(introduction...)

The Whole Strategy

Hologram 4: The Detailed Description

The control of sexually transmitted diseases (STDs) is an essential component of all public health programs. Controlling STDs is important because they not only cause great morbidity but as studies have shown, left uncontrolled, they significantly increase the spread of HIV. Developing country health providers at all levels, in both the public and private sectors, are confronted with many patients with STDs. In some countries, STD-related complaints are among the most common reasons why adults seek health care. However, primary health care facilities in developing countries and other resource-poor settings face several constraints in the management of patients with STDs. These constraints include lack of access to the laboratory technology necessary for making etiologic diagnoses of STDs, shortages of well-trained staff, high workloads and limited staff time available per patient. Thus, in resource-poor settings the appropriate STD management tool should enable health care workers to make a correct diagnosis in most patients within a short time and without sophisticated laboratory tests, specialized skills, or, preferably, the need for a repeat visit by the patient.

STDs have devastating health effects, especially for women. STDs, such as gonorrhea and chlamydia, are important factors that cause pelvic inflammatory disease (PID), chronic pelvic pain, ectopic pregnancies, sterility, pre-term deliveries and, along with syphilis, poor birth outcomes. Venereal warts have been linked with cervical cancer. If a mother is infected with an STD, such as syphilis, gonorrhea, chlamydia, or hepatitis B, at the time of birth, she may transmit the infection to the child. Some of the effects of these infections on a newborn are conjunctivitis, pneumonia, crippling bone and teeth disorders, and liver disease.

There are many components of a successful STD control program. These include prevention programs to reduce high risk behaviors, promote increased and correct use of condoms, improve screening of asymptomatic populations looking for undetected disease, and aggressively pursue treatment for sexual partners of index cases. However, comprehensive case management of STDs is the cornerstone of STD control. Prompt and effective case detection and treatment result in immediate health benefits for individual patients. Furthermore, reducing the duration of patients' infectiousness decreases the incidence and prevalence of STD in the population. In addition, it is possible to detect and treat asymptomatic STDs by identifying the sexual contacts of STD patients.

This booklet begins with an overview of the burden of HIV and STD on countries and the role of STD on HIV transmission. The syndromic management of STDs is then presented, including its advantages, disadvantages and cost-effectiveness. The design of STD flowcharts follows, with specific examples of flowcharts provided for urethral discharge syndrome in men, vaginal discharge syndrome in women, pelvic inflammatory disease and genital ulcer disease. Other components of comprehensive STD case management are also examined, such as partner treatment, health education, training, and syphilis screening and treatment. The application of STD syndromic management specifically in Latin America and the Caribbean is presented, highlighting the AIDSCAP priority countries of Haiti, Jamaica, Brazil, Honduras and the Dominican Republic. Finally, major lessons learned are discussed, and the booklet concludes with recommended steps to implement the syndromic approach to improve client-centered STD service delivery.