach simplifies and standardizes STD data collection and analysis that in turn facilitates surveillance and planning.

Disadvantages

There are some remaining concerns regarding syndromic case management. It can result in a certain proportion of female patients with vaginal discharge being over treated since the symptoms of cervical infection are not specific. This is especially true in low prevalence settings, such as in primary health centers where few STDs are seen. The syndromic approach also ignores asymptomatic cases, which are most common in women and make up over half of all STDs. As the name suggests, STD syndromic management is based on symptoms or signs and is not applied to asymptomatic populations unless they are sexual contacts to a syndromically diagnosed case. Additionally, it can result in the overuse of some drugs that may be expensive and difficult to obtain. Although by using single dose treatments, the chance of antibiotic resistance developing due to syndromic management would be rare.

While the syndromic approach has proven to be the best case management for genital ulcers and urethral discharge in men, the case management of women with vaginal discharge remains very difficult. The most common cause of vaginal discharge is vaginitis (i.e., bacterial vaginosis, candidiasis, or trichomoniasis), but the most serious cause, public health wise, is cervical infection. It is, therefore, recommended to incorporate a risk assessment for cervical infection in the flowchart. A risk assessment is a series of behavioral and demographic markers that, if present, increase a woman's probability of having an STD, independent of her symptoms or signs. This approach has been successfully evaluated in various settings.

Although contacting sexual partners of index STD cases for treatment should be an essential component of any STD control program, doing so based on an STD syndrome is delicate. For men with a urethral discharge or men or women with a genital ulcer, it would be rare for these syndromes not to be caused by an STD, and partner referral is straight forward. However, for women with vaginal discharge, the accuracy of the model is less exact, resulting in women without a real STD notifying their sexual partners about an STD. This obviously could have severe domestic and social consequences.