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close this bookSexually Transmitted Diseases (STD) Syndromic Management (AIDSCAP/FHI, 1997, 54 p.)
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View the documentValidity Testing of a Flowchart: Sensitivity and Specificity


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.