Sexually Transmitted Diseases (STD) Syndromic Management (AIDSCAP/FHI, 1997, 54 p.): DESIGN OF STD FLOWCHARTS: (introduction...)

Sexually Transmitted Diseases (STD) Syndromic Management (AIDSCAP/FHI, 1997, 54 p.)

(introduction...)

HOLOGRAPHIC OVERVIEW

INTRODUCTION

(introduction...)

HIV and STD Global Burden

Role of STD on HIV Transmission

STD SYNDROMIC MANAGEMENT

(introduction...)

Definition

Theoretical Foundation

Advantages and Disadvantages

Cost-Effectiveness

DESIGN OF STD FLOWCHARTS

(introduction...)

Common Flowcharts

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Urethral Discharge Syndrome in Men

Vaginal Discharge Syndrome in Women

Pelvic Inflammatory Disease: The Management of Lower Abdominal Pain

Genital Ulcer Disease

Validity Testing of a Flowchart: Sensitivity and Specificity

OTHER COMPONENTS OF COMPREHENSIVE STD CASE MANAGEMENT

(introduction...)

Partner Treatment

Health Education

Condom Distribution

Adding Strategies

Syphilis Screening and Treatment

Training

INTRODUCTION OF STD SYNDROMIC MANAGEMENT IN LAC

(introduction...)

Haiti

Jamaica

Brazil

Honduras

Dominican Republic

LESSONS LEARNED

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Building Consensus and Communication

Development and Implementation of STD Flowcharts

Improving Access to STD Care

Detecting Asymptomatic STDs

RECOMMENDATIONS

REFERENCES

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A team of public health specialists should design diagnostic and therapeutic flowcharts for use at the national level. Key people to involve in the design are the coordinators of national programs, including STD/AIDS control, primary health care, essential drug, family planning, and maternal and child health. In some situations, it is advisable to ask specialists, such as gynecologists, microbiologists, genito-urinary specialists and pharmacists, to participate. The involvement of these specialties can help to ensure their cooperation and increase the acceptance of the flowcharts.

In order to ensure that as many patients as possible receive correct diagnoses, background information on local etiologies of STD syndromes, including mixed etiologies, is essential in designing an STD management flowchart. Data on validity and cost-effectiveness can be obtained from the literature or from special studies. Decisions on the most cost-effective treatments must be based on local or regional antimicrobial susceptibility patterns, results of treatment trials, toxicity data and the cost of the drugs.

To ensure efficient management of STDs, flowcharts should be adapted to the level of development of the health services. Feasibility is determined by the presence of laboratory facilities; the infrastructure available for physical examination (availability of an examination room with privacy, examination table, adequate specula, gloves and light source, and facilities to disinfect specula regularly); the level of training of personnel (ability to perform a speculum examination); access to a higher-level health care facility for referrals; the drugs available in health care facilities; and the staff time available per patient.

Local and cultural perceptions about STDs and health-seeking behavior will, to a large extent, determine the usefulness of certain flowcharts. For example, when designing a flowchart, it is important to consider whether a genital examination by a health care worker of the opposite sex is culturally acceptable.